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

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

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

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

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

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

%B medRxiv %G eng %R 10.1101/2023.06.09.23291217 %0 Journal Article %J Forum Health Econ Policy %D Forthcoming %T The Health and Retirement Study: Contextual Data Augmentation. %A Dick, Christopher %K Climate %K contextual data %K evictions %X

The Health and Retirement Study is an amazing resource for those studying aging in the United States, and a fantastic model for other countries who have created similar longitudinal studies. The raw amount of information, from data on income, wealth, and use of health services to employment, retirement, and family connections on to the collection of clinical biomarkers can be both empowering and overwhelming to a researcher. Luckily through the process of engagement with the research community and constant improvement, these reams of data are not only consistently growing in a thoughtful and focused direction, they are also explained and summarized to increase the ease of use for all. One of the very useful areas of the HRS is the Contextual Data File (CDF), which is the focus of this review. The CDF provides access to easy-to-use helpful community-level data in a secure environment that has allowed researchers to answer questions that would have otherwise been difficult or impossible to tackle. The current CDF includes data in six categories (University of Michigan Institute for Social Research. 2017. . Ann Arbor: University of Michigan. Also available at https://hrs.isr.umich.edu/about/data-book, 17): 1. Socio-economic Status and Demographic Structure 2. Psychosocial Stressors 3. Health Care 4. Physical Hazards 5. Amenities 6. Land Use and the Built Environment. Each of these areas have allowed researchers to answer interesting questions such as what is the impact of air pollution on cognition in older adults (Ailshire, J., and K. M. Walsemann. 2021. "Education Differences in the Adverse Impact of PM 2.5 on Incident Cognitive Impairment Among U.S. Older Adults." 79 (2): 615-25), the impact of neighborhood characteristics on obesity in older adults (Grafova, I. B., V. A. Freedman, R. Kumar, and J. Rogowski. 2008. "Neighborhoods and Obesity in Later Life." 98: 2065-71), or even what do we gain from introducing contextual data to a survey analysis (Wilkinson, L. R., K. F. Ferraro, and B. R. Kemp. 2017. "Contextualization of Survey Data: What Do We Gain and Does it Matter?" 14 (3): 234-52)? My review focuses on the potential to expand contextual data in a few of these areas. From new data sets developed and released by the U.S. Census Bureau, to improved measurements of climate and environmental risk, there are numerous new data sources that would be a boon to the research community if they were joined together with the HRS. The following section begins by breaking down the opportunity provided by community or place-based data before moving on to specific recommendations for new data that could be included in the HRS contextual data file.

%B Forum Health Econ Policy %G eng %R 10.1515/fhep-2021-0068 %0 Journal Article %J Journal of Applied Gerontology: the official journal of the southern gerontology society %D Forthcoming %T Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis. %A Du, Chenguang %A Katz, Benjamin %A Shrestha, Prabisha %A Hori, Kazuki %A Dave, Gaurav %K cognitive function %K cross-lagged panel analysis %K health care access %K health retirement study %X

The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Drawing a sample ( = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care.

%B Journal of Applied Gerontology: the official journal of the southern gerontology society %P 7334648241230015 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/38321751?dopt=Abstract %R 10.1177/07334648241230015 %0 Journal Article %J Alzheimer's & Dementia: the journal of the Alzheimer's association %D Forthcoming %T Health care utilization and costs in the years preceding dementia identification. %A Kumar, Raj G %A Lund, Evan Bollens %A Ornstein, Katherine A %A Li, Jing %A Covinsky, Kenneth E %A Kelley, Amy S %K Alzheimer's disease and related dementias %K comorbidities %K Epidemiology %K Health Care Costs %K Health care utilization %K mild cognitive impairment %X

INTRODUCTION: There is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification.

METHODS: In this retrospective cohort study we obtained data on n = 5547 beneficiaries from the Health and Retirement Study (HRS)-Medicare linked sample (n = 1241 with and n = 4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder-balanced reference group without dementia.

RESULTS: We found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life.

CONCLUSIONS: This study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia.

HIGHLIGHTS: Several studies have documented the tremendous healthcare-related costs of living with dementia, particularly toward the end of life. Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre-clinical phase. However, health services research to date has seldom considered the time before incident dementia. This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically-similar comparison group without dementia.

%B Alzheimer's & Dementia: the journal of the Alzheimer's association %G eng %R 10.1002/alz.13476 %0 Journal Article %J bioRxiv %D Forthcoming %T Heterogeneity in polygenic scores for common human traits %A Erin B Ware %A Lauren L Schmitz %A Jessica Faul %A Arianna M Gard %A Colter Mitchell %A Wei Zhao %A David R Weir %A Sharon L R Kardia %K Genetics %K Heterogeneity %K PGS %X This study investigates the creation of polygenic scores (PGS)s for human population research. PGSs are a linear, usually weighted, combination of risk alleles that estimate the cumulative genetic risk of an individual for a particular trait. While conceptually simple, there are numerous ways to estimate PGSs, not all achieving the same end goals. In this paper, we systematically investigate the impact of four key decisions in the building of PGSs from published genome-wide association meta-analysis results: 1) whether to use single nucleotide polymorphisms (SNPs) assessed by imputation, 2) criteria for selecting which SNPs to include in the score, 3) whether to account for linkage disequilibrium (LD), and 4) if accounting for LD, which type of method best captures the correlation structure among SNPs (i.e. clumping vs. pruning). Using the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal panel study of Americans over the age of 50, we examine the predictive ability as well as the variability and co-variability in PGSs arising from these different estimation approaches. We examine four traits with large published and replicated genome-wide association studies (height, body mass index, educational attainment, and depression). Our central finding demonstrates PGSs that include all available SNPs either explain the most amount of variation in an outcome or are not significantly different than the PGSs that does. Thus, for reproducibility through rigor and transparency, we recommend that researchers include a PGS with all available SNPs as a reference, and provide substantial justification for using alternative methods. %B bioRxiv %G eng %R 10.1101/106062 %0 Journal Article %J Research Square %D Forthcoming %T The Hidden Role of Racial Wealth Disparities in Older Adults’ Vulnerability to COVID-19 %A Ruth Winecoff %A Padmaja Ayyagari %A Melissa McInerney %A Kosali I. Simon %A M Kate Bundorf %K COVID-19 %K Racial wealth disparities %X Background: To examine racial and ethnic differences in wealth and other economic, exposure and baseline health-related risks of COVID-19 among older adults in the U.S. Methods: Using rich data on wealth and long-term care use among older Americans unique to the 2016 Health and Retirement Study, we quantify differences in COVID-19 vulnerability among non-Hispanic white, non-Hispanic Black and Hispanic respondents aged 50+. We measure wealth, other economic (insurance, income); exposure (long-term care, employment, telework, household size); and health (chronic conditions, smoking) risk stratified by age (50-64, 65+). Results: Blacks and Hispanics face dramatically greater financial risk that potentially increases exposure to COVID-19, relative to whites; Blacks and Hispanics are four to five times more likely to have no financial wealth. Blacks are also more likely than whites to use long-term care. Blacks and Hispanics also are less likely to have health insurance and face greater risk of exposure to COVID-19 because they are less likely to telework, and Hispanic older adults reside in larger households. Black and Hispanic older adults are also more likely to have a chronic condition associated with worse COVID-19 outcomes. Conclusions: Our results suggest that wealth differences may play a substantial role in contributing to the very large racial and ethnic disparities in the health burden of COVID-19. Racial disparities in long-term care, where COVID-19 risks are higher, contribute to make older Black Americans even more vulnerable to COVID-19. %B Research Square %@ 2693-5015 %G eng %R 10.21203/rs.3.rs-271452/v1 %0 Journal Article %J Aging & Mental Health %D Forthcoming %T Hospitalization's association with depression in adults over 50 years old: does living arrangement matter? Findings from the Health and Retirement Study. %A Missell-Gray, Rachel %A Van Orden, Kimberly %A Simning, Adam %K Caregiving %K depression %K Disability %K Living arrangement %K post-acute care %X

OBJECTIVES: To examine how living arrangements are associated with depressive symptoms in late middle-life and older adults following hospitalization within the last two years.

DESIGN: We used the 2016 wave of the Health and Retirement Study (HRS), a nationally representative survey of adults over 50 years old living in the United States.

METHODS: The dependent variable was whether HRS participants screened positive for having depressive symptoms. The primary independent variable was self-reported hospitalization in the prior two years. We stratified bivariate analyses and multivariate logistic regressions by living arrangement to examine hospitalizations' association with depressive symptoms.

RESULTS: Depressive symptoms were less prevalent among participants who were married or partnered and living with a partner (14.0%) compared to those who were not married or partnered and were living with others (31.7%) and were not married or partnered and were living alone (27.8%). In multivariate analyses stratified by living arrangement, however, hospitalization was associated with depressive symptoms for those married or partnered and living with a partner (OR = 1.39, 95% CI: 1.14-1.69) but not for those who were not married and living with other(s) (OR = 0.88, 95% CI: 0.65-1.18) and not married or partnered and living alone (OR = 1.06, 95% CI: 0.82-1.36).

CONCLUSIONS: Late middle-life and older adults residing with spouses or cohabitating appear at risk for having depressive symptoms following a hospitalization. A better understanding of how relationships and living arrangements may affect depression risk in the context of an acute medical illness is needed to identify points of intervention.

%B Aging & Mental Health %G eng %R 10.1080/13607863.2022.2163978 %0 Journal Article %J Sociological Methods & Research %D Forthcoming %T How bad could it be? Worst-case bounds on bias in multistate models due to unobserved transitions %A Christian Dudel %A Daniel C Schneider %K Bias %K Disability %K Identification %K Life Expectancy %K Markov Model %X Multistate models are often used in social research to analyze how individuals move between states. A typical application is the estimation of the lifetime spent in a certain state, like the lifetime spent in employment, or the lifetime spent in good health. Unfortunately, the estimation of such quantities is prone to several biases. In this paper, we study the bias due to the often implicitly used assumption that there are no unobserved transitions between states. This assumption does often not hold for the panel data typically used to estimate multistate models, as the states occupied by individuals are only known at specific points in time, and further transitions between panel waves are not recorded. We present partially identified estimates of the lifetime spent in a state, or worse-case bounds, which show the maximum possible level of bias due to unobserved transitions. We provide two examples studying the lifetime spent in disability (disabled life expectancy; DLE). The first example applies our methods to results on cohort trends in DLE in the U.S. taken from Crimmins et al. (2009). In the second example, we replicate findings from Mehta and Myrskylä (2017), and apply our methods to data from the U.S. Health and Retirement Study (HRS) in order to estimate the effects of health behaviors on DLE. %B Sociological Methods & Research %@ 0049-1241 %G eng %R 10.1177/0049124121995540 %0 Report %D 2024 %T Health and Retirement Study 2020 Tracker %A HRS Staff %K data description %K Tracker %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor %P 1-38 %G eng %0 Web Page %D 2024 %T Hypertension Concordance in Heterosexual Couples Consistent in Different Countries %A Stong, Colby %K CHARLS %K Couples %K ELSA %K Hypertension %K LASI %I Cardiology Advisor %G eng %U https://www.thecardiologyadvisor.com/home/topics/hypertension/hypertension-concordance-heterosexual-couples-consistent-in-different-countries/ %0 Journal Article %J BMC Geriatr %D 2023 %T Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts. %A Li, Guochen %A Lu, Yanqiang %A Shao, Liping %A Wu, Luying %A Qiao, Yanan %A Ding, Yi %A Ke, Chaofu %K Aged %K Hand Strength %K Heart Diseases %K Humans %K Longitudinal Studies %K Middle Aged %K Prospective Studies %K Stroke %X

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

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

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

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

%B BMC Geriatr %V 23 %P 268 %G eng %N 1 %R 10.1186/s12877-023-03953-8 %0 Journal Article %J Alzheimers Dement (Amst) %D 2023 %T Harmonization of cognitive screening tools for dementia across diverse samples: A simulation study. %A Gavett, Brandon E %A Ilango, Sindana D %A Koscik, Rebecca %A Ma, Yue %A Helfand, Benjamin %A Eng, Chloe W %A Gross, Alden %A Trittschuh, Emily H %A Richard N Jones %A Mungas, Dan %K cognitive screening %K Dementia %K Simulation %X

INTRODUCTION: Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to explore, using simulation, the necessary conditions for accurate harmonization of cognitive data.

METHOD: Neuropsychological test scores from the US Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) were subjected to IRT analysis to estimate item parameters and sample means and standard deviations. These estimates were used to generate simulated item response patterns under 10 scenarios that adjusted the quality and quantity of linking items used in harmonization. IRT-derived factor scores were compared to the known population values to assess bias, efficiency, accuracy, and reliability of the harmonized data.

RESULTS: The current configuration of HRS and MHAS data was not suitable for harmonization, as poor linking item quality led to large bias in both cohorts. Scenarios with more numerous and higher quality linking items led to less biased and more accurate harmonization.

DISCUSSION: Linking items must possess low measurement error across the range of latent ability for co-calibration to be successful.

HIGHLIGHTS: We developed a statistical simulation platform to evaluate the degree to which cross-sample harmonization accuracy varies as a function of the quality and quantity of linking items.Two large studies of aging-one in Mexico and one in the United States-use three common items to measure cognition.These three common items have weak correspondence with the ability being measured and are all low in difficulty.Harmonized scores derived from the three common linking items will provide biased and inaccurate estimates of cognitive ability.Harmonization accuracy is greatest when linking items vary in difficulty and are strongly related to the ability being measured.

%B Alzheimers Dement (Amst) %V 15 %P e12438 %G eng %N 2 %R 10.1002/dad2.12438 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Have Middle-Aged and Older Americans Become Lonelier? 20-Year Trends From the Health and Retirement Study. %A Surkalim, Daniel L %A Clare, Philip J %A Eres, Robert %A Gebel, Klaus %A Bauman, Adrian %A Ding, Ding %X

OBJECTIVES: Despite media and public dialog portraying loneliness as a worsening problem, little is known about how the prevalence of loneliness has changed over time. Our study aims to identify (a) temporal trends in episodic and sustained loneliness (lonely in 1 wave vs consistently lonely in 3 consecutive waves); (b) trends across sociodemographic subgroups by sex, race/ethnicity, birth cohort, education, employment status, marital status, and living alone; and (c) longitudinal predictors of loneliness in middle-aged and older Americans (≥50 years).

METHODS: Based on Waves 3 (1996) to 14 (2018) of the Health and Retirement Study (n = 18,841-23,227), we conducted a series of lagged mixed-effects Poisson regression models to assess trends of episodic and sustained loneliness in the overall and sociodemographic subgroup samples (by sex, race/ethnicity, birth cohort, education, employment, relationship, and living alone status). To examine the predictors of episodic and sustained loneliness, we used a multivariate mixed-effects Poisson regression model with all sociodemographic variables entered into the same model.

RESULTS: Episodic loneliness prevalence decreased from 20.1% to 15.5% and sustained loneliness from 4.6% to 3.6%. Trends were similar across most subgroups. Males, Caucasians, those born in 1928-1945, with university education, working, married/partnered, and those not living alone reported lower episodic and sustained loneliness, although associations with sustained loneliness were stronger.

DISCUSSION: Contrary to common perceptions, loneliness has decreased over 20 years of follow-up in middle-aged and older Americans. Several sociodemographic subgroups have been identified as having a higher risk of loneliness, prompting targeted public health attention.

%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad062 %0 Journal Article %J Behavioral Medicine %D 2023 %T Health Behavior Changes after a Diabetes Diagnosis: The Moderating Role of Social Support. %A Qin, Weidi %K Diabetes %K Health Behavior %K Self-efficacy %K Social Support %X

The present study aims to investigate the relationship between a diagnosis of diabetes and health behavior changes among middle-aged and older adults, and whether self-efficacy and social support moderate the relationship. The study sample was selected from the 2006 to 2016 waves of the Health and Retirement Study (N = 13,143). A diagnosis of diabetes was ascertained by self-reported physician-diagnosed condition. Self-efficacy was measured using a 5-item scale. Social support from family and friends was measured separately by a same 3-item scale. Three health behaviors were assessed, including drinking, smoking, and physical activity. Mixed-effects regression models were conducted to test the study aims. Findings showed that participants reduced drinking after a diagnosis of diabetes. A significant interaction between social support from family and a diabetes diagnosis was found in predicting drinking reduction and smoking cessation. These findings suggest that a diagnosis of diabetes may trigger individuals' motivation to initiate health-promoting behaviors. Mobilizing social support from family may help individuals adopt health-promoting behaviors and manage diabetes after a diagnosis.

%B Behavioral Medicine %V 49 %P 292-301 %G eng %N 3 %R 10.1080/08964289.2022.2050670 %0 Journal Article %J International Studies of Economics %D 2023 %T Health insurance coverage and marriage behavior: Is there evidence of marriage lock? %A Chen, Tianxu %K employer-sponsored health insurance; marriage behavior; marriage lock; Medicare %X Premiums and eligibility for health insurance may cause a “marriage lock,” in which couples stay married for the sake of maintaining health insurance coverage. By using the Health and Retirement Study for adults aged 60–70, I examine whether employer-based health insurance coverage for the spouse discourages divorce for spousal health insurance coverage-dependent individuals. Diverse difference-in-difference models provide evidence of a 7 percentage points increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. The estimates thus provide evidence that marriage lock exists. © 2023 The Authors. International Studies of Economics published by John Wiley & Sons Australia, Ltd on behalf of Shanghai University of Finance and Economics. %B International Studies of Economics %G eng %R 10.1002/ise3.45 %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T Health Insurance Coverage as a Social Determinant of Osteoporosis Diagnosis in a Population-Based Cohort Study of Older American Adults. %A Godde, Kanya %A Gough Courtney, Margaret %A Roberts, Josephine %K access to care %K Health Disparities %K Insurance %X

Social determinants of health theoretical frameworks identify health insurance coverage as a determinant of older adults' osteoporosis diagnoses, which results in health inequities. In this research, we used the longitudinal Health and Retirement Study dataset of older United States adults, sampled biennially from 2012 to 2016. Logistic regressions estimated odds of osteoporosis diagnosis with and without a bone scan and/or hip fracture, holding insurance type, and health and demographic factors constant. Results were validated using the National Health and Nutrition Examination Survey. Probable underdiagnosing is present in older adults identifying as Black/African American and as males without a bone scan, regardless of fracture status, potentially as products of structural racism and sexism. Models including a bone scan show a reduction in disparities. These findings suggest having a bone scan is still crucial for addressing health inequities in older adults, and remedying barriers to accessing a scan is paramount.

%B Journal of Applied Gerontology %V 42 %P 302-312 %G eng %N 2 %R 10.1177/07334648221132792 %0 Journal Article %J The Journal of Consumer Affairs %D 2023 %T Health shocks and mortgage debt payoff among American homeowners over age 50: A survival analysis %A Qun Zhang %A Hyungsoo Kim %K health shock %K homeowners %K mortgage debt %X Mortgage debt is financially burdensome for many older homeowners in the United States. As people age, declining health can bring about increased healthcare costs. Focusing on homeowners aged 50 and older in the U.S., we investigate two research questions: (1) To what extent does a heath shock affect the likelihood of paying off a mortgage voluntarily or involuntarily? and (2) how long does a health shock delay the time it takes to pay off a mortgage? We used eight biannual waves (2004–2018) of the Health and Retirement Study containing 11,772 borrowers to build survival regression models. Results showed that a health shock reduced the likelihood of voluntary payoff by 12%, while it increased the probability of involuntary payoff by 18%. A health shock delayed voluntary and involuntary payoffs for 30 and 21 months, respectively. We discuss tax deduction and HELOCs as strategies to reduce older homeowners' mortgage strain. %B The Journal of Consumer Affairs %V 57 %P 357-386 %G eng %N 1 %R 10.1111/joca.12503 %0 Journal Article %J Soc Psychiatry Psychiatr Epidemiol %D 2023 %T Health trajectories of individuals who quit active religious attendance: analysis of four prospective cohort studies in the United States. %A Jokela, Markus %A Laakasuo, Michael %X

PURPOSE: To examine whether trajectories of health (depressive symptoms, psychological wellbeing, self-rated health, and body mass index) and health behaviors (smoking, heavy alcohol consumption, physical inactivity, and cannabis use) changed for individuals who first reported at least monthly religious attendance and then in subsequent study waves reported no active religious attendance.

METHODS: Data were from four cohort studies from the United States collected between 1996 and 2018: National Longitudinal Survey of 1997 (NLSY1997); National Longitudinal Survey of Young Adults (NLSY-YA); Transition to Adulthood Supplement of the Panel Study of Income Dynamics (PSID-TA); and Health and Retirement Study (HRS) with a total n = 6592 individuals and 37,743 person-observations.

RESULTS: None of the 10-year trajectories of health or health behaviors changed for the worse after the change from active to inactive religious attendance. Instead, the adverse trends were observed already during the time of active religious attendance.

CONCLUSION: These results suggest that religious disengagement is a correlate-not a cause-of a life course characterized by poorer health and health behaviors. The religious decline caused by people leaving their religion is unlikely to influence population health.

%B Soc Psychiatry Psychiatr Epidemiol %G eng %R 10.1007/s00127-023-02497-x %0 Thesis %B ProQuest Dissertations and Theses %D 2023 %T Healthcare Discrimination Trends and Associations With Chronic Illnesses, Depression, and Biomarkers Among Hispanic Older Adults Using Data From the Health and Retirement Study, 2010-2020 %A Olmos,Brenda %K 0344:Social research %K 0566:Health sciences %K 0569:Nursing %K Biomarkers %K Chronic illness %K Diabetes %K Discrimination %K Health sciences %K Hispanic %K Nursing %K Racism %K Social research %X Introduction: As of 2020, approximately 1 in 5 Americans reported experiencing discrimination in healthcare settings. Unfair treatment in everyday environments has been measured extensively, especially differences between White and Black adults, but older adults’ and Hispanics’ experiences with discrimination in healthcare institutions are not well known. Older adults of all races/ethnicities are at higher risk for chronic illness, so this study aimed to address the experiences of healthcare discrimination (HCD) among those who are older (age 50+), minoritized (specifically Hispanic), and living with chronic illness (including, but not limited to, type 2 diabetes). A review of the literature on HCD in Hispanic adults revealed that there is no consensus on a definition of HCD, most research on it is not backed by a theoretical framework, and Hispanics are often studied as a monolithic group rather than a heterogenous racial-ethnic identity. This project was based on a newly developed whole-person model that identifies the concepts most relevant to Latinx older adults who function at multiple levels of intersectionality. The integrated model depicts possible pathways of physiological and psychological embodiment of lived experiences of minoritized older persons managing chronic illness who are living in a society deeply embedded with structural racism and oppression. Associations between HCD and chronic illnesses as well as biomarkers related to the chronic illnesses were addressed. Trends of HCD over time were explored and racial-ethnic groups’ odds of reporting HCD were compared. Methods: We used 2010–2020 data (collected every 2 years) from the Health and Retirement Study, a nationally representative study of US non-institutionalized adults ages 50+ (n=15,278 participants contributing up to 27,655 observations) to examine associations between patient-reported experiences of HCD and chronic illnesses (i.e., type 2 diabetes, hypertension, heart conditions, stroke, depression, dementia, and Alzheimer’s disease, depressive symptoms scores, and cognition scores) as well as biomarkers of cardiometabolic risk (i.e., hemoglobin A1c, high-density lipoprotein, and total cholesterol), and whether relationships were modified by age, gender, race-ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) and other social determinants of health. We fit generalized estimating equation models (GEE) specifying a binomial distribution and logit link for categorical outcomes and a normal distribution for continuous outcomes. We performed GEE to assess linear trends of HCD from 2010-2020. We also performed Cochran’s Q test to assess statistically significant differences between HCD prevalence in individual year pairs. Finally, we used GEE again to appraise which racial-ethnic group had the highest odds of reporting HCD.Results: In the unadjusted model, self-reported HCD was associated with higher odds of type 2 diabetes, stroke, depression, depressive symptom (CESD) scores, cognition (TCSI) scores, hemoglobin A1c, and high-density lipoprotein levels. In the adjusted model, the associations were between HCD and stroke, depression, CESD scores, hemoglobin A1c, and high-density lipoprotein. The prevalence of HCD among all participants ranged from the lowest in 2020 (15.4%) to the highest in 2016 (19.5%). There was a statistically significant overall decreasing trend in HCD among the full analytic sample, among Whites only, and among Hispanics only. There was a statistically significant difference in HCD prevalence between 2016 and 2020. Of the 3 racial-ethnic groups, Black older adults had an association between race-ethnicity and reporting HCD.Conclusions: Among all 3 race-ethnicity groups together, HCD was associated with higher risk for type 2 diabetes, stroke, depression, more depressive symptoms, lower cognition (TCSI) scores, higher hemoglobin A1c, and lower high-density lipoprotein levels. Among Hispanic older adults, HCD was not associated with any outcomes. Prevalence of HCD decreased for Whites and peaked in 2016 for Hispanics and Black Americans, but the decreasing trend was statistically significant among the entire sample, among Whites as a separate group, and among Hispanics as a separate group. Additionally, there was a statistically significant difference in HCD prevalence between 2016 and 2020, signaling that timing and sociopolitical climate towards minoritized groups and immigrants may influence HCD prevalence and reporting. The theoretical framework was supported by the findings; HCD was shown to affect chronic illness outcomes in older adults living at multiple layers of intersectionality. %B ProQuest Dissertations and Theses %P 143 %@ 9798380130257 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/healthcare-discrimination-trends-associations/docview/2854315023/se-2 %9 phd %0 Journal Article %J J Appl Gerontol %D 2023 %T Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. %A Rahemi, Zahra %A Malatyali, Ayse %A Bacsu, Juanita-Dawne R %A Sefcik, Justine S %A Petrovsky, Darina V %A Baker, Zachary G %A Ma, Kris Pui Kwan %A Smith, Matthew L %A Adams, Swann A %K Advance care planning %K cognitive levels %K Healthcare %K Older Adults %X

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP measure was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

%B J Appl Gerontol %P 7334648231191667 %G eng %R 10.1177/07334648231191667 %0 Web Page %D 2023 %T Heat exposure can undermine cognitive health in later life among socially vulnerable populations %A Dolan, Eric W. %K Cognition %K heat exposure %K Vulnerable Populations %I PsyPost %G eng %U https://www.psypost.org/2023/10/heat-exposure-can-undermine-cognitive-health-in-later-life-among-socially-vulnerable-populations-213926 %0 Web Page %D 2023 %T Here's the Average Social Security Benefit at Age 62 %A Williams, Sean %K claiming age %K Social Security %I The Motley Fool %G eng %U https://www.fool.com/retirement/2023/09/23/heres-the-average-social-security-benefit-age-62/ %0 Journal Article %J Innovation and Aging %D 2023 %T The Hidden Toll of Incarceration: Exploring the Link Between Incarceration Histories and Pain Among Older Adults in the United States. %A Yang, Yulin %A Lutz, Gabriel %A Zhang, Yilin %A Chen, Chixiang %A Kheirbek, Raya Elfadel %K incarceration %K pain %K Palliative care %X

BACKGROUND AND OBJECTIVES: Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study examines the relationships between incarceration histories and pain outcomes among middle-aged and older adults in the United States.

RESEARCH DESIGN AND METHODS: Data from a nationally representative sample of community-dwelling adults aged 51 and over in the 2012-2018 biennial waves of the U.S. Health and Retirement Study was analyzed to examine how incarceration histories influence older adults' risks of reporting moderate-to-severe pain and pain with physical limitations. We relied on a propensity score matching approach to account for the potential confounding bias. We fit weighted generalized estimating equation models to assess the relationships between incarceration history and pain outcomes. Models were further stratified by gender.

RESULTS: After propensity score matching, our sample included 2,516 respondents aged 65 years on average ( = 8.72), 21% female, and 838 with incarceration histories. Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (prevalence ratio [PR] = 1.30, 95% confidence Interval [CI]: 1.20, 1.52) and pain with physical limitations (PR = 1.48, 95% CI: 1.30, 1.68) even after adjusting for sociodemographic covariates and early life experiences. In the models stratified by gender, the associations between incarceration histories and incarceration were similar among women and men.

DISCUSSION AND IMPLICATIONS: In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal management strategies to reduce the burden of disabling pain. Interventions should prioritize socioeconomically vulnerable groups who may have the least access to pain treatment in later life.

%B Innovation and Aging %V 7 %P igad116 %G eng %N 10 %R 10.1093/geroni/igad116 %0 Journal Article %J PLoS One %D 2023 %T History of incarceration and age-related neurodegeneration: Testing models of genetic and environmental risks in a longitudinal panel study of older adults. %A Tanksley, Peter T %A Logan, Matthew W %A Barnes, J C %K environment %K genetic %K incarceration %K Neurodegeneration %X

History of incarceration is associated with an excess of morbidity and mortality. While the incarceration experience itself comes with substantive health risks (e.g., injury, psychological stress, exposure to infectious disease), most individuals eventually return from prison to the general population where they will be diagnosed with the same age-related conditions that drive mortality in the non-incarcerated population but at exaggerated rates. However, the interplay between history of incarceration as a risk factor and more traditional risk factors for age-related diseases (e.g., genetic risk factors) has not been studied. Here, we focus on cognitive impairment, a hallmark of neurodegenerative conditions like Alzheimer's disease, as an age-related state that may be uniquely impacted by the confluence of environmental stressors (e.g., incarceration) and genetic risk factors. Using data from the Health and Retirement Study, we found that incarceration and APOE-ε4 genotype (i.e., the chief genetic risk factor for Alzheimer's disease) both constituted substantive risk factors for cognitive impairment in terms of overall risk and earlier onset. The observed effects were mutually independent, however, suggesting that the risk conveyed by incarceration and APOE-ε4 genotype operate across different risk pathways. Our results have implications for the study of criminal-legal contact as a public health risk factor for age-related, neurodegenerative conditions.

%B PLoS One %V 18 %P e0288303 %8 2023 %G eng %N 12 %R 10.1371/journal.pone.0288303 %0 Journal Article %J JAMA Network Open %D 2023 %T History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. %A Garcia-Grossman, Ilana R %A Cenzer, Irena %A Steinman, Michael A %A Williams, Brie A %K Activities of Daily Living %K Chronic disease %K Diabetes Mellitus %K Health Care %K Lung Diseases %K Outcome Assessment %X

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

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

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

EXPOSURES: Self-reported history of incarceration.

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

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

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

%B JAMA Network Open %V 6 %P e2249785 %G eng %N 1 %R 10.1001/jamanetworkopen.2022.49785 %0 Journal Article %J JAMA %D 2023 %T History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers. %A Kezios, Katrina L %A Lu, Peiyi %A Calonico, Sebastian %A Al Hazzouri, Adina Zeki %K Employment %K Income %K Poverty %K Salaries and Fringe Benefits %X

IMPORTANCE: Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.

OBJECTIVE: To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.

EXPOSURES: Low-wage-less than the hourly wage for full-time, full-year work at the federal poverty line-earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.

MAIN OUTCOMES AND MEASURES: Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.

RESULTS: Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).

CONCLUSIONS AND RELEVANCE: Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.

%B JAMA %V 329 %P 561-573 %G eng %N 7 %R 10.1001/jama.2023.0367 %0 Web Page %D 2023 %T Hobbies Are The Secret To Happiness? Pleasurable Activities Help Older Adults Avoid Depression %A Anderer, John %K activities %K depression %K Happiness %K hobbies %I StudyFinds %G eng %U https://studyfinds.org/hobbies-happiness-depression/ %0 Journal Article %J Nature Medicine %D 2023 %T Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries. %A Mak, Hei Wan %A Noguchi, Taiji %A Bone, Jessica K %A Wels, Jacques %A Gao, Qian %A Kondo, Katsunori %A Saito, Tami %A Fancourt, Daisy %K hobbies %K Life Expectancy %K Mental Health %K Self Report %X

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

%B Nature Medicine %V 29 %P 2233-2240 %G eng %N 9 %R 10.1038/s41591-023-02506-1 %0 Journal Article %J American Economic Journal: Economic Policy %D 2023 %T Housing in Medicaid: Should It Really Change? %A Achou, Bertrand %K homestead exemption %K lower-income %K Medicaid %K Retirement %X Housing is mostly exempted from Medicaid and Supplemental Social Insurance means tests. Reforms of this special treatment have been debated, but little is known about its costs, benefits, and redistributive implications. I estimate a life cycle model of single retirees accounting for this exemption. It shows that the homestead exemption explains important patterns of Medicaid recipiency and that it is highly valued. It also shows that estate recovery could cover most of its costs with possibly limited negative welfare consequences. Finally, the model predicts that removing the homestead exemption or enforcing estate recovery programs would reduce redistribution toward lower-income retirees. %B American Economic Journal: Economic Policy %V 15 %P 1-36 %G eng %N 1 %R 10.1257/pol.20200178 %0 Thesis %B Health Policy %D 2023 %T Housing Markets and Health Outcomes %A Noemie Sportiche %X This dissertation consists of three chapters on the relationship between housing markets and health outcomes. Chapter 1. Can Fair Share Policies Expand Neighborhood Choice? Evidence from Bypassing Exclusionary Zoning under Massachusetts Chapter 40B Opening up neighborhoods that offer greater opportunities for social mobility to low-and moderate-income households remains a challenge in the United States. Exclusionary zoning practices act as a barrier to current efforts by restricting the supply of affordable housing. In this paper, we examine whether fair share policies which seek to bypass these restrictive zoning practices offer a potential solution. Focusing on Massachusetts Chapter 40B, we find clear evidence that such policies expand the types of neighborhoods currently available to low- and moderate-income households. Leveraging novel data on 40B development addresses linked to a wide range of public and administrative records, we find that 40B housing is located in neighborhoods with greater economic mobility, better schools, greater social capital, less pollution, better health outcomes, and lower incarceration rates than both the typical Massachusetts resident and to the beneficiaries of the state’s Low-Income Housing Tax Credit, Housing Choice Voucher, and Public Housing programs. Consistent with previous research on policies that have segregated affordable housing and opportunity, we also find that 40B neighborhoods are iii substantially whiter and wealthier than both types of comparison areas. Differences between 40B neighborhoods and those with other program beneficiaries – which are on the order of 1 to 2 standard deviations – are striking large. An examination of underlying policy mechanisms suggests that bypassing exclusionary zoning plays a central role in explaining these differences in neighborhood conditions. Chapter 2. Early-Life Impacts of Affordable Housing in High-Income Areas: Evidence from Massachusetts Chapter 40B Desegregation-focused housing policies aimed at reducing disparities in neighborhood conditions may also reduce disparities in health outcomes. This paper examines the effects of one such policy on the health of pregnant people and their newborn infants. Specifically, I study the impact of Massachusetts Chapter 40B, a major civil rights-era housing policy that increases the supply of affordable ownership and rental housing in higher-income areas to facilitate moves for lower-income households to those areas. Using a difference-in-differences approach that compares the health outcomes of birthing parents who move to 40B housing to those of demographically-matched birthing parents who move from similar origin neighborhoods, I find that moving to 40B housing produces meaningful improvements in birth outcomes and some gains in birthing parents’ health only among 40B renters. I find no evidence of health effects among 40B owners. Among renters, improvements in birth outcomes are largest among Black beneficiaries, and are driven largely by people moving from neighborhoods with higher levels of poverty, more Black residents, and higher male incarceration rates. These results suggest that desegregation-focused housing policies like 40B could help improve racial and economic disparities in early-life health among certain populations. iv Chapter 3. Economic Crises and Mental Health: Effects of the Great Recession on Older Americans We examine the effect of the Great Recession of 2007-2009 on the mental health of older adults, using longitudinal Health and Retirement Study data linked to area-level data on house prices. We use a variety of measures to capture mental health and rely on the very large crosssectional variation in falling house prices to identify the impact of the Great Recession on those outcomes. We also account for people who moved in response to falling prices by fixing each person’s location immediately prior to the house price collapse. Our central finding is that the Great Recession had heterogeneous effects on health. While mental health was not affected for the average older adult, mental health declined among homeowners with few financial assets, who were therefore more vulnerable to falling house prices. Importantly, health impacts in this group differed by race and ethnicity: depression and functional limitations worsened among Black and other non-white homeowners and medication use increased among white homeowners. There were no measurable impacts for Hispanic homeowners. These results highlight the importance of examining heterogeneity across multiple dimensions when examining the health impacts of economic conditions. %B Health Policy %I Harvard University %C Cambridge, MA %V PhD %G eng %U https://dash.harvard.edu/handle/1/37375506 %0 Journal Article %J Research on Aging %D 2023 %T How Do Marital Transitions Affect Self-Perceptions of Aging? %A Turner, Shelbie G %A Witzel, Dakota D %A Stawski, Robert S %A Hooker, Karen %K Divorce %K Marriage %K self-perceptions of aging %K Widowhood %X

OBJECTIVES: We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging.

METHOD: We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood.

RESULTS: Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women.

DISCUSSION: Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.

%B Research on Aging %G eng %R 10.1177/01640275221113219 %0 Journal Article %J International Studies of Economics %D 2023 %T How do subjective mortality beliefs affect the value of social security and the optimal claiming ages? %A Dai, Tiantian %A Sun, Wei %A Webb, Anthony %K Annuity %K Life Expectancy %K Social Security %K subjective mortality beliefs %K variance of age of death %X Households that postpone claiming Social Security benefits are, in effect, making additional purchases of the Social Security annuity and acquiring valuable longevity insurance. This paper investigates the impact of plausible variations of subjective mortality beliefs on the value of delayed claiming and the optimal claiming ages of retired workers. Using the Health and Retirement Study data, we show that older individuals could, on average, predict their life expectancy correctly; however, the average variance of age of death calculated from subjective mortality tables is 6.2%–14.4% lower than that from cohort life tables. Using numerical optimization techniques, we further show that, theoretically, older households place a lower value on delaying claiming when they have greater confidence in their ability to forecast their age of death. But the magnitude of this effect is not large enough to change their optimal claiming ages, unless they hold extreme subjective mortality beliefs. As a result, we conclude that subjective mortality beliefs alone cannot explain the prevalence of early claiming behaviors. © 2023 The Authors. International Studies of Economics published by John Wiley & Sons Australia, Ltd on behalf of Shanghai University of Finance and Economics. %B International Studies of Economics %G eng %R 10.1002/ise3.69 %0 Web Page %D 2023 %T How does physical mobility affect working years and income? %A National Safety Council %K Income %K physical mobility %K working years %I National Safety Council %G eng %U https://www.safetyandhealthmagazine.com/articles/24810-study-explores-physical-mobility-in-later-years-and-income %0 Journal Article %J J Aging Soc Policy %D 2023 %T How Medicaid Financial Eligibility Rules Exclude Financially and Medically Vulnerable Older Adults. %A Cohen, Marc A %A Tavares, Jane %K Finances %K Medicaid %K Older Adults %X

Millions of older Americans rely on Medicaid because it is the largest payer of long-term services and supports. To qualify for the program, low-income individuals age 65 and over must meet income standards based on the dated Federal Poverty Level as well as asset tests that are often viewed as quite stringent. There has long been concern that current eligibility standards exclude many adults with significant health and financial vulnerabilities. We use updated household socio-demographic and financial information to simulate the impacts of five alternative financial eligibility standards on the number and profile of older adults that would gain Medicaid coverage. The study clearly demonstrates that a large number of financially- and health-vulnerable older adults are excluded from the Medicaid program under current policy. The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them.

%B J Aging Soc Policy %P 1-16 %G eng %R 10.1080/08959420.2023.2195784 %0 Journal Article %J medRxiv %D 2023 %T "How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke". %A Elayoubi, Joanne %A Haley, William E %A Nelson, Monica E %A Hueluer, Gizem %X

BACKGROUND: Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke.

METHODS: Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment.

RESULTS: Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Pre-stroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared to one's pre-stroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms.

CONCLUSIONS: Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.

%B medRxiv %G eng %R 10.1101/2023.03.07.23286965 %0 Web Page %D 2023 %T How Social Security Statements Help Retirement Planning %A Markowitz, Andy %K Retirement Planning %K Social Security %I AARP %G eng %U https://www.aarp.org/retirement/social-security/info-2023/statements-and-retirement-planning.html %0 Web Page %D 2023 %T How Staying Active Could Make You Richer %A Kissell, Chris %K health %K Income %K mobility %K Work %I Money Talks News %G eng %U https://www.moneytalksnews.com/how-staying-active-could-make-you-richer/ %0 Journal Article %J Age and Ageing %D 2023 %T How to construct a frailty index from an existing dataset in 10 steps. %A Theou, Olga %A Haviva, Clove %A Wallace, Lindsay %A Searle, Samuel D %A Rockwood, Kenneth %K Aged %K Aging %K Frail Elderly %K Frailty %K Geriatric Assessment %K Humans %K Retrospective Studies %X

BACKGROUND: The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example.

METHODS: We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps.

RESULTS: The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps.

CONCLUSIONS: This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing.

%B Age and Ageing %V 52 %G eng %N 12 %R 10.1093/ageing/afad221 %0 Journal Article %J Age and Ageing %D 2023 %T How to construct a frailty index from an existing dataset in 10 steps %A Theou, Olga %A Haviva, Clove %A Wallace, Lindsay %A Searle, Samuel D %A Rockwood, Kenneth %K frail %K Frailty %K Health and Retirement Study %K health measurement %K Morbidity %K Older people %X Background: The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example. Methods: We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps. Results: The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps. Conclusions: This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing. © 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. %B Age and Ageing %V 52 %G eng %R 10.1093/ageing/afad221 %0 Thesis %D 2023 %T HYPERTENSION AND HEART DISEASE IN LATER LIFE: THE ROLE OF DEPRESSION, SUBJECTIVE AGE, AND PREVENTATIVE HEALTH BEHAVIORS %A CELESTE C. BEAULIEU %X Subjective age and depressive symptoms are different indicators of mental health that have implications for physical health. Subjective age has multiple meanings and is measured in a variety of ways. This dissertation investigated subjective age as the age an individual feels. The relationship between subjective age and health behaviors is not fully understood, and thus, requires more scholarly research. This dissertation uses the Health and Retirement Study to investigate the relationships between subjective age and depressive symptoms, the health behaviors of physical activity and diet, and cardiovascular health outcomes. The dissertation is composed of three studies. Study 1 explores the relationships between subjective age and physical health and diet, and the moderating effect of chronological age. Results indicate that feeling younger is related to exercising more frequently, and to engaging in a healthier diet, supporting my hypotheses. There is no moderating effect of chronological age; this hypothesis is not supported. v Study 2 investigates the relationship between depressive symptoms, physical activity, diet, and hypertension. Depressive symptoms and physical activity are observed in 2012, diet in 2013, and hypertension in 2014. Two measures of diet are used, the Mediterranean Diet Score (MedDiet) and the Mediterranean-DASH Diet Intervention for Neurocognitive Delay (MIND diet). In terms of hypertension, while direct and indirect (mediating) effects are found for physical activity, only direct effects are found for the MedDiet. These results partially support my hypotheses. The MIND diet is not statistically related to hypertension; thus, my hypothesis about this relationship is not supported. Further, older adults with more depressive symptoms engage in less physical activity, have a less healthy diet, and are more likely to have hypertension at the following wave. This supports my hypothesis. Study 3 analyzes the relationship between depressive symptoms, hypertension and heart disease. Depressive symptoms and hypertension are observed in 2014 and heart disease is observed in 2016. Further, this study investigates the moderating roles of gender and raceethnic status. Direct relationships are found for all key variables, but no indirect effect was found. These results partially supported my hypotheses. Gender did not moderate any of the relationships; this hypothesis was not supported. Race-ethnic status moderates all relationships. Hispanic older adults are more likely to develop hypertension and heart disease when they report more depressive symptoms, compared to non-Hispanic White older adults. Both non-Hispanic Black and Hispanic respondents are more likely to develop heart disease if they have hypertension than are non-Hispanic White respondents. These results provide partial support for my hypotheses. Results from these three studies add to the current scholarly literature by highlighting the importance of mental health and health behaviors for cardiovascular health outcomes vi among older adults in the United States. Public health programs should focus on improving mental health education and resources, especially for historically marginalized communities. %I University of Massachusetts Boston %C Boston %V Doctor of Philosophy %G eng %U https://www.proquest.com/docview/2822876747?pq-origsite=gscholar&fromopenview=true %0 Journal Article %J JAMA Network Open %D 2023 %T Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. %A Zhang, Boya %A Kenneth M. Langa %A Weuve, Jennifer %A D'Souza, Jennifer %A Szpiro, Adam %A Jessica Faul %A Mendes de Leon, Carlos %A Kaufman, Joel D %A Lisabeth, Lynda %A Hirth, Richard A %A Adar, Sara D %K Air Pollution %K Dementia %K Hypertension %K Particulate Matter %K Stroke %X

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

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

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

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

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

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

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

%B JAMA Network Open %V 6 %P e2333470 %G eng %N 9 %R 10.1001/jamanetworkopen.2023.33470 %0 Journal Article %J Drugs & Aging %D 2022 %T Hallucinations, Antipsychotic Use, and Mortality in Older Adults with Dementia: Retrospective Cohort Study of Two Medicare-Linked National Health Surveys. %A Hamedani, Ali G %A Weintraub, Daniel %A Willis, Allison W %K Antipsychotic Agents %K Dementia %K Medicare %K Retrospective Studies %X

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

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

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

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

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

%B Drugs & Aging %V 39 %P 967-974 %G eng %N 12 %R 10.1007/s40266-022-00991-6 %0 Journal Article %J The Journal of Strength and Conditioning Research %D 2022 %T Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans %A Klawitter, Lukus %A Brenda Vincent %A Choi, Bong-Jin %A Smith, Joseph %A Hammer, Kimberly D. %A Donald A Jurivich %A Lindsey J Dahl %A Ryan P McGrath %K Chronic disease %K Exercise %K Mass Screening %K Risk Factors %K sarcopenia %X Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006–2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider–diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04–1.14) and 1.27 (CI: 1.11–1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29–1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk. %B The Journal of Strength and Conditioning Research %V 36 %P 106-112 %G eng %N 1 %R 10.1519/JSC.0000000000004166 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T Handgrip Strength Asymmetry Is Associated With Limitations in Individual Basic Self-Care Tasks. %A Mahoney, Sean J %A Kyle J Hackney %A Donald A Jurivich %A Lindsey J Dahl %A Johnson, Carol %A Ryan P McGrath %K Activities of Daily Living %K Disability %K Frailty %K self-care %X

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01-1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03-1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01-1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01-1.93]) and 1.44 (CI = [1.05-1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

%B Journal of Applied Gerontology %V 41 %P 450-454 %G eng %N 2 %R 10.1177/0733464820982409 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2022 %T Handgrip strength asymmetry is associated with slow gait speed and poorer standing balance in older Americans. %A McGrath, Ryan %A Lang, Justin J %A Ortega, Francisco B %A Chaput, Jean-Philippe %A Zhang, Kai %A Smith, Joseph %A Vincent, Brenda %A Piñero, Jose Castro %A Garcia, Magdalena Cuenca %A Tomkinson, Grant R %K Geriatric Assessment %K Geriatrics %K muscle strength dynamometer %K Physical Functional Performance %K walking speed %X

INTRODUCTION: Handgrip strength (HGS) asymmetry may help identify the functional asymmetries that contribute to mobility limitations. We sought to determine the associations of HGS asymmetry on gait speed and standing balance in older Americans.

MATERIALS AND METHODS: The analytic sample included 8,396 adults aged ≥65-years for the last wave in which they participated in the 2006-2016 Health and Retirement Study. Participants were categorized into asymmetry groups based on the degree of HGS asymmetry. Persons with gait speed <0.8 meters/second were slow. Balance scores ranged from 0-4 with lower scores representing poorer standing balance.

RESULTS: Older Americans with 20.1%-30.0% asymmetry had 1.22 (95% confidence interval (CI): 1.05-1.42) greater odds for slow gait speed, while those with >30.0% asymmetry had 1.23 (CI: 1.05-1.44) greater odds. Persons with 10.1%-20.0%, 20.1%-30.0%, and >30% asymmetry had 1.09 (CI: 1.07-1.22), 1.23 (CI: 1.07-1.42) and 1.40 (CI: 1.22-1.61) greater odds for poorer static balance, respectively. Those in each individual asymmetry group had greater odds for slow gait speed: 1.14 (CI: 1.03-1.26) for >10.0%, 1.19 (CI: 1.07-1.33) for >20.0%, and 1.16 (CI: 1.01-1.35) for >30.0%. Similar results were observed for poorer balance: 1.20 (CI: 1.09-1.32) for >10.0%, 1.27 (CI: 1.15-1.41) for >20.0%, and 1.31 (CI: 1.16-1.49) for >30.0%. Every 10% asymmetry increase was associated with 1.62 (CI: 1.32-1.99) greater odds for poorer balance.

CONCLUSIONS: The bimanual aspects of HGS asymmetry may reflect the bilateral movements required for mobility, and the relationship between upper and lower extremity strength and function may elucidate our findings.

%B Archives of Gerontology and Geriatrics %V 102 %P 104716 %G eng %R 10.1016/j.archger.2022.104716 %0 Journal Article %J OBM Geriatrics %D 2022 %T Happy and Satisfied in Very Late Life? Findings from the Health and Retirement Study %A Rotem Arieli %A Gina Lee %A Yeon Ji Ryou %A Peter Martin %K centenarian %K exceptional longevity %K Happiness %K Leave Behind Questionnaire %K Life Satisfaction %K Optimism %K Purpose in life %K Self-rated health %K Subjective well-being %X This research aims to examine cross-sectional and longitudinal associations of positive subjective well-being among centenarians and near-centenarians in the Health and Retirement Study. Participants who eventually survived to age 98 or older (N = 516) were included. Study variables included demographic characteristics, health and activities of daily living (ADL) functioning, cognitive functioning, and positive well-being. Additionally, a smaller subsample (n = 192) of participants with supplemental leave-behind questionnaire (LBQ) data, some of whom (n = 30) were assessed across three comparative time points, were included to examine psychological well-being variables over time. In the full sample, approximately 86% and 81% of participants over or near the age of 100 reported enjoying their lives and being happy, respectively. Also in the full sample, better self-rated health (SRH) was associated with greater happiness/enjoyment. Results with the LBQ subsample (n = 192) identified that a) greater life satisfaction related to better SRH, b) better cognitive functioning related to greater optimism and purpose in life, and c) more educated and non-White participants tended to have greater purpose in life. Finally, for the longitudinal subsample, life satisfaction increased significantly while purpose in life decreased significantly as participants neared age 100. Implications for this study include a greater focus on developing interventions geared toward improving psychological well-being; specifically, increasing purpose in life and optimism, as well as focusing on improving happiness and life enjoyment. %B OBM Geriatrics %V 6 %P 29 %G eng %N 4 %R 10.21926/obm.geriatr.2204211 %0 Report %D 2022 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study %A Jacqui Smith %A Lindsay Ryan %A Yoobin Park %A Alexandra D. Crosswell %A Drystan F. Phillips %A Lee, Jinkook %K cross-national studies %K harmonization %B CESR-SCHAEFFER WORKING PAPER SERIES %I CESR-SCHAEFFER, University of Southern California %G eng %U https://cesr.usc.edu/documents/WP_2022_006.pdf %0 Web Page %D 2022 %T Has COVID Created a Retirement Confidence Conundrum? %A Nevin E. Adams %K COVID-19 %K Retirement %I National Association of Plan Advisors %G eng %U https://www.napa-net.org/news-info/daily-news/has-covid-created-retirement-confidence-conundrum %0 Web Page %D 2022 %T Having a sense of purpose may help you live longer, research shows %A Berman, Robby %K Longevity %K Sense of purpose %I Medical New Today %G eng %U https://www.medicalnewstoday.com/articles/longevity-having-a-purpose-may-help-you-live-longer-healthier %0 Journal Article %J Review of Economics of the Household %D 2022 %T Health and household labor supply: instantaneous and adaptive behavior of an aging workforce %A Ning Li %K Aging Workforce %K health shock %K spousal labor supply %K Time allocation %X This paper examines how an individual’s labor supply responds immediately to her spouse’s health shock in an aging household and how she adjusts her labor supply over time after her spouse’s health shock. Different from previous work, this paper considers the subsequent health evolution following the spouse’s health shock by proposing an adaptation model where the long-term labor supply adjustment of an individual is allowed to depend on her spouse’s health evolution after the initial shock. Analysis of the 1996-2012 data from the Health and Retirement Study (HRS) suggests that in the short run, both husbands and wives change their labor supply very little when their spouses become ill, but in the long run, a husband’s labor supply adjustment does vary with his wife’s current health status after her initial health shock. In contrast, the wife’s annual work hours are not affected by her husband’s health shock in the long run, regardless of husband’s subsequent health status. Households with an ill wife are probably at greater risk than those with an unhealthy husband in the long run, which may be attributed to the role that women have traditionally played in the household. %B Review of Economics of the Household %G eng %R 10.1007/s11150-022-09636-4 %0 Report %D 2022 %T Health and Retirement Study: Genetic Data Consortia Collaboration %A Jessica Faul %A Jennifer A Smith %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %0 Report %D 2022 %T Health and Retirement Study Imputation of Cognitive Functioning Measures: 1992-2018 %A Ryan J McCammon %A Gwenith G Fisher %A Hassan, Halimah %A Jessica Faul %A Rogers, Willard %A David R Weir %K Health Conditions and Status %K Methodology %I Survey Research Center, University of Michigan %C Ann Arbor, Michigan %G eng %U https://hrsdata.isr.umich.edu/sites/default/files/documentation/data-descriptions/1651088507/COGIMP9218_dd.pdf %4 Cognition/HRS User Guide/methodology %0 Report %D 2022 %T Health, Disability, and the Evolving Nature of Work %A Butrica, Barbara A. %A Mudrazija, Stipica %K Long-term Care %K O*NET %K Social Security %X This paper explores whether the evolving nature of work has impacted the relationship between health and work-related disability and disability applications through its impact on job demands. Using data from the Health and Retirement Study, supplemented with data on job demands from the Occupational Requirement Survey and Occupational Information Network, we document trends in the association of health and functioning with the risk of experiencing a work-limiting health event and applying for or receiving disability benefits, and assess whether the changing composition of jobs and job demands impacts the strength of this relationship. %B Working Paper %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/working-papers-social-security/health-disability-and-the-evolving-nature-of-work/ %0 Journal Article %J Circulation %D 2022 %T Health Disparities in Cholesterol Screening Among Older Americans: Longitudinal Analysis of the Health and Retirement Study (2008-2018) %A Wan-Chin Kuo %A Serena L Sorensen %A Heather M Johnson %K cholesterol screening %K Health Disparities %K race and ethnicity %X Introduction: Hypercholesterolemia is often asymptomatic and requires cholesterol screening to be identified. Current guidelines recommend adults at low risk for cardiovascular disease (CVD) to receive cholesterol screening at least every 5 years with more frequent screenings in older adults and/or at higher CVD risk. Yet, currently, about 25% of Americans do not meet the every-5-year screening recommendations. While disparities in the prevention and treatment of hypercholesterolemia continue to rise, little is known regarding factors influencing cholesterol screening among older Americans in the past 10 years. Methods: This longitudinal analysis used data from the Health and Retirement Study (HRS). HRS is a nationally representative survey of older adults in the U.S. The current study focused on data collected from 2008 (Wave 9) to 2018 (Wave 14). Participants who passed away by 2019, ever had CVD or stroke, were under age 55 at baseline, had more than 3 waves of missing data in self-reported cholesterol screening, or any missing data in covariates were excluded from the current analysis. In total, 7643 participants were included. Meeting cholesterol screening recommendations was defined as those reporting more than two cholesterol screenings between waves 9-14. Poisson regression and logistic regression were used for data analysis. Results: Compared to Black, Indigenous, and People of Color (BIPOC), White older Americans were more likely to meet cholesterol screening recommendations (odds ratio= 1.60; p<0.001) and reported a higher frequency of cholesterol screening (incidence rate ratio=1.06; p<0.001). The racial differences remained significant after the adjustment of covariates. Non-smokers (p<0.001), females (p=0.022), having private insurance (p<0.001), higher education (p<0.001), higher BMI (p=0.003), having diabetes (p<0.001), and having hypertension (p<0.001) were associated with a higher likelihood of meeting cholesterol screening recommendations. Conclusions: Important disparities in cholesterol screening were identified among racial minorities, smokers, individuals without private insurance, or with lower educational attainment, highlighting important barriers to address in cardiovascular preventive care. %B Circulation %V 146 %P A10105-A10105 %G eng %N Suppl_1 %R 10.1161/circ.146.suppl_1.10105 %0 Journal Article %J Journal of Risk and Financial Management %D 2022 %T Health Insurance Patterns of Older Veterans: Evidence from the Health and Retirement Study %A Stype, Amanda C. %K Insurance %K Veterans %X With the increased availability of community care to veterans from the VA MISSION Act, policymakers and providers need to understand how older veterans are insured, particularly before Medicare eligibility at age 65. Using data from 1996 to 2018, this study examines the insurance patterns of veterans prior to the expansion of access to community care through the VA and compares those patterns to nonveterans. This study finds that veterans are more likely to have insurance than nonveterans and that they are less likely to rely on Medicaid and Medicare before age 65. Regression estimates also suggest that veterans with at least some college education are less likely to have private insurance and are more likely to be uninsured than nonveterans with the same educational attainment. %B Journal of Risk and Financial Management %V 15 %P 333 %G eng %N 8 %R 10.3390/jrfm15080333 %0 Journal Article %J The Journal of Financial Data Science %D 2022 %T Health State Risk Categorization: A Machine Learning Clustering Approach Using Health and Retirement Study Data %A Tan, Fu %A Mehta, Dhagash %K health state risk %K Machine learning %X For countries such as the United States, which lacks a universal health care system, future health care costs can create significant uncertainty that a retirement investment strategy must be built to manage. One of the most important factors determining health care costs is the individual’s health status. Hence, categorizing individuals into meaningful health risk types is an essential task. The conventional approach is to use individuals’ self-rated health state categorization. In this work, the authors provide an objective and data-driven machine learning (ML)–based approach to categorize heath state risk by using the most widely used US household surveys on older Americans, the Health and Retirement Study (HRS). The authors propose an approach of employing the K-modes clustering method to algorithmically cluster on an exhaustive list of categorical health-related variables in the HRS. The resulting clusters are shown to provide an objective, interpretable, and practical health state risk categorization. The authors then compare and contrast the ML-based and self-rated health state categorizations and discuss the implications of the differences. They also illustrate the difficulty in predicting out-of-pocket costs based on self-rated health status and how ML-based categorizations can generate more-accurate health care cost estimates for personalized retirement planning. The results in this article open different avenues of research, including behavioral science analysis for health and retirement study. %B The Journal of Financial Data Science %V 4 %P 139–167 %G eng %N 2 %R 10.3905/jfds.2022.4.2.139 %0 Web Page %D 2022 %T Health Stress accelerates aging of immune system, study finds %A Hopper, Leigh %K Cancer %K Cardiovascular disease %K Discrimination %K immune aging %K Stress %X Everyday stressors, traumatic events, job strain and discrimination prematurely weaken the body’s mix of immune cells, potentially increasing a person’s risk of disease. %I University of Southern California %G eng %U https://news.usc.edu/200213/stress-aging-immune-system/ %0 Journal Article %J Journal of Immigrant and Minority Health %D 2022 %T Healthy Debate: Major Depression among Older Immigrants and the United States 2016 Election. %A Rachel S. Bergmans %A Kelly, Kristen M %A Riley Wegryn-Jones %K Foreign born %K Gerontology %K Health Disparities %K Psychiatric epidemiology %K Social Environment %X

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

%B Journal of Immigrant and Minority Health %V 24 %P 360-367 %G eng %N 2 %R 10.1007/s10903-021-01217-4 %0 Journal Article %J Innovation in Aging %D 2022 %T HEARING LOSS AND ITS CONSEQUENCES FOR SPOUSAL MENTAL HEALTH: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A West, Jessica %A Smith, Sherri %A Dupre, Matthew %K Hearing loss %K Mental Health %K Spouses %X Hearing loss (HL) is an increasingly prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course perspective and stress process framework highlight that an individual’s stressors may have a short and/or long-term impact on the health of others. However, little is known about how HL influences the proliferation of stress within married couples. Drawing on nationally-representative data from 11 waves (1998-2018) of the Health and Retirement Study (n=9,000 individuals, 4,500 couples), we use age-based mixed models to examine how one’s own HL, spouse’s HL, or both spouses have HL shape the level and changes in depressive symptoms. For men, we find that their wives’ HL, their own HL, and both spouses having HL are each associated with an increase in depressive symptoms—and that the associations persist as spouses age. For women, we find that their own HL and both spouses having HL is associated with an increase in depressive symptoms. Furthermore, we find that the differences in women’s depressive symptoms between spouses who both have HL and those who do not have HL significantly declines with age. We also find no evidence to suggest that husbands’ HL is associated with wives’ depressive symptoms. Together, these findings suggest that the connections between spouses’ HL and their depressive symptoms are a dynamic process that unfolds differently by gender over time. Interventions that recognize the proliferation of stress associated with HL may help both individuals with HL and their spouses reduce their depressive symptoms. %B Innovation in Aging %V 6 %P 431 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1692 %0 Web Page %D 2022 %T Help prevent dementia by managing multimorbidity, researchers counsel %A Lasek, Alicia %K dementia prevention %K multimorbidity %I McKnights %G eng %U https://www.mcknights.com/news/clinical-news/help-prevent-dementia-by-managing-multimorbidity-researchers-counsel/ %0 Journal Article %J Genwell Project %D 2022 %T Helping others: A path to social connectedness, health, and well-being for older Canadians %A Julia Nakamura %A Marisa Nelson %A Michelle Lin %A Frances S. Chen %K health %K older Canadians %K Well-being %B Genwell Project %G eng %U https://genwellproject.org/helping-others-a-path-to-social-connectedness-health-and-well-being-for-older-canadians/ %0 Web Page %D 2022 %T Here’s How Much Social Security Income Retirees Have Left After Medical Costs %A Gold, Jim %K medical cost %K Social security income %I MoneyTalksNews %G eng %U https://www.moneytalksnews.com/heres-how-much-social-security-income-retirees-have-left-after-medical-costs/ %0 Web Page %D 2022 %T Higher aging satisfaction improves subsequent health outcomes %A Marabito, Maria %K Aging %K health outcomes %K Satisfaction %X Adults with higher aging satisfaction were more likely to have improved health and well-being later in life, according to findings published in JAMA Network Open. %I Healio %G eng %U https://www.healio.com/news/primary-care/20220216/higher-aging-satisfaction-improves-subsequent-health-outcomes %0 Thesis %B Sociology %D 2022 %T Home Away From Home: Education, Health, and Nursing Home Care %A Ryan, Cayley %K Education %K health %K nursing home care %X Nursing homes are dominant late-life health care institutions slated to grow in importance as the United States experiences a dramatic demographic shift characterized by a significant segment of the population entering older age groups. Though a substantial portion of the U.S. population is about to enter the period of life in which they are at highest risk of entering a nursing home, we know little about how their demographic identities and accumulated resources influence their decisions about using nursing homes. This study contributes a more thorough examination of the relationship between education, health, and use of nursing homes. Education is hypothesized to affect nursing home usage through two pathways: access (e.g., institutional familiarity) and need (e.g., development of health conditions). Two different models are run using data from Wave 13 of the Health and Retirement Study to explore these questions. The results show that the link between education and nursing home usage primarily operates through the access pathway, as high school and college-educated respondents had significantly higher odds of reporting any nursing home usage compared to their non-degree-holding peers but did not show a significant difference in the expected time spent in nursing homes. These findings have important implications for the influence of education over the life course into older ages and highlight a potential source of health inequity. %B Sociology %I The Pennsylvania State University %C State College, PA %V Master of Arts %G eng %U https://etda.libraries.psu.edu/catalog/29085cer5700 %0 Journal Article %J Economics Letters %D 2022 %T Homeownership in old age and at the time of death %A Gary V. Engelhardt %A Michael D. Eriksen %K Bequests %K Elderly homeownership %X We construct estimates of U.S. homeownership rates as individuals age and die, using exit-interview data from the Health and Retirement Study. Homeownership falls to under 8% among the oldest old (centenarians). However, most Americans do not live that long—40%–50% die as homeowners. For those, 16% of housing assets are spent down in the final 16 months of life. The remainder is transferred to surviving spouses (52%) and other heirs (32%). %B Economics Letters %V 212 %P 110340 %G eng %R 10.1016/j.econlet.2022.110340 %0 Journal Article %J Journal of Aging and Health %D 2022 %T Hope, Purpose, and Religiosity: The Impact of Psychosocial Resources on Trajectories of Depressive Symptoms Among Middle-Aged and Older Blacks. %A Mitchell, Uchechi A %A Nguyen, Ann W %A Brown, Lauren L %K African Americans %K Age differences %K Mental Health %K Protective factors %K Resilience %K stress process %X

We assessed the effects of hope, purpose in life, and religiosity on trajectories of depressive symptoms among middle-aged and older Blacks, with a focus on age differences in these associations. Data come from 1906 respondents from the 2006-2016 Health and Retirement Study. Linear mixed models were estimated and included interactions between age and time and between age and each psychosocial resource. Depressive symptoms decreased for Blacks ages 51-64, did not change for those 65-74, and increased among Blacks age 75+. Hope and purpose in life were inversely associated with symptom levels but were not associated with change over time in symptomology. Associations were stronger among the youngest age group and weakest among the oldest. Religiosity was unrelated to depressive symptoms. Psychosocial resources protect against depressive symptoms in age-dependent ways among middle-aged and older Blacks. Differences in these effects may be related to aging, cohort, and selection effects.

%B Journal of Aging and Health %V 34 %P 363-377 %G eng %N 3 %R 10.1177/08982643221085820 %0 Generic %D 2022 %T HOPELESSNESS AMONG MIDDLE-AGED AND OLDER ADULTS: A COMPARISON OF NATIVE WHITES, NATIVE MINORITIES, AND IMMIGRANTS %A Guo, Man %A Wang, Yi %A Carter, Kara %K hopelessness %K Immigrants %K middle-aged adult %K minorities %K Older adult %K Whites %X Abstract Sense of hopelessness is closely linked to poor physical/mental health and elevated suicidal risk. The aging and immigration processes put middle-aged and older immigrants at a greater risk of feeling hopeless. However, we know little about hopelessness among this population. This study asks two questions: do middle-aged and older immigrants have higher levels of hopelessness compared to native-born Whites and native-born ethnic minorities? If so, what factors contribute to such differences? Data was from the 2018 psychosocial assessment of the Health and Retirement Study (N = 5,534). ANOVA was used to compare levels of hopelessness among three groups of middle-aged/older adults (50 yrs+): native-born Whites (n =3,603), native-born minorities (n = 1,209), and immigrants (n = 722). Linear regressions were used to examine the association between nativity/race and hopelessness, with five sets of explanatory variables (i.e., SES, health, social support, social engagement, and neighborhood characteristics) entered in the models individually and then collectively. The findings showed that middle-aged/older immigrants had the highest levels of hopelessness, followed by native minorities, and then native Whites. Controlling for each set of the explanatory variables respectively reduced the group differences between native Whites and native ethnic minorities, but not between Whites and immigrants. When controlling for all the explanatory variables, the levels of hopelessness no longer differed significantly between immigrants and native Whites. Findings suggest that immigrants’ multiple disadvantages in personal, family, and social lives may contribute to their heightened levels of hopelessness. Interventions are sorely needed to protect against hopelessness for this population. %G eng %R 10.1093/geroni/igac059.047 %0 Journal Article %J Innovation in Aging %D 2022 %T HOUSEHOLD COMPOSITION AND THE RESILIENCE OF OLDER ADULTS AGING IN COMMUNITY DURING COVID-19 %A Scheckler, Samara %A Molinsky, Jennifer %A Herbert, Christopher %K Aging %K household composition %K Older Adults %X Household composition is associated with older residents’ access to resources. This research uses the pandemic period as a stress-test to detect differences in resilience between older adults who lived alone, with a partner, or with other co-residents. Using the Health and Retirement Study (HRS) from 2010 through 2018, we first developed a profile of pre-pandemic needs and resources for each household composition. Using the 2020 HRS survey wave, we then compared pandemicperiod experiences between the three household types. Older adults living in partner households had more economic resources prior to the pandemic and experienced the fewest disruptions to their finances and personal assistance compared with other types. Older adults living alone entered the pandemic with the least financial resources and personal assistance, particularly in the context of need. These residents also lost more assistance and experienced more loneliness during the pandemic. Co-resident households received the most informal personal care support, which remained relatively stable during the pandemic. They had more economic resources than singleperson households prior to the pandemic but experienced more pandemic-related financial hardships than other types. Household composition was systematically related to resilience during the pandemic, and Social Security policy might increase the capacity of older adults living alone to cope with large-scale disruptions. %B Innovation in Aging %V 6 %P 280-280 %8 12 %G eng %R 10.1093/geroni/igac059.1112 %0 Report %D 2022 %T Housing Equity Extraction from Older Adults via Reduction in Home Improvement %A Murray, Tim %A Dunn, Richard A. %K home improvement %K household production %K housing equity %K Retirement %X Housing equity accounts for a substantial share of retirees’ total wealth, yet many do not use their housing equity to increase consumption in retirement as the Life-Cycle Hypothesis predicts they should. We show that retirees spend a decreasing share of their house value on home improvement as they age, cumulatively summing to 8.4 percent of mean house value for married households. This reduction in home improvement could explain why house values for older adults have lower appreciation rates and why the quality of houses of older adults has decline. Reduction in home improvement can serve as a method of equity extraction for households that are unable to acquire traditional or reverse mortgage instruments. %G eng %U https://timmurrayecon.com/wp-content/uploads/2022/08/murray_dunn_equity_extraction.pdf %0 Journal Article %J Housing and Society %D 2022 %T Housing status, mortgage debt and financial burden as barriers to health among older adults in the U.S %A Mehdipanah, Roshanak %A Martin, Jaclyn %A Eisenberg, Alexa K. %A Amy J Schulz %A Lewis B Morgenstern %A Kenneth M. Langa %K health %K Housing %K housing tenure %K mortgage %K Older adult %X ABSTRACT We examine relations between housing status, mortgage, financial burden, and healthy aging among older U.S. adults. We combine cross-sectional data from 2012 to 2014 Health and Retirement Study cohorts. Using regression models, we examined associations between owners and renters, mortgage and non-mortgage holders, financial strain, and difficulty paying bills, and poor self-rated health (SRH), heart condition (HC) and hospitalization (past two years). We find that compared to owners, renters had greater likelihood of poor SRH and hospitalization. Regardless of tenure, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Mortgage holders had lower likelihood of poor SRH. Accounting for mortgage status, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Associations between tenure or mortgage status and health were not modified by either financial burden factors. We conclude that there need to be more robust and inclusive programs that assist older populations with housing could improve self-rated health, with particular attention to renters, mortgage holders and those experiencing financial burden. %B Housing and Society %V 49 %P 58-72. %@ 0888-2746 %G eng %N 1 %R https://doi.org/10.1080/08882746.2021.1881373 %0 Web Page %D 2022 %T How did COVID-19 impact Social Security claiming compared to the Great Recession? %A Alicia H. Munnell %K COVID-19 %K Great Recession %K Social Security claiming %I MarketWatch %G eng %U https://www.marketwatch.com/story/how-did-covid-19-impact-social-security-claiming-compared-to-the-great-recession-11666632791?mod=mw_latestnews %0 Report %D 2022 %T How Does COVID-Induced Early Retirement Compare to the Great Recession? %A Chen, Anqi %A Liu, Siyan %A Alicia H. Munnell %K COVID-19 %K Early retirement %K Great Recession %K Pandemic %X In early 2020, the COVID Recession seemed like it would result in an increase in early Social Security claiming, similar to the Great Recession. However, pretty quickly the COVID Recession turned out to be quite different. It was spurred by a health crisis, potentially increasing the likelihood of early claiming among older workers and accompanied by a quick recovery in the stock market followed by rapidly-rising prices that could enable many with assets to retire early. On the other hand, the unprecedented expansion and generosity of unemployment insurance (UI) offered a way for lower-paid workers to stay in the labor force. The following analysis, using data from the Health and Retirement Study (HRS), compares how the claiming pattern changed in the recession years 2008-2010 from the expansion years 2004-2006 with how the pattern changed in the recession year 2020 from the expansion years 2016-2018. %B Working Papers %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-does-covid-induced-early-retirement-compare-to-the-great-recession/ %0 Report %D 2022 %T How Does Local Cost-of-Living Affect Retirement for Low and Moderate Earners? %A Quinby, Laura D. %A Gal Wettstein %K cost-of-living %K Low income %K moderate income %K Retirement %X This paper uses the Health and Retirement Study to explore how local cost-of-living affects Social Security replacement rates and household behavior. In theory, labor markets with high cost-of-living also offer more compensation. If this compensating differential is paid in wages, rather than benefits, it reduces the share of earnings replaced by Social Security due to the progressive benefit structure. This paper examines how important the cost-of-living penalty is, in practice, and whether it impacts households’ saving or labor supply. %B Working Papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/how-does-local-cost-of-living-affect-retirement-for-low-and-moderate-earners/ %0 Report %D 2022 %T HOW MUCH DO RETIREES SPEND ON UNCERTAIN HEALTH COSTS? %A Arapakis, Karolos %K health cost %K Medicaid %K Medicare %K out-of-pocket costs %K Retirees %X The brief’s key findings are: One risk that retirees face is uncertain out-of-pocket health costs, over and above predictable insurance premiums. The analysis shows that total spending on retirees’ health care – including long-term care and excluding premiums – is high. But insurers like Medicare and Medicaid cover about 80 percent of the costs. As a result, 65-year-old households, on average, are estimated to pay $67,000 out-of-pocket over their remaining lifetime. %B Briefs %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/briefs/how-much-do-retirees-spend-on-uncertain-health-costs/ %0 Web Page %D 2022 %T How Much Less You’ll Spend Throughout Retirement Depends on These 2 Factors %A Villanova, Patrick %K health %K Retirement %K Spending %K Wealth %B yahoo!finance %I Yahoo.com %G eng %U https://uk.finance.yahoo.com/news/much-less-ll-spend-throughout-222057678.html %0 Web Page %D 2022 %T How Much Retirement Income You'll Have After Paying Medical Expenses %A Obel, MIke %K Out-of-pocket medical expenses %K Retirement income %K Social Security Benefits %K women %I smartasset %G eng %U https://www.yahoo.com/video/much-retirement-income-youll-paying-161413006.html %0 Report %D 2022 %T How Redistributive Are Public Health Care Schemes? Evidence from Medicare and Medicaid in Old Age %A Arapakis, Karolos %A Eric French %A John Bailey Jones %A McCauley, Jeremy %K Medicaid %K Medicare %K public health care %K Social Security earnings records %X Most health care for the U.S. population 65 and older is publicly provided through Medicare and Medicaid. Despite the massive expenditures of these systems, little is known about how redistributive they are. Using data from the Health and Retirement Study matched to administrative Medicare, Medicaid, and Social Security earnings records, we estimate the distribution of lifetime Medicare and Medicaid benefits received and the distribution of lifetime taxes paid to finance these benefits. For the cohort who turned 65 between 1999 and 2004, we find that benefits are greater among those with high income, in large part because they live longer. Nonetheless, high-income people pay more in the way of taxes. Middle-income households gain the most from these programs as these people live long yet pay modest taxes. All income groups gain from these programs: This cohort’s lifetime tax contribution did not cover the medical benefits it received. This deficit is paid by younger cohorts. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/how-redistributive-are-public-health-care-schemes-evidence-from-medicare-and-medicaid-in-old-age/ %0 Journal Article %J Scientific Reports %D 2022 %T How social/environmental determinants and inflammation affect salivary telomere length among middle-older adults in the health and retirement study. %A Courtney, Margaret Gough %A Roberts, Josephine %A Godde, Kanya %K C-reactive protein %K Inflammation %K Retirement %K Social determinants of health %K Telomere %K Telomere Shortening %X

Social epidemiology posits that chronic stress from social determinants will lead to a prolonged inflammatory response that may induce accelerated aging as measured, for example, through telomere length (TL). In this paper, we hypothesize variables across demographic, health-related, and contextual/environmental domains influence the body's stress response, increase inflammation (as measured through high-sensitivity C-reactive protein (hs-CRP)), and thereby lead to shortening of telomeres. This population-based research uses data from the 2008 Health and Retirement Study on participants ages ≤ 54-95 + years, estimating logistic regression and Cox proportional hazards models of variables (with and without confounders) across the domains on shortened TL. A mediation analysis is also conducted. Contrary to expectations, hs-CRP is not associated with risk of shortened TL. Rather, factors related to accessing health care, underlying conditions of frailty, and social inequality appear to predict risk of shorter TL, and models demonstrate considerable confounding. Further, hs-CRP is not a mediator for TL. Therefore, the social determinants of health examined do not appear to follow an inflammatory pathway for shortened TL. The finding of a relationship to social determinants affecting access to health care and medical conditions underscores the need to address social determinants alongside primary care when examining health inequities.

%B Scientific Reports %V 12 %P 8882 %G eng %N 1 %R 10.1038/s41598-022-12742-z %0 Web Page %D 2022 %T How stress may accelerate aging of the immune system %A Klopack, Eric T %K Aging %K Immune System %K Stress %I The Washington Post %G eng %U https://www.washingtonpost.com/health/2022/07/18/stress-aging-immunity-connection/ %0 Report %D 2022 %T How Well Do Retirees Assess the Risks They Face in Retirement? %A Wenliang Hou %K Financial risks %K health costs %K Retirement %X The brief’s key findings are: Retirees face many financial risks, such as outliving their money, investment losses, and unexpected health expenses. How important are these risks and how well do retirees perceive them? The analysis finds a big disconnect between how actual and perceived risks are ranked:Actual: 1) longevity; 2) health; and 3) market. Perceived: 1) market; 2) longevity; and 3) health. In short, retirees overestimate market volatility and underestimate how long they will live and their health costs. %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs/how-well-do-retirees-assess-the-risks-they-face-in-retirement/ %0 Journal Article %J Aging & Mental Health %D 2022 %T How widowhood status relates to engagement in advance care planning among older adults: does race/ethnicity matter? %A Shinae L Choi %A Su Hyun Shin %A Rebecca S Allen %K Advance care planning %K Advance directives %K Race/ethnicity %K Widowhood %X

OBJECTIVES: This study investigated whether and to what extent widowhood status is related to engagement in advance care planning (ACP), and further whether race/ethnicity moderated the relation.

METHODS: We analyzed a total of 11,257 older Americans from the Health and Retirement Study using random-effect regression models after controlling for covariates and year-fixed effects.

RESULTS: We found that both being a widow/widower ever and having been widowed for a longer period of time were associated with a higher probability of engagement in ACP. Specifically, we found that a one-year increase in the number of years since spousal death was associated with 1.02 ( < 0.05, 95% CI = 1.00, 1.03) changes in the odds ratios of informal ACP; however, inclusion of a quadratic term indicated that this association reversed after the peak. Moreover, our findings suggested a moderating effect of race/ethnicity on the relations of the length of time since spousal loss with engagement in ACP. Specifically, the odds of widowed non-Hispanic Blacks discussing with someone the care or medical treatment (informal ACP) and having a living will (formal ACP) were 0.96 ( < 0.05, 95% CI = 0.93, 1.00) and 0.88 ( < 0.05, 95% CI = 0.79, 0.97) times that of non-widowed non-Hispanic Whites. Compared with their non-Hispanic White counterparts, widowed non-Hispanic Blacks were less likely to engage in ACP, and the negative relations were exacerbated when they became widows/widowers.

CONCLUSION: We elaborated on these findings and discussed their implications for understanding the moderating effect of race/ethnicity on the relation between late-life widowhood and engagement in ACP. In order to develop programs that enhance engagement in ACP and reduce racial/ethnic disparities, research must incorporate intersectionality theory with attention to motivations and decision-making style among diverse widows/widowers. The findings from this study could help inform policy makers when developing public health programs and health care reimbursement programs that enhance engagement in ACP among widows/widowers.

%B Aging & Mental Health %V 26 %P 604-613 %G eng %N 3 %R 10.1080/13607863.2020.1867823 %0 Web Page %D 2022 %T How will boomers draw down their 401(k) balances? %A Alicia H. Munnell %K 401(k) %K boomers %K defined-benefit plan %I MarketWatch %G eng %U https://www.marketwatch.com/story/how-will-boomers-draw-down-their-401-k-balances-11651524654 %0 Journal Article %J Journal of the American Heart Association %D 2022 %T Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis. %A Fernandez, Jessica R %A Montiel Ishino, Francisco A %A Williams, Faustine %A Slopen, Natalie %A Forde, Allana T %K Diabetes Mellitus %K ethnicity %K Hypertension %K Latent Class Analysis %K Retirement %X

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

%B Journal of the American Heart Association %V 11 %P e024594 %G eng %N 12 %R 10.1161/JAHA.121.024594 %0 Report %D 2021 %T Habit Formation in the Consumption of Health Care Services in Rural and Urban America %A Xue, Bingjin %A Meyerhoefer, Chad %K health care services %K rural %K urban life %X Does habit exist in health care consumption? How strong is it? Is there any rural-urban disparity? The answers to these questions shed light on whether and to what extent we can rely on the independence axiom in the derivation of the classic discounted utility framework and modeling health demand. We exploit a bounding approach in conjunction with the Arellano-Bond point estimation and provide the first estimates of habit formation in the consumption of health care services. We use a long panel data from the Health and Retirement Study to mitigate the Nickell’s bias. By implementing a two-part model, we also account for the psychological distinguishment between habit-initiated and habit-performed behaviors. We find persistent habits in the consumption of prescription drugs and dental care among the elderly, while no evidence of habitual consumption of hospital care, office-based medical visits or outpatient surgeries. Results from the two-part model show that health care consumption is mostly a habit-initiated behavior that requires less cognitive input when initiating health care use through an initial visit. Differences of the found habitual consumption are insignificant between rural and urban America. %I Agricultural & Applied Economics Association Annual Meeting %C Austin, TX %G eng %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Handgrip Strength Asymmetry and Weakness Together are Associated with Functional Disability in Aging Americans %A Ryan P McGrath %A Brenda Vincent %A Donald A Jurivich %A Kyle J Hackney %A Grant R Tomkinson %A Lindsey J Dahl %A Brian C Clark %K Biomarkers %K Disablement Process %K Epidemiology %K Functional Performance %X Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.The analytic sample included 18,468 Americans aged ≥50-years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS \>10\% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS \>10\% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS \>10\% stronger on their non-dominant hand were classified as having non-dominant HGS asymmetry. Men with HGS \<26-kilograms and women with HGS \<16-kilograms were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95\% confidence interval (CI): 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for non-dominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and non-dominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry.HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers. %B The Journals of Gerontology: Series A %V 76 %P 291 %G eng %N 2 %R 10.1093/gerona/glaa100 %0 Journal Article %J Aging Clinical and Experimental Research %D 2021 %T Handgrip strength asymmetry is associated with future falls in older Americans. %A Ryan P McGrath %A Brian C Clark %A Cesari, Matteo %A Johnson, Carol %A Donald A Jurivich %K Asymmetric HGS %K Falls %K impaired neuromuscular function %X

BACKGROUND: Examining handgrip strength (HGS) asymmetry could extend the utility of handgrip dynamometers for screening future falls.

AIMS: We sought to determine the associations of HGS asymmetry on future falls in older Americans.

METHODS: The analytic sample included 10,446 adults aged at least 65 years from the 2006-2016 waves of the Health and Retirement Study. Falls were self-reported. A handgrip dynamometer measured HGS. The highest HGS on each hand was used for determining HGS asymmetry ratio: (non-dominant HGS/dominant HGS). Those with HGS asymmetry ratio < 1.0 had their ratio inverted to make all HGS asymmetry ratios ≥ 1.0. Participants were categorized into asymmetry groups based on their inverted HGS asymmetry ratio: (1) 0.0-10.0%, (2) 10.1-20.0%, (3) 20.1-30.0%, and (4) > 30.0%. Generalized estimating equations were used for the analyses.

RESULTS: Every 0.10 increase in HGS asymmetry ratio was associated with 1.26 (95% confidence interval (CI) 1.07-1.48) greater odds for future falls. Relative to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 30.0% had 1.15 (CI 1.01-1.33) greater odds for future falls; however, the associations were not significant for those with HGS asymmetry 10.1-20.0% (odds ratio: 1.06; CI 0.98-1.14) and 20.1-30.0% (odds ratio: 1.10; CI 0.99-1.22). Compared to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 10.0% and > 20.0% had 1.07 (CI 1.01-1.16) and 1.12 (CI 1.02-1.22) greater odds for future falls, respectively.

DISCUSSION: Asymmetric HGS, as a possible biomarker of impaired neuromuscular function, may help predict falls.

CONCLUSIONS: We recommend that HGS asymmetry be considered in HGS protocols and fall risk assessments.

%B Aging Clinical and Experimental Research %V 33 %P 2461-2469 %G eng %N 9 %R 10.1007/s40520-020-01757-z %0 Journal Article %J Journal of the American Medical Directors Association %D 2021 %T Handgrip Weakness and Asymmetry Independently Predict the Development of New Activity Limitations: Results From Analyses of Longitudinal Data From the US Health and Retirement Study. %A Parker, Kelly %A Rhee, Yeong %A Grant R Tomkinson %A Brenda Vincent %A Melissa L O'Connor %A Ryan P McGrath %K Cognitive Dysfunction %K Geriatric Assessment %K Independent Living %K muscle strength dynamometer %K Muscle Weakness %X

OBJECTIVES: Examining strength asymmetries in assessments of muscle function may improve screenings for limitations in independent living tasks such as instrumental activities of daily living (IADL). We sought to determine the associations between handgrip strength (HGS) asymmetry and future IADL limitations in aging Americans.

DESIGN: Longitudinal-panel.

SETTING AND PARTICIPANTS: Secondary analyses of data from participants aged at least 50 years from the 2006-2016 waves of the Health and Retirement Study. The analytic sample included 18,235 Americans who identified hand dominance and had measures of HGS for both hands in a single wave.

METHODS: Hand dominance was self-reported, and a handgrip dynamometer measured HGS on each hand. The highest HGS values on each hand were used to calculate the HGS asymmetry ratio: (nondominant HGS/dominant HGS). Individuals with HGS asymmetry ratio <0.80 or >1.20 had HGS asymmetry. Persons with HGS asymmetry ratio <0.80 had dominant HGS asymmetry, whereas participants with HGS asymmetry ratio >1.20 had nondominant HGS asymmetry. Persons with HGS asymmetry ratio <1.0 also had their ratio inversed to make all HGS asymmetry ratios ≥1.0. IADL were self-reported. Covariate-adjusted generalized estimating equations were used for the analyses.

RESULTS: Participants with HGS asymmetry had 1.12 [95% confidence interval (CI): 1.03-1.20] greater odds for future IADL limitations. Each HGS asymmetry dominance group also had greater odds for future IADL limitations: 1.09 (CI: 1.01-1.18) for individuals with dominant HGS asymmetry and 1.29 (CI: 1.09-1.52) for persons with nondominant HGS asymmetry. Every 0.10 increase in inverted HGS asymmetry ratio was associated with 1.30 (CI: 1.07-1.57) greater odds for future IADL limitations.

CONCLUSIONS AND IMPLICATIONS: Assessing HGS asymmetry, as another potential biomarker of impaired muscle function, may provide novel insights for predicting IADL limitations. Future research should continue examining how strength asymmetries, and other aspects of muscle function beyond maximal strength, factor into the disabling cascade.

%B Journal of the American Medical Directors Association %V 22 %P 821-826.e1 %G eng %N 4 %R 10.1016/j.jamda.2020.11.006 %0 Web Page %D 2021 %T Having trouble falling asleep predicts cognitive impairment in later life %K cognitive impairment %K insomnia %X A study of nearly 2,500 adults found that having trouble falling asleep, as compared to other patterns of insomnia, was the main insomnia symptom that predicted cognitive impairment 14 years later. %I Science Daily %G eng %U https://www.sciencedaily.com/releases/2021/06/210609143440.htm %0 Generic %D 2021 %T The Health and Retirement Study: Contextual Data Augmentation %A Dick, Christopher %K contextual data file %K demographic structure %K Health Care %K physical hazards %K psychosocial stressors %K socio-economic status %I National Institute on Aging %C Bethesda, MD %0 Report %D 2021 %T Health and Retirement Study Imputation of Lifetime Earnings: Data Description and Technical Documentation %A Fang, Chichun %K lifetime earnings %K Social Security Administration %X This data product, Imputation of Lifetime Earnings, provides lifetime earnings estimates of respondents in the Health and Retirement Study (HRS). It uses information from earnings records provided by the Social Security Administration (SSA), imputation, as well as projection, to estimate cumulative lifetime earnings through various ages. This documentation details the types of SSA earnings records available to the HRS, how the earnings records are utilized in this data product, and what imputation and projection methods are used when SSA earnings records are not available. Users who only need to know the definitions of variables included in this data product may proceed to Section 4 directly. This restricted data product is intended for exclusive use by you and the persons specified in the Agreement for Use of Restricted Data from the Health and Retirement Study and/or the Supplemental Agreement with Research Staff for Use of Restricted Data from the Health and Retirement Study. The HRS gratefully acknowledges the special assistance of the SSA’s Office of Research and Statistics for their assistance in retrieving the administrative records of HRS respondents who gave consent for those records to be used for research purposes. %I Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %U https://hrs.isr.umich.edu/sites/default/files/restricted_data_docs/1635887419/HRS%20Imputation%20of%20Lifetime%20Earnings.pdf %0 Journal Article %J Medical Care %D 2021 %T Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States. %A Lenzen, Sabrina %A Bakx, Pieter %A Bom, Judith %A Eddy Van Doorslaer %K Dementia %K Health Care %K Out-of-pocket medical expenses %K SHARE %X

BACKGROUND: Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries.

OBJECTIVE: The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics.

RESEARCH DESIGN: We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics.

RESULTS: Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914-4899) vs. 246 USD (73-418)-2017 price levels].

CONCLUSIONS: Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.

%B Medical Care %V 59 %P 543-549 %G eng %N 6 %R 10.1097/MLR.0000000000001539 %0 Journal Article %J Social Science & Medicine %D 2021 %T Health Consequences of Retirement Due to Non-Health Reasons or Poor Health %A Sae Hwang Han %K Depressive symptoms %K Endogeneity %K labor force behavior %K Self-rated health %K Within-between random effects model %X ObjectivesThis study aimed to contribute to our understanding of the complex linkage between retirement and health by estimating health consequences of retirement transitions that were not driven by health reasons separately from those caused by poor health, while taking into consideration the health differences that exist between individuals who engage in different labor force behaviors.MethodsTen waves of rich data from the U.S. Health and Retirement Study (N=9,351; 52,658 person-wave observations) were used to estimate within-person associations between retirement transitions and subsequent health, assessed with self-rated health and depressive symptoms. To account for the bidirectional relationship between retirement and health, retiree’s self-reports of the reasons for labor force withdrawal were used to identify and parse out retirement transitions driven by poor health from the retirement transitions that were unrelated to health reasons. Results: Retirement transitions were unrelated to subsequent health if the withdrawal from the labor force was driven by non-health reasons, whereas retirement transitions driven by poor health were associated with worse subsequent health. Retirement transitions that were phased through partial retirement were associated with worse health outcomes compared to transitioning from full-time work to complete retirement.ConclusionsStudy findings suggest that retirement policies designed to prolong working lives may be implemented without adversely influencing health of older individuals, and potentially delay negative health outcomes associated with retirement for some segments of the older population for whom labor force participation is considered more valuable. %B Social Science & Medicine %V 273 %P 113767 %@ 0277-9536 %G eng %R https://doi.org/10.1016/j.socscimed.2021.113767 %0 Journal Article %J Journal of Health Economics %D 2021 %T Health dynamics shape life-cycle incomes. %A Rainer Kotschy %K Demography %K Economics %K Educational Status %K Employment %K Fertility %K Health Workforce %K Humans %K Income %K Population Dynamics %K Socioeconomic factors %X

This paper empirically investigates the long-run effects of major health improvements on income growth in the United States. To isolate exogenous changes in health, the econometric model uses quasi-experimental variation in cardiovascular disease mortality across states over time. Based on data for the white population, the results show that there is a causal link between health and income per person, and they provide novel evidence that health dynamics shape life-cycle incomes. Life-cycle income profiles slope more strongly at the beginning and at the end of work life in 2000 than in 1960, indicating that age becomes a more prominent determinant of income dynamics over this period. The channels for this transformation include better health, higher educational attainment, and changing labor supply.

%B Journal of Health Economics %V 75 %P 102398 %G eng %R 10.1016/j.jhealeco.2020.102398 %0 Journal Article %J Social Science & Medicine %D 2021 %T Health risks of natural hazards and resilience resources: Evidence from a U.S. nationwide longitudinal study %A Su Hyun Shin %A Ji, Hyunjung %K Conservation of resource theory %K Coping behavior %K Health condition %K Natural hazards %K Resilience resources %X BackgroundAlthough natural disasters can threaten health and well-being, some people show greater resilience to their effects than others. Identifying the characteristics related to resilience has important implications for reducing the health risks in the aftermath of a disaster.ObjectiveUsing the Conservation of Resources Theory as a framework, we study the role of resources in moderating the adverse effects of natural disasters on people's health and coping behaviors.MethodWe match 20,658 unique individuals aged 50 or older from the 2012–2016 waves of the Health and Retirement Study to the county-level annual natural hazard data provided by the Federal Emergency Management Agency. Using individual-fixed effect models, we first model whether the experience of natural disasters can predict people's health and coping behaviors. We then explore heterogeneity in such effects by interacting individual- and county-level resilience resources with the number of natural disasters.ResultsThe results show that with increased exposure to natural disasters, older adults are more likely to experience difficulties performing instrumental daily activities. They also tend to have fewer overnight hospital stays, higher out-of-pocket medical expenses, and increased alcohol dependency. However, older adults with certain socio-economic characteristics ‒ white, higher education, higher income, and homeownership ‒ are better able than others to mitigate any adverse health effects of natural disasters. One significant community-level resource is a robust healthcare capacity in a county with a high ratio of healthcare practitioners, where older adults are more likely to seek hospital care and have lower alcohol dependency.ConclusionsHealth resilience can be improved by strengthening community-level healthcare capacity, with a particular focus on residents with lower socio-economic resources. Failing to address healthcare provision inequalities may exacerbate health disparities. %B Social Science & Medicine %V 281 %P 114110 %@ 0277-9536 %G eng %R 10.1016/j.socscimed.2021.114110 %0 Journal Article %J SN Social Sciences %D 2021 %T Healthcare satisfaction among the older adults with Alzheimer’s disease or dementia %A Hui-Peng Liew %K Cluster Analysis %K Conjoint analysis %K healthcare satisfaction %X The study seeks to examine how older adults in the United States with either Alzheimer’s disease or dementia rate the importance of attributes associated with healthcare seeking and utilization (e.g., affordability, type of facility, and accessibility). Using conjoint and cluster analyses, the purpose of this study is assessed using data from the 2014 Health and Retirement Study. Findings revealed that satisfaction pertaining to these attributes slightly differed across clusters. This suggests that it is important to ensure that healthcare services are affordable and accessible, and the preferences of older adults are taken into consideration when making treatment or other relevant programmatic recommendations. %B SN Social Sciences %V 1 %@ 2662-9283 %G eng %N 1 %R https://doi.org/10.1007/s43545-020-00035-z %0 Journal Article %J Aging %D 2021 %T Healthy memory aging - the benefits of regular daily activities increase with age. %A Krakovska, Olga %A Christie, Gregory J %A Farzan, Faranak %A Sixsmith, Andrew %A Ester, Martin %A Moreno, Sylvain %K Cognitive decline %K Daily activities %K healthy aging %K Machine learning %X

As the number of older adults increases, so does the pressure on health care systems due to age-related disorders. Attempts to reduce cognitive decline have focused on individual interventions such as exercise or diet, with limited success. This study adopted a different approach by investigating the impact of combined daily activities on memory decline. We used data from the National Institute of Aging's Health and Retirement Study to explore two new questions: does combining activities affect memory decline, and if yes, does this impact change across the lifespan? We created a new machine learning model using 33 daily activities and involving 3210 participants. Our results showed that the effect of combined activities on memory decline was stronger than any individual activity's impact. Moreover, this effect increased with age, whereas the importance of historical factors such as education, and baseline memory decreased. The present findings point out the importance of selecting multiple, diverse activities for older adults as they age. These results could have a significant impact on aging health policies promoting new programs such as social prescribing.

%B Aging %V 13 %P 25643-25652 %G eng %N 24 %R 10.18632/aging.203753 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Hearing Impairment and Mental Health Among Married Couples %A Jessica S West %K Couples %K hearing %K Mental Health %X Disablement is a significant health problem and chronic stressor for older adults and is associated with negative mental health outcomes. Although some research has explored how disability extends beyond individuals to influence the mental health of their support networks, less population-based research has assessed the consequences of hearing impairment, a growing public health concern that affects 72.4\% of people aged 65 and older. Moreover, although much research has examined the negative individual impact of hearing impairment, less population-based research has assessed its consequences on spouses. To fill this gap, the current study builds on gender, marriage, and stress proliferation research to examine 1) the association between own hearing impairment and spouses’ depressive symptoms, and 2) whether this association varies by the gender of the spouse.Fixed-effects regression models were conducted using data from 5,485 couples (10,970 individuals) from 10 waves of the Health and Retirement Study (1998-2016).Wives’ fair or poor hearing is significantly associated with an increase in husbands’ depressive symptoms, net of controls. However, husbands’ fair or poor hearing is not associated with an increase in wives’ depressive symptoms.These findings suggest that hearing impairment can proliferate from one spouse to the other, but that this proliferation depends on gender. Health care providers need to be aware of the implications for husbands when treating women with hearing impairment. %B The Journals of Gerontology: Series B %V 76 %P 933-943 %G eng %N 5 %R 10.1093/geronb/gbaa023 %0 Journal Article %J Circulation %D 2021 %T Heart Failure as an Independent Predictor of Insomnia Symptoms %A Rida Gharzeddine %A Margaret M McCarthy %A Gary Yu %A Victoria V Dickson %K Heart Failure %K insomnia symptoms %X Background: Heart failure (HF) is accompanied with several untoward outcomes including insomnia symptoms. Many factors including comorbidities, experienced symptoms, and psychosocial characteristics associated with HF were attributed to the high prevalence of insomnia symptoms in persons with HF. However, it is not yet clear if HF itself contributes to insomnia symptoms regardless of these associated factors. Purpose: The purpose of this analysis was to investigate the association of HF with insomnia symptoms in adjusted models for sociodemographic, clinical, and lifestyle factors. Methods: A secondary data analysis guided by the neurocognitive model of insomnia was conducted on data from the health and retirement study using multiple logistic regression. The total sample size included 17,910 subjects of which 1,189 were identified to have HF. Results: The results showed that those with HF were approximately two times more likely to have insomnia symptoms (OR:1.95, p <0.001) in the unadjusted model. After adjusting for age, sex, race, ethnicity, education, marital status, income, poverty level, sleep-disordered breathing, obesity, depression symptoms, comorbid diseases, smoking, alcohol consumption, and physical activity using block-wise selection, HF maintained a significant association with insomnia symptoms (OR:1.15, p<0.05). When looking at each insomnia symptom separately, HF significantly predicted difficulty initiating sleep (OR: 1.23, p < 0.01) in the fully adjusted model, but maintained a trend with difficulty maintaining sleep and early morning awakening. Conclusion: These results are suggestive of an alerting effect in HF which could be attributed to its pathophysiology. Specifically, the neurohormonal compensatory mechanism and the increased sympathetic stimulation in heart failure may exert an alerting effect during the day and contribute to a hyper-arousal state and difficulty initiating sleep before it partially wears off after sleep. Further studies are needed to investigate this hypothesis. %B Circulation %V 144 %P A12801 %G eng %N Suppl _1 %R 10.1161/circ.144.suppl_1.12801 %0 Report %D 2021 %T Heterogeneity in Self-Employment and the Transition to Retirement among Older Adults in the United States %A Abramowitz, Joelle %K Retirement %K Self-employment %X The fraction of workers who are self-employed increases with age, but the types of self-employment that older workers do and the effects of this work on their well-being is not well understood. This project examines such heterogeneity by considering how differing investment and managerial responsibilities in self-employment contribute to disparities in characteristics and measures of economic, physical, and mental well-being. The paper first uses internal narrative descriptions of industry and occupation in the 1994 to 2018 Health and Retirement Study and machine learning methods to classify self-employment reports into a useful framework of self-employment roles. The project then uses these roles to examine self-employment heterogeneity and finds substantial differences in demographic characteristics, work characteristics, income, benefits, quality of life, and retirement expectations across self-employment roles. Further work finds distinctive patterns in role changes with the transition to retirement such that large shares of workers in all roles transition into independent self-employment at the time of retirement. Work linking to administrative records suggests substantial discrepancies, which vary across roles, between survey responses and administrative records and finds the most prominent discrepancies for post-retirement independent self-employment. The paper’s findings motivate future research exploring the work trajectories leading to these roles and their consequences on financial, physical, and mental well-being into retirement. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/heterogeneity-in-self-employment-and-the-transition-to-retirement-among-older-adults-in-the-united-states/ %0 Thesis %B Economics %D 2021 %T HETEROGENEOUS AND UNCERTAIN HEALTH DYNAMICS AND WORKING DECISIONS OF OLDER ADULTS %A Angela Denis Pagliero %K beliefs %K health dynamics %K Retirement %K uncertainty %X As the population ages, governments and international organizations are trying to lengthen the labor-force participation of older adults. For older adults, health is an important determinant of working decisions. In this paper, I introduce heterogeneity in health dynamics with age and argue uncertainty about health dynamics affects the working decisions of older adults. Using the Health and Retirement Study, I first show evidence of heterogeneity in health profiles with age. Second, I use subjective survival expectations to infer health beliefs in a Bayesian-learning framework. Third, I flexibly estimate how working decisions depend on those beliefs, using a neural-network approach that does not require additional structure. The results show beliefs have substantial negative bias. That is, on average, individuals incorrectly believe their health will deteriorate too fast. Furthermore, eliminating that bias would increase labor-force participation by up to 2 percentage points. In the last part of the paper, I look at a policy that could affect beliefs: the provision of information on blood-glucose and cholesterol levels. I take advantage of the randomization in the collection and provision of such information. The results show the information has only small effects on beliefs and working decisions, and consequently, policies with larger effects on beliefs are needed to delay retirement. %B Economics %I The University of Chicago %C Chicago, IL %V Ph.D. %G eng %U https://knowledge.uchicago.edu/record/2999 %0 Report %D 2021 %T Heterogenous Trajectories in Physical, Mental and Cognitive Health among Older Americans: Roles of Genetics and Earlier SES %A Hoang, Cung Truong %A Amin, Vikesh %A Behrman, Jere R. %A Hans-Peter Kohler %A Iliana V. Kohler %K Aging trajectories %K childhood socioeconomic status %K polygenic scores %K schooling %X We investigate the roles of genetic predispositions, childhood SES and adult schooling attainment in shaping trajectories for three important components of the overall health and wellbeing of older adults -- BMI, depressive symptoms and cognition. We use the Health & Retirement Study (HRS) and group-based trajectory modelling (GBTM) to identify subgroups of people who share the same underlying trajectories over ages 50-94 years. After identifying common underlying trajectories, we use fractional multinomial logit models to estimate associations of (1) polygenic scores for BMI, depression, ever-smoked, education, cognition and subjective wellbeing, (2) childhood SES and (3) schooling attainment on the probabilities of trajectory group membership. While genetic predispositions do play a part in predicting trajectory group membership, our results highlight the long arm of socioeconomic factors. Schooling attainment is the most robust predictor—it predicts increased probabilities of belonging to trajectories with BMI in the normal rage, low depressive symptoms and high initial cognition. Childhood circumstances are manifested in trajectories to a lesser extent, with childhood SES only predicting the likelihood of being on the low depressive symptoms trajectory. We also find suggestive evidence that associations of schooling attainment on the probabilities of being on trajectories with BMI in the normal rage, low depressive symptoms and high initial cognition vary with genetic predispositions. %B University of Pennsylvania Population Center Working Paper (PSC/PARC) %I University of Pennsylvania %C Philadelphia, PA %G eng %U https://repository.upenn.edu/psc_publications/76/ %0 Journal Article %J Review of Economics of the Household %D 2021 %T Hire or care: the effects of aging parents on household labor supply %A Wang, Jue (Jessie) %K Elder care %K Household decisions %K Labor Supply %X This paper analyzes how aging parents’ health conditions affect household labor supply. I propose a time-use model with wage heterogeneity and assume that care responsibilities involve both time and budget constraints. When households can purchase care services, differences in secondary earners’ wages and care requirements lead to heterogeneity in household responses to a parental health shock. Primary earners and high-wage secondary earners work more. I confirm the model’s predictions by using panel data from the Health and Retirement Study to construct an exogenous shock from the change in parents’ health conditions and estimate its impact on labor supply. %B Review of Economics of the Household %@ 1573-7152 %G eng %R 10.1007/s11150-021-09571-w %0 Journal Article %J American Psychologist %D 2021 %T Historical Change in Midlife Health, Well-Being, and Despair: Cross-Cultural and Socioeconomic Comparisons %A Frank J Infurna %A Staben, Omar %A Margie E Lachman %A Denis Gerstorf %K adult development %K culture change %K KLoSA %K MHAS %K socioeconomic differences %X Recent empirical evidence has documented that US middle-aged adults today are reporting lower mental and physical health than same-aged peers several decades ago. Individuals who attained fewer years of education have been most vulnerable to these historical changes. One overarching question is whether this phenomenon is confined to the US or whether it is transpiring across other high-income and upper-middle-income nations. To examine this question, we use nationally representative longitudinal panel data from five nations across different continents and cultural backgrounds (US, Australia, Germany, South Korea, and Mexico). Results revealed historical improvements in physical health for people in their 40s and early 50s across all five nations. Conversely, the direction of historical change in mental health vastly differed across nations. Later-born cohorts of US middle-aged adults exhibit worsening mental health and cognition. Australian middle-aged adults also experienced worsening mental health with historical time. In contrast, historical improvements for mental health were observed in Germany, South Korea, and Mexico. For US middle-aged adults, the protective effect of education diminished in later-born cohorts. Consistent across the other nations, individuals with fewer years of education were most vulnerable to historical declines or benefitted the least from historical improvements. We discuss potential reasons underlying similarities and differences between the US and other nations in these historical trends and consider the role of education. %B American Psychologist %V 76 %P 870-887 %G eng %N 6 %R 10.1037/amp0000817 %0 Journal Article %J BMC Public Health %D 2021 %T History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND. %A Penny L. Brennan %A Holahan, Charles J %A Moos, Rudolf H %A Kathleen K Schutte %K Alcohol Consumption %K CIND %K Dementia %K Drinking problems %X

OBJECTIVE: To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later.

METHOD: A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later.

RESULTS: Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.

CONCLUSIONS: For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

%B BMC Public Health %V 21 %P 2319 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/34949174?dopt=Abstract %R 10.1186/s12889-021-12358-4 %0 Journal Article %J The Journal of Gerontology, Series B %D 2021 %T Hostility and Loneliness in Older Adult Married couples: An Indirect Effect through Friendships. %A Dikla Segel-Karpas %A Ashley E. Ermer %K cynical hostility %K dyads %K friendship %K Loneliness %K marital relationships %X

OBJECTIVES: Cynical hostility is a cognitive schema according to which people cannot be trusted, and it has associations with individuals' loneliness. The present study takes a dyadic approach to examine whether cynical hostility is related to one's own and their spouse's loneliness. We further explore whether friendship factors serve as a mediator between individuals' and spouses' cynical hostility and loneliness.

METHOD: We used two waves of the Health and Retirement Study (N=1065 couples) and Actor-Partner Interdependence Models (APIMs) with Mediation to examine the proposed model. Mediation was tested with the construction of path models and significance levels were reached using bootstrapping.

RESULTS: For both husbands and wives, cynical hostility was significantly associated with loneliness. Husband's loneliness was also significantly associated with his wife's cynical hostility, but wife's loneliness was not associated with her husband's cynical hostility. We further found that the association between wife's own cynical hostility and loneliness was mediated by lower levels of contact with, and support from friends. Friendship factors did not serve as mediators for husbands.

DISCUSSION: Husbands and wives who have higher levels of cynical hostility may be more vulnerable to loneliness. High levels of cynical hostility in women may be related to deficits in their quantity and quality of friendship, and thus be associated with loneliness. Men who are married to women with a higher level of cynical hostility may experience increased loneliness, but this relationship is not explained by men's friendships.

%B The Journal of Gerontology, Series B %V 76 %P 306-316 %G eng %N 2 %R 10.1093/geronb/gbaa170 %0 Thesis %B Economics %D 2021 %T Household Incomes and Medical Outcomes: Evaluation of Cost-related Factors in Older Adults with Diabetes %A Hanigan, McKenzie %K Diabetes %K household income %K medical outcomes %X This paper assessed the relationship of income position among samples of older diabetic adults in the US on relative financial and medical outcomes. Using data from the Health and Retirement Study, unadjusted and adjusted variables indicating medical expenditures and rates of medication underuse were analyzed by relative income position and compared across two age groups (55 – 64 and 65 – 74). Low-income diabetic populations were found to spend substantially higher portions of total income on medical costs compared to high income diabetics (34.08% in the bottom 10% vs. 1.24% in the top 10% for ages 55 – 64). Rates of medication underuse were found to be differentiated at the median income position for the sample ages 55 – 64 and significantly higher across all income groups as compared to the sample ages 65 – 74. Results of this study reinforce significant established socioeconomic effects on health disparities and suggest a need for policy addressing this issue. %B Economics %I University of Michigan %C Ann Arbor, MI %G eng %U https://lsa.umich.edu/content/dam/econ-assets/Econdocs/HonorsTheses/Household%20Incomes%20and%20Medical%20Outcomes.pdf %0 Journal Article %J Journal of Empirical Finance %D 2021 %T Household portfolio allocation, uncertainty, and risk %A Brown, Sarah %A Gray, Daniel %A Harris, Mark N. %A Spencer, Christopher %K Applied econometrics %K asset allocation %K Background risk %K Fractional models %X Analysing the Panel Study of Income Dynamics and the Health and Retirement Study, we investigate the extent to which US households reduce their financial risk exposure when confronted with background risk. Our novel modelling approach – termed a deflated ordered fractional model – quantifies how the overall composition of a household portfolio with three asset classes adjusts with background risk, and is unique in recovering for any given risky asset class the shares that are reallocated to each safer asset category. Background risk exerts a significant impact on household portfolios, inducing a ‘flight from risk’ from riskier to safer assets. %B Journal of Empirical Finance %V 63 %P 96-117 %@ 0927-5398 %G eng %R 10.1016/j.jempfin.2021.05.004 %0 Journal Article %J Housing Studies %D 2021 %T Housing and cardiometabolic risk among older renters and homeowners %A Mawhorter, Sarah %A Eileen M. Crimmins %A Jennifer A Ailshire %K cardiometabolic risk %K health %K Homeownership %K housing affordability %K housing conditions %X Scholars consistently find that renters have poorer health outcomes when compared with homeowners. Health disparities between renters and homeowners likely widen over the life course, yet few studies have examined this link among older adults, and the connection is not fully understood. Homeowners’ relative socio-economic advantage may explain their better health; renters also more commonly experience adverse housing conditions and financial challenges, both of which can harm health. In this paper, we analyse the extent to which socio-economic advantage, housing conditions, and financial strain explain the relationship between homeownership and health among adults over age 50, using Health and Retirement Study 2010/2012 data to assess cardiometabolic risk (CMR) levels using biomarkers for inflammation, cardiovascular health, and metabolic function. We find that people living with poor housing conditions and financial strain have higher CMR levels, even taking socio-economic advantage into account. This analysis sheds light on the housing-related health challenges of older adults, especially older renters. %B Housing Studies %@ 0267-3037 %G eng %R 10.1080/02673037.2021.1941792 %0 Journal Article %J Journal of Public Economics %D 2021 %T Housing liquidity and long-term care insurance demand: A quantitative evaluation %A Achou, Bertrand %K Housing %K Insurance %K Life-cycle %K Liquidity %K Long-term Care %K Retirement %X In theory, illiquid housing may substitute for long-term care insurance (LTCI) as retirees decumulate housing wealth mainly when moving to long-term care facilities. In this paper, I build and estimate a rich life-cycle model of single retirees in order to evaluate whether the impact of housing liquidity on LTCI demand is large. Overall, I find that the prospects of increasing LTCI demand by making housing more liquid are quite limited, as even large increases in housing liquidity generate modest increases in LTCI demand. I also find a limited impact of housing liquidity on the demand for life annuities. Finally, I show that the types of bequest motives used to rationalize the low take-up of reverse mortgages are generally inconsistent with the low demand for LTCI, suggesting that other factors may play a role in this low take-up of reverse mortgages. %B Journal of Public Economics %V 194 %P 104353 %@ 0047-2727 %G eng %R https://doi.org/10.1016/j.jpubeco.2020.104353 %0 Report %D 2021 %T How Do Households Adjust Their Earnings, Saving, and Consumption After Children Leave? %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K children %K consumption %K Earnings %K Household %K Savings %X Whether parents adjust their consumption after their children leave home has important implications for our understanding of retirement income adequacy. Prior studies have found that parents reduce consumption after their children become independent, allowing them to save more for retirement. Other studies, however, have found that savings for retirement does not increase. If households are both consuming less but not saving more after the children leave, where are the resources going? The project examines three ways to reconcile these seemingly inconsistent results: 1) parents may be saving by paying down debt faster, 2) parents may still be providing financial support to their grown children, and 3) parents may be adjusting their labor. %B CRR Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-do-households-adjust-their-earnings-saving-and-consumption-after-children-leave/ %0 Conference Paper %B Retirement and Disability Research Consortium 23rd Annual Meeting %D 2021 %T How Do Households Adjust Their Saving After Children Leave Home? %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K children %K Households %K Savings %X Whether parents adjust their savings and consumption after their children leave home has important implications for our understanding of retirement adequacy. Life-cycle savings studies suggest that people are saving optimally (Scholz and Seshadri 2006, 2008). On the other hand, studies based on the assumption of steady consumption over the working years conclude that many households will end up unprepared for retirement (Mitchell and Moore 1998; Munnell, Orlova, and Webb 2013). Assumptions about how consumption changes after children leave have an important effect on estimates of retirement preparedness. Munnell, Rutledge, and Webb (2014) show that differences in the treatment of children explain about half of the difference in the estimates of the percent of households with inadequate savings. Several studies have tried to examine empirically which of these two theories better describes household behavior once children leave but have not answered the question. Biggs (2019), for example, found that parents decrease their consumption more than non-parent households at older ages, suggesting that parents may be increasing their savings. At the same time, Dushi et al. (2016), using W-2 tax data, found that parents did not increase their 401(k) contributions after their children became financially independent. If households are both consuming less but not saving more after their children leave, the question that arises is where are the resources going? One potential way to square the circle is recognizing that 401(k) accounts are not the only way for households to save; parents could be saving by paying down their mortgage or other forms of debt after their children leave home. Another possible explanation is that typical measures of consumption do not capture all the ways that households expend their resources – parents could continue to provide financial support for their children by helping with down payments or paying off student loans. A broader definition of consumption that includes financial transfers might suggest that parents are not reducing consumption after children leave. Finally, parents may also opt for more leisure, and, as a result earn less after their children become independent, which could produce a decline in consumption and no increase in saving. Reconciling the seemingly conflicting findings will help shed light on whether household are saving enough for retirement. %B Retirement and Disability Research Consortium 23rd Annual Meeting %I Center for Financial Security, University of Wisconsin-Madison %C Virtual Event %8 08/2021 %G eng %U https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf#page=7 %0 Journal Article %J International Journal of Aging & Human Development %D 2021 %T How Do Older Adults Recruited Using MTurk Differ From Those in a National Probability Sample? %A Ogletree, Aaron M. %A Katz, Benjamin %K Cognition %K depression %K feasibility %K MTurk %K online participants %X A growing number of studies within the field of gerontology have included samples recruited from Amazon's Mechanical Turk (MTurk), an online crowdsourcing portal. While some research has examined how younger adult participants recruited through other means may differ from those recruited using MTurk, little work has addressed this question with older adults specifically. In the present study, we examined how older adults recruited via MTurk might differ from those recruited via a national probability sample, the Health and Retirement Study (HRS), on a battery of outcomes related to health and cognition. Using a Latin-square design, we examined the relationship between recruitment time, remuneration amount, and measures of cognitive functioning. We found substantial differences between our MTurk sample and the participants within the HRS, most notably within measures of verbal fluency and analogical reasoning. Additionally, remuneration amount was related to differences in time to complete recruitment, particularly at the lowest remuneration level, where recruitment completion required between 138 and 485 additional hours. While the general consensus has been that MTurk samples are a reasonable proxy for the larger population, this work suggests that researchers should be wary of overgeneralizing research conducted with older adults recruited through this portal. %B International Journal of Aging & Human Development %V 93 %P 700-721 %G eng %N 2 %R 10.1177/0091415020940197 %0 Journal Article %J Journal of Pension Economics and Finance %D 2021 %T How do older workers use nontraditional jobs? %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Abigail N. Walters %K Alternative work %K employer benefits %K nontraditional jobs %K Older workers %K retirement security %K Sequence analysis %X Working consistently through one's early 60s is key to retirement security. However, workers without access to retirement plans and health insurance will likely struggle to achieve such security. This paper uses the Health and Retirement Study to identify nontraditional jobs – which lack these benefits – and applies sequence analysis to explore how workers aged 50–62 use them. The results suggest that most nontraditional jobs are used by workers consistently, and that fewer workers use these jobs briefly or as a bridge to retirement. Workers consistently in nontraditional jobs end up with less retirement income and are more likely to be depressed. %B Journal of Pension Economics and Finance %V 20 %P 374–392 %G eng %N 3 %R 10.1017/S1474747220000086 %0 Report %D 2021 %T How Does Debt Shape Health Outcomes for Older Americans? %A Mudrazija, Stipica %A Barbara A Butrica %K Debt %K health outcomes %K Mental Health %K Physical Health %X This study explores the association between debt burdens and health at older ages. It examines a range of physical and mental health measures and assesses how they may be shaped by the debt held by older adults. It compares health outcomes for older adults with and without debt. It also explores whether the amount or type of debt modifies the debt-health nexus. To address the likely endogeneity of debt and health, the study employs marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without having to rely on unverifiable assumptions regarding the underlying population distribution, as is the case with random- and fixed-effects models. Data for this study come primarily from the Health and Retirement Study, and the sample is limited to respondents ages 55 and older from the 1998 through 2016 survey waves. %B Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-does-debt-shape-health-outcomes-for-older-americans/ %0 Web Page %D 2021 %T How Employees Handle Their Retirement Savings During Work Transitions %A The Pew Charitable Trusts %K retirement savings %K Transitions %X This brief examines the common characteristics among people who took money from their accounts, and those who left their accounts untouched, during the 2014-16 time period. The research uses data from the University of Michigan’s Health and Retirement Study (HRS), a nationally representative survey that follows workers and retirees ages 50 and over. %B Issue Brief %I The Pew Charitable Trusts %C Washington, D.C. %G eng %U https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/05/how-employees-handle-their-retirement-savings-during-work-transitions %0 Newspaper Article %B The New York Times %D 2021 %T How Exercise May Help Us Flourish %A Reynolds, Gretchen %K Exercise %K Sense of purpose %X Physical activity can promote a sense of purpose in life, creating a virtuous cycle that keeps you moving. %B The New York Times %C New York, New York %G eng %U https://www.nytimes.com/2021/05/12/well/move/exercise-mental-health-flourishing.html %0 Journal Article %J The Journal of the Economics of Ageing %D 2021 %T How Financial Literacy Shapes the Demand for Financial Advice at Older Ages %A Kim, Hugh H. %A Maurer, Raimond %A Olivia S. Mitchell %K financial advice %K Financial literacy %K Financial Management %X We investigate how financial literacy shapes older Americans’ demand for financial advice. Using an experimental module fielded in the Health and Retirement Study, we show that financial literacy strongly improves the quality but not the quantity of financial advice sought. In particular, more financially literate people seek financial help from professionals. This effect is more pronounced among older people and those with more wealth and more complex financial positions. Our analysis result implies that financial literacy and financial advisory services are complementary with, rather than substitutes for, each other. %B The Journal of the Economics of Ageing %V 20 %P 100329 %@ 2212-828X %G eng %R 10.1016/j.jeoa.2021.100329Get %0 Web Page %D 2021 %T How much do retirees want to consume? %A Alicia H. Munnell %K consumption %K Retirees %I MarketWatch %G eng %U https://www.marketwatch.com/story/how-much-do-retirees-want-to-consume-11640095651 %0 Report %D 2021 %T How Much Does Social Security Offset the Motherhood Penalty? %A Matthew S. Rutledge %A Alice Zulkarnain %A Sara Ellen King %K Motherhood %K Social Security %X When women become mothers, their labor market income often takes a substantial hit. This “motherhood earnings penalty” becomes even larger with each additional child and permanently reduces earnings throughout mothers’ worklives. Previous studies have linked the penalty to mothers’ reduced educational attainment, more time out of the workforce, higher job search costs, and poor job matches. What remains unanswered is the extent to which the penalty impacts women’s retirement income. This brief, based on a recent study, answers part of this question by looking at how Social Security provisions address the motherhood penalty. The discussion proceeds as follows. The first section explains how Social Security can impact the motherhood earnings penalty and reduce retirement income shortfalls for mothers. The second section lays out the data and methodology for this analysis. The third section finds that Social Security offsets a substantial portion of the earnings penalty. The final section concludes that – despite the equalizing role played by Social Security – a motherhood earnings penalty will remain without policy intervention, such as earnings credits for caregivers. %B Briefs %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs/how-much-does-social-security-offset-the-motherhood-penalty/ %0 Web Page %D 2021 %T How Religious Community Is Linked to Human Flourishing %A Tyler J VanderWeele %K Life Satisfaction %K Religion %X Key Points: An analysis of data from tens of thousands of people found that those who regularly attended religious services were, on average, less likely to become depressed, to smoke, or to drink heavily. Regular service attendance was also related to a lower likelihood of dying during a study's follow-up period. People who frequently attend services may benefit from higher life satisfaction, purpose in life, and other indicators of flourishing. %I Psychology Today %G eng %U https://www.psychologytoday.com/ca/blog/human-flourishing/202102/how-religious-community-is-linked-human-flourishing %0 Journal Article %J The Gerontologist %D 2021 %T How Self-Employed Older Adults Differ by Age: Evidence and Implications From the Health and Retirement Study %A Cal J. Halvorsen %K Employment %K Entrepreneurship %K Financial capital %K Human capital %K Social capital %X There has been increased attention in recent years on self-employment in later life, with about one in five workers past of the age of 50 working for themselves. This study aims to build upon previous documentation of the characteristics of self-employed older adults by estimating how these characteristics vary by age.Using seven waves of the Health and Retirement Study with a sample of more than 12,000 working older adults, this study considers how the association between self-employment and sociodemographic characteristics; indicators of human, social, and financial capital; and risk tolerance differ between adults aged 50 to 61 and 62 years and older. Binary logistic regression and seemingly unrelated estimation are used to estimate and compare the characteristics by age group.Compared to wage-and-salary work and controlling for all other factors in the models, the oldest self-employed group was more likely to identify as Black, report lower health, and receive health insurance from several sources than the younger group. Further, the older group reported lower individual earnings from work yet higher total household income (less individual earnings) and was also less likely to formally volunteer at the highest commitment levels.With some exceptions, these results indicate that the diversity of self-employed older adults within traditional retirement age is greater than among those before this age. Implications regarding how access to key safety net programs, such as Social Security retirement benefits and Medicare, may lead to this finding are discussed. %B The Gerontologist %V 61 %P 763-774 %8 2020 %@ 0016-9013 %G eng %N 5 %R https://doi.org/10.1093/geront/gnaa132 %0 Report %D 2021 %T HRS 2016 Sampling Weights %A Lee, Sunghee %A Nishimura, Raphael %A Burton, Paul %A Ryan J McCammon %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Handgrip Strength Asymmetry and Weakness Are Associated with Lower Cognitive Function: A Panel Study %A Ryan P McGrath %A Peggy M Cawthon %A Cesari, Matteo %A Soham Al Snih %A Brian C Clark %K Aging %K functional laterality %K Geriatric Assessment %K Geriatrics %K muscle strength dynamometer %X BACKGROUND/OBJECTIVES Examining handgrip strength (HGS) asymmetry and weakness together may extend the predictive capacity of HGS for capturing possible health problems such as cognitive impairment. The purpose of this study was to determine the associations of HGS asymmetry and weakness on lower cognitive functioning in a national sample of aging Americans. DESIGN Longitudinal panel. SETTING Participant residences. PARTICIPANTS The analytic sample included 17,163 Americans aged 65.0 years (standard deviation = 10.1 years) who participated in the 2006 to 2016 waves of the Health and Retirement Study (HRS). MEASUREMENTS A handgrip dynamometer was used to measure HGS; weakness was defined as HGS below 26 kg (men) or below 16 kg (women). Persons with HGS above 10% stronger on either hand were considered as having any HGS asymmetry. Those with HGS that was more than 10% stronger on their dominant or nondominant hand were considered as having dominant or nondominant HGS asymmetry, respectively. The Telephone Interview of Cognitive Status determined lower cognitive functioning (≤11 for ages 50-64 years; ≤10 for ages ≥65 years). Covariate-adjusted linear mixed-effects models analyzed the associations of each HGS asymmetry and weakness group on lower cognitive functioning. RESULTS Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had greater odds for lower cognitive functioning: 1.15 (95% confidence interval [CI] = 1.03-1.27) for any HGS asymmetry alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, and 1.95 (95% CI = 1.51-2.53) for any HGS asymmetry and weakness. Each HGS asymmetry dominance and weakness group also had greater odds for lower cognitive functioning: 1.12 (95% CI = 1.01-1.25) for asymmetric dominant HGS alone, 1.27 (95% CI = 1.05-1.53) for asymmetric nondominant HGS alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, 1.89 (95% CI = 1.39-2.57) for weakness and asymmetric dominant HGS, and 2.10 (95% CI = 1.37-3.20) for weakness and asymmetric nondominant HGS. Conclusion The presence of both HGS asymmetry and weakness may predict accelerated declines in cognitive functioning. %B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.16556 %0 Journal Article %J Journal of the American Medical Directors Association %D 2020 %T Handgrip Strength Asymmetry and Weakness May Accelerate Time to Mortality in Aging Americans %A Ryan P McGrath %A Grant R Tomkinson %A Dain P. LaRoche %A Brenda Vincent %A Colin W. Bond %A Kyle J Hackney %K Death %K Frailty %K Geriatric Assessment %K Muscle Strength %K muscle strength dynamometer %X Objectives Assessing handgrip strength (HGS) asymmetry may provide insights into HGS as a prognostic assessment of strength capacity and vitality. This study sought to determine the associations of HGS asymmetry and weakness on time to mortality in aging Americans. Design Longitudinal panel. Setting Secondary analyses of data from participants aged ≥50 years from the 2006‒2014 waves of the Health and Retirement Study. Participants The analytic sample included 19,325 Americans who identified hand dominance and had measures of HGS for both hands in a single wave. Measures A handgrip dynamometer was used to measure HGS. Men and women who were considered weak had HGS <26 kg and <16 kg, respectively. The highest HGS values from the dominant and nondominant hands were used to calculate HGS ratio: (nondominant HGS/dominant HGS). Those with HGS ratio <0.90 or >1.10 had any HGS asymmetry. Moreover, participants with HGS ratio <0.90 had dominant HGS asymmetry, whereas those with HGS ratio >1.10 had nondominant HGS asymmetry. The National Death Index and postmortem interviews verified date of death. Covariate-adjusted Cox models were used for analyses. Results Those with any HGS asymmetry had a 1.10 [95% confidence interval (CI) 1.03‒1.17] higher hazard for mortality, while those with weakness had a 1.44 (CI 1.32‒1.58) higher hazard for mortality. Likewise, participants with dominant HGS asymmetry had a 1.11 (CI 1.03‒1.18) higher hazard for mortality, and those with weakness had a 1.45 (CI 1.32‒1.58) higher hazard for mortality; however, the association was not significant for those with nondominant HGS asymmetry (hazard ratio: 1.07; CI 0.96‒1.18). Conclusions and Implications HGS asymmetry and weakness are markers of impaired strength capacity that independently accelerate time to mortality, but the magnitude of these associations was more prominent for weakness. Nevertheless, assessments of asymmetric HGS are a simple adjunct analysis that may show promise for increasing the prognostic value of handgrip dynamometers. %B Journal of the American Medical Directors Association %G eng %R 10.1016/j.jamda.2020.04.030 %0 Web Page %D 2020 %T Happy Retirees? Maybe Not: Why Life Satisfaction Isn’t Necessarily ‘U-Shaped’ After All %A Bauer, Elizabeth %K Life Satisfaction %K Retirement %X Happiness, experts say, is U-shaped: generally speaking, we are happy/full of life satisfaction as young adults but, as we reach middle age, we become less satisfied, with a trough in one’s early 50s; from this trough we rebound to ever-increasing satisfaction levels as we age. It’s remarkable, really, considering the physical infirmities we face, plus financial worries, loss of loved ones, and more. What explains this? We become wiser and we are able to see all of life’s ups and downs with a greater sense of perspective. But what if that’s not true? %I Forbes %C Jersey City, New Jersey %G eng %U https://www.forbes.com/sites/ebauer/2020/12/06/why-life-satisfaction-isnt-necessarily-u-shaped-after-all/?sh=34a5562f4d97 %0 Journal Article %J Neuroepidemiology %D 2020 %T The Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Study Design and Methods %A Kenneth M. Langa %A Lindsay H Ryan %A Ryan J McCammon %A Richard N Jones %A Jennifer J Manly %A Deborah A Levine %A Amanda Sonnega %A Farron, M. %A David R Weir %K Cognition %K cognitive assessment %K study design %X Introduction: The Harmonized Cognitive Assessment Protocol (HCAP) Project is a substudy within the Health and Retirement Study (HRS), an ongoing nationally representative panel study of about 20,000 adults aged 51 or older in the United States. The HCAP is part of an international research collaboration funded by the National Institute on Aging to better measure and identify cognitive impairment and dementia in representative population-based samples of older adults, in the context of ongoing longitudinal studies of aging in high-, middle-, and low-income countries around the world. Methods: The HCAP cognitive test battery was designed to measure a range of key cognitive domains affected by cognitive aging (including attention, memory, executive function, language, and visuospatial function) and to allow harmonization and comparisons to other studies in the United States and around the world. The HCAP included a pair of in-person interviews, one with the target HRS respondent (a randomly selected HRS sample member, aged 65+) that lasted approximately 1 h and one with an informant nominated by the respondent that lasted approximately 20 min. The final HRS HCAP sample included 3,496 study subjects, representing a 79% response rate among those invited to participate. Conclusion: Linking detailed HCAP cognitive assessments to the wealth of available longitudinal HRS data on cognition, health, biomarkers, genetics, health care utilization, informal care, and economic resources and behavior will provide unique and expanded opportunities to study cognitive impairment and dementia in a nationally representative US population-based sample. The fielding of similar HCAP projects in multiple countries around the world will provide additional opportunities to study international differences in the prevalence, incidence, and outcomes of dementia globally with comparable data. Like all HRS data, HCAP data are publicly available at no cost to researchers. %B Neuroepidemiology %8 2019 %@ 0251-5350 %G eng %R 10.1159/000503004 %0 Report %D 2020 %T Health and the share of wealth held in risky assets %A Vega, Alejandro %A Velli, Evangelia %K aging couples %K health shock %K household portfolio choice %K risky financial assets %K share of risky assets %X This paper focuses on the correlation between negative health shocks and the households’ shareof wealth held in risky assets. By using U.S. data from the Health and Retirement Study, we try toestablish a link between negative health shocks and financial outcomes such as a household’s probabilityof owning risky assets and share of risky assets held. In our definition of a recent negative health shock,we include: cancer or malignant tumor diagnoses, stroke or transient ischemic attack, and heart attack,coronary heart disease, angina, congestive heart failure, or other heart problems. We find an importantnegative correlation between a negative health shock to the female and her household’s probabilityof owning risky assets and share of risky assets held, respectively. In contrast, we do not find acorresponding statistically significant correlation for males. %I Department of Economics, Umea University %C Umea %G eng %U https://ideas.repec.org/p/hhs/umnees/0972.html %9 Report %0 Journal Article %J Death Studies %D 2020 %T Health care utilization as a predictor of death anxiety in older adults %A Becker, Todd D. %K death anxiety %K end-of-life training %K Health care utilization %X AbstractThe relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N?=?3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient?provider communication and alleviate patients? death anxiety. Future research should explore the directionality between study variables. %B Death Studies %@ 0748-1187 %G eng %R 10.1080/07481187.2020.1774942 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Health effects of late-career unemployment %A Maren W Voss %A Lori Wadsworth %A Wendy Church Birmingham %A Merryman, M. Beth %A Crabtree, Lisa %A Subasic, Kathy %A Hung, Man %K Job loss %K Retirement Planning and Satisfaction %K Unemployment %X Objective: Job loss has a demonstrated negative impact on physical and mental health. Involuntary retirement has also been linked to poorer physical and mental health outcomes. This study examined whether late-career unemployment is related to involuntary retirement and health declines postretirement. Method: Analysis was conducted using the 2000-2012 U.S. Health and Retirement Study (HRS) survey data with unemployment months regressed with demographic and baseline health measures on physical and mental health. Results: Individuals with late-career unemployment reported more involuntary retirement timing (47.0%) compared with those reporting no unemployment (27.9%). Late-career unemployment had no significant effect on self-reported physical health (β =.003, p =.84), but was significantly associated with lower levels of mental health (β =.039; p <.01). Conclusion: Self-reports of late-career unemployment are not associated with physical health in retirement, but unemployment is associated with involuntary retirement timing and mental health declines in retirement. Unemployment late in the working career should be addressed as a public mental health concern. %B Journal of Aging and Health %V 32 %P 106-116 %G eng %U https://journals.sagepub.com/doi/10.1177/0898264318806792 %N 1 %9 Journal %! J Aging Health %R 10.1177/0898264318806792 %0 Thesis %B Department of Economics %D 2020 %T Health Effects of Spousal Caregiving Among Elderly Americans %A Renee Garrow %K depression %K health %K Informal care %K Long-term Care %X I examine the mental health and general health effects of providing informal care for one’s spouse using data from the Health and Retirement Study in the United States. Prior research has focused on children providing care for parents. In this paper, I provide the first analysis of these health effects among U.S. adults who provide care for their spouses. Using propensity score matching, I find that caregiving leads to an increase in depressive symptoms. Results are particularly strong and significant for female caregivers. I find that symptoms of depression increase with the intensity of caregiving. I find no evidence that caregiving leads to worse self-assessed health. This research is relevant to understanding the net benefit of informal caregiving in the context of the U.S. healthcare system. %B Department of Economics %I Willam and Mary %C Williamsburg %V Bachelor of Arts %G eng %U https://scholarworks.wm.edu/cgi/viewcontent.cgi?article=2498&context=honorstheses %0 Journal Article %J Journal of Family and Economic Issues %D 2020 %T Health Literacy and Difference in Current Wealth Among Middle-Aged and Older Adults %A Gillen, Martie %A Yang, Hongwei %A Hyungsoo Kim %K health %K Health Literacy %K Wealth %K Wealth Inequality %X Numerous studies suggest that health literacy improves health outcomes at older ages. But how, and to what extent, health literacy contributes to improving financial outcomes has not been examined. This study proposed a conceptual framework to explain the mechanisms between health literacy and current wealth. Data from the Health and Retirement Study (HRS) are used to estimate proposed direct and indirect effects between health literacy and current wealth. We found that, for the most part, health literacy is directly associated with wealth rather than indirectly through mediating variables. Alternatively, out of all indirect effects investigated in the model, health literacy affects wealth mainly through the path of chronic condition, work limitation, and income. %B Journal of Family and Economic Issues %V 41 %P 281–299 %G eng %N 2 %R 10.1007/s10834-019-09648-w %0 Journal Article %J Ear and Hearing %D 2020 %T Health literacy and self-reported hearing aid use in the Health and Retirement Study. %A Niall Andre Muns Klyn %A Zain Mohammed Shaikh %A Dhar, Sumitrajit %K Health Behavior %K Health Conditions and Status %K Hearing aids %K Self-reported health %X

OBJECTIVES: Understanding the determinants of hearing aid use is important to improve the provision of hearing healthcare. Prior research has indicated that materials in the clinic and online, as well as audiologists' language during appointments, require a higher literacy level than most patients possess. We hypothesized that low health literacy is a barrier to entry in hearing healthcare, and therefore that health literacy would be positively correlated with the probability of hearing aid use.

DESIGN: We performed retrospective analyses of the Health and Retirement Study, a longitudinal survey of American adults of retirement age. Objective health literacy was measured in different but overlapping subsamples using subsets of the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine (n = 1240, n = 1586, and n = 2412). Subjective health literacy was assessed using a single-question screener in a larger sample (n = 8362). Separate discrete time models including common covariates of hearing aid use were constructed for each subsample.

RESULTS: Objective health literacy measures did not correlate significantly with hearing aid use when age, gender, race/ethnicity, self-assessed hearing ability, and net income were included in the models. Subjective health literacy did correlate significantly with hearing aid use in the complete model, with lower subjective health literacy correlated with lower odds of reporting hearing aid use.

CONCLUSIONS: Taken at face value, the results provide mixed evidence for a link between health literacy and hearing aid use. The results from the analysis of the largest sample, using the subjective health literacy measure, were consistent with the hypothesis that low health literacy is a barrier to hearing aid use. However, this was not supported by the analysis of the objective health literacy measures in these samples. Further research using full health literacy measurement tools and capturing other relevant variables would offer clarification on this conflict. The literacy level of clinical materials and conversation is a modifiable potential factor in hearing aid uptake, so further clinical and research consideration is warranted.

%B Ear and Hearing %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31369472?dopt=Abstract %R 10.1097/AUD.0000000000000770 %0 Journal Article %J Collabra: Psychology %D 2020 %T Is Healthy Neuroticism Associated with Health Behaviors? A Coordinated Integrative Data Analysis %A Graham, Eileen %A Sara J Weston %A Nicholas A. Turiano %A Damaris Aschwanden %A Booth, Tom %A Harrison, Fleur %A James, Byran %A Nathan A Lewis %A Makkar, Steven %A Mueller, Swantje %A Wisniewski, Kristi %A Yoneda, Tomiko %A Zhaoyang, Ruixue %A Avron Spiro III %A Willis, Sherry %A K. Warner Schaie %A Sliwinski, Martin %A Lipton, Richard %A Katz, Mindy %A Ian J Deary %A Elizabeth Zelinski %A David A Bennett %A Sachdev, P S %A Brodaty, H %A Troller, Julian %A Ames, David %A Margaret J Wright %A Denis Gerstorf %A Allemand, Mathias %A Drewelies, Johanna %A Wagner, Gert G %A Muniz-Terrera, Graciela %A Andrea M Piccinin %A Scott M Hofer %A Daniel K. Mroczek %K Coordinated IDA %K Health behaviors %K Healthy Neuroticism %X Current literature suggests that neuroticism is positively associated with maladaptive life choices, likelihood of disease, and mortality. However, recent research has identified circumstances under which neuroticism is associated with positive outcomes. The current project examined whether “healthy neuroticism”, defined as the interaction of neuroticism and conscientiousness, was associated with the following health behaviors: smoking, alcohol consumption, and physical activity. Using a pre-registered multi-study coordinated integrative data analysis (IDA) approach, we investigated whether “healthy neuroticism” predicted the odds of engaging in each of the aforementioned activities. Each study estimated identical models, using the same covariates and data transformations, enabling optimal comparability of results. These results were then meta-analyzed in order to estimate an average (N-weighted) effect and to ascertain the extent of heterogeneity in the effects. Overall, these results suggest that neuroticism alone was not related to health behaviors, while individuals higher in conscientiousness were less likely to be smokers or drinkers, and more likely to engage in physical activity. In terms of the healthy neuroticism interaction of neuroticism and conscientiousness, significant interactions for smoking and physical activity suggest that the association between neuroticism and health behaviors was smaller among those high in conscientiousness. These findings lend credence to the idea that healthy neuroticism may be linked to certain health behaviors and that these effects are generalizable across several heterogeneous samples. %B Collabra: Psychology %V 6 %G eng %N 1 %R http://doi.org/10.1525/collabra.266 %0 Journal Article %J Journal of Business & Economic StatisticsJournal of Business & Economic Statistics %D 2020 %T Heterogeneity in Expectations, Risk Tolerance, and Household Stock Shares: The Attenuation Puzzle %A Ameriks, John %A Kezdi, Gabor %A Lee, Minjoon %A Matthew D. Shapiro %K household portfolio choice %K Risk preference %K Subjective stock returns distribution %K Survey measurement %X AbstractThis article jointly estimates the relationship between stock share and expectations and risk preferences. The survey allows individual-level, quantitative estimates of risk tolerance and of the perceived mean, and variance of stock returns. These estimates have economically and statistically significant association for the distribution of stock shares with relative magnitudes in proportion with the predictions of theories. Incorporating survey measurement error in the estimation model increases the estimated associations 2-fold, but they are still substantially attenuated being only about 5% of what benchmark finance theories predict. Because of the careful attention in the estimation to measurement error, the attenuation likely arises from economic behavior rather than errors in variables. %B Journal of Business & Economic StatisticsJournal of Business & Economic Statistics %V 38 %P 633 - 646 %@ 0735-0015 %G eng %N 3 %R 10.1080/07350015.2018.1549560 %0 Report %D 2020 %T Home Maintenance and Housing Disinvestment among Older Americans %A Murray, Tim %A Dunn, Richard A. %K Equity %K home production %K Housing %K maintenance %K Retirement %X Housing assets account for a significant share of total household wealth for older Americans, but contrary to the predictions of the permanent income hypothesis, there is little evidence that households use housing equity as a regular source of income in retirement to smooth consumption. This study investigates the role that endogenous depreciation of the housing stock through deferred maintenance plays in allowing older households to extract value from their homes. We develop a household production model where households can either purchase professional services or undertake maintenance by combining market goods and time. We then estimate the value of home production to calculate the total value of housing disinvestment. We find that married households disinvest $20,864 between the ages of 65-84 by decreasing time and expenditure on maintenance, or 9.4% of mean home value. In contrast, single households disinvest an average $2,636 over the same ages, suggesting important complementarity in spousal time. Interestingly, not only do households extract an important share of home value through deferred maintenance, they appear to be forward looking, increasing both time and expenditure on maintenance in the years just prior to age 65 in expectation that they will reduce maintenance after retirement. %B Working Paper %G eng %U https://timmurrayecon.com/wp-content/uploads/2020/08/Housing-Maintenace-and-Disinvestment-among-Older-Americans_web.pdf %0 Conference Paper %B Retirement and Disability Research Consortium 22nd Annual Meeting %D 2020 %T Home Ownership and Housing Debt in Retirement: Financial Asset for Consumption Smoothing or Albatross Around the Neck of Retirees? %A Fichtner, Jason %K Home ownership %K housing debt %K Retirement %X For many retirees, the home is their most valuable asset. A house is both used as an investment and for consumption. If a home is paid for at the time a person retires, they no longer have to service a mortgage or pay monthly rent, thus freeing up retirement income for other purposes. In this case, a large portion of income from Social Security can be devoted to consumption, benefiting the person’s standard of living. However, a mortgage that is not paid off creates a greater mandatory expense that may threaten the ability of Social Security benefits to replace income devoted to consumption in retirement. Additionally, home equity can be used to finance consumption in retirement, be it general, or targeted – such as for emergent health-related expenses or a financial emergency. While recent trends in housing asset appreciation appear to be improving the financial well-being of older Americans, without also understanding the level and use of housing debt, it is difficult to know whether retired homeowners are financially more secure. Using the Health and Retirement Study (HRS) panel data from 1992-2016, this paper addresses three related topics. First, it updates information on how household mortgage-related debt evolved for various HRS cohorts. Second, it explores how homeowners have used home debt near, and in, retirement. Third, it considers whether there are important public policy lessons on the role of using home-related debt for achieving a financially secure retirement. %B Retirement and Disability Research Consortium 22nd Annual Meeting %I Retirement and Disability Research Consortium %C Virtual %G eng %U https://crr.bc.edu/wp-content/uploads/2020/01/2020-RDRC-Meeting-Booklet.pdf#page=96 %0 Web Page %D 2020 %T Hope for the Next Year, and Beyond %A Tyler J VanderWeele %K Aging %K health %K Hope %K Well-being %X This past year has been difficult for our country, and for the world. We have been struggling through a deadly pandemic. We have faced tensions across racial and political lines. Many have faced tremendous economic hardship. Some are doubtless wondering if there is any reason for hope. Dare we hope for the future? And what is hope? Is it realistic? Does it help at all? Over the past couple of years, we have been trying to better understand and assess hope at the Human Flourishing Program at Harvard, to attempt to shed light on some of these critical questions of our day. %I Psychology Today %C New York, NY %G eng %U https://www.psychologytoday.com/ca/blog/human-flourishing/202012/hope-the-next-year-and-beyond %0 Journal Article %J Innovation in Aging %D 2020 %T Hopelessness among Middle-aged and Older Blacks: The Negative Impact of Discrimination and Protecting Power of Social and Religious Resources %A Uchechi A Mitchell %A Gutierrez-Kapheim, Melissa %A Ann W Nguyen %A Al-Amin, Nadia %K African American %K Mental Health %K Minority Issues %K race %K Religion and spirituality %K Social networks %K Social Support %K Stress & Coping %X Hopelessness—a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges—is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older Blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of Blacks.Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by two age groups, ages 51-64, representing middle-age (n=1,302) and age 65 and older, representing old age (n=887). Interaction terms tested whether each resource moderated the discrimination-hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics.Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older Blacks. For middle-aged Blacks, the resources did not moderate the discrimination-hopelessness relationship; rather higher levels of support (b=-.294, p<0.01), religiosity (b=-.297, p<0.001), religious attendance (b=-.218, p<0.05) were independently and inversely associated with hopelessness. For older Blacks, higher levels of religiosity moderated the discrimination-hopelessness relationship (b=-.208, p<0.05) and higher levels of support (b=-.304, p<0.05) and social engagement (b=-.236, p<0.05) were independently and inversely associated with hopelessness.Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older Blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older Blacks as a buffer against the negative consequences of discrimination on hopelessness. %B Innovation in Aging %V 4 %P igaa044 %@ 2399-5300 %G eng %N 5 %R 10.1093/geroni/igaa044 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths %A John G. Cagle %A Lee, Joonyup %A Katherine A Ornstein %A Jack M. Guralnik %K End-of-life care %K Health and Retirement Study %K healthcare utilization %K Hospice %X OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non-cancer deaths. SETTING Study data were provided by a population-based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. %B Journal of the American Geriatrics Society %V 68 %P 783-793 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16294 %N 4 %R 10.1111/jgs.16294 %0 Report %D 2020 %T Household responses to disability shocks: Spousal labor supply, caregiving, and disability insurance %A Siha Lee %K Caregiving %K Disability %K Social Security %K spousal labor supply %X This paper examines married women’s time allocation to market hours and spousal care in the event of their husbands’ disability and its implications for evaluating the insurance value of the Social Security Disability Insurance (SSDI) program. First, I find that while spousal labor supply responses to husbands’ disability are small, wives spend a sizable amount of time in spousal care after their husbands become disabled. Motivated by these facts, I develop a dynamic model of married households that incorporates husbands’ disability status, wives’ time allocation choices, health state dependent utility, and the institutional features of SSDI. Counterfactual experiments indicate that caregiving needs substantially attenuate spousal labor supply responses and increase the insurance value of SSDI relative to its costs. Furthermore, policy reforms such as supplementary caregiving benefits can improve social welfare. %B Canadian Labour Economics Forum Working Paper Series %I University of Waterloo %C Waterloo, Ontario %G eng %U https://www.econstor.eu/bitstream/10419/215772/1/169428462X.pdf %9 Report %0 Thesis %D 2020 %T Housing demand and tenure choice for senior citizens: Lessons from three essays %A Kim, Jinyhup %K housing affordability %K property taxes %K residential mobility %X The U.S. housing market faces a huge surge brought on by the growth of the older population. Housing researchers and gerontologists are now focusing on potential challenges that older households could face over the coming decades and are attempting to estimate how such challenges will affect the housing market. This marks a critical point for assessing housing affordability, availability of accessible housing, and housing demands based on geographical locations – all of which will be of utmost importance to aging populations in the coming decades. Although the older population is growing rapidly and is receiving considerable attention from both researchers and policymakers, there have been relatively few empirical studies about the housing behaviors of older Americans. This dissertation examines the aforementioned three challenges through empirical essays by employing micro-data (e.g., the 2004–2014 Health and Retirement Study, the 2011 American Housing Survey, and the 2013–2017 Public Use Microdata Sample). Specifically, the first paper will examine the reasons why elderly homeowners make the downward transition from homeownership, with a particular focus on the significance of property taxes on elderly behaviors. The second paper will investigate the living conditions of existing housing for stayers – those who have remained in their place of dwelling since reaching the retirement age of 65 – and estimate how accessible their housing is to meet the daily needs for aging in place. The third paper will seek empirical determinants on residential mobility and housing choices by elderly households in the Baltimore MSA, accessing the net impact of individual and housing attributes on migration behaviors and housing consumption. The results of these analyses show that property tax abatement programs fail to provide tax subsidies targeted to low income seniors in need. Furthermore, policy approaches to grow the accessible housing stock have proven largely unsuccessful. Finally, seniors who migrate throughout the Baltimore MSA show a strong tendency to downsize and become renters – particularly of apartments – regardless of location. This research will provide timely new evidence, which will help decision-makers better understand the burning issues that impact aging adults’ housing-related behaviors in the U.S. housing market. %I University of Maryland %C College Park, MD %G eng %R 10.13016/5trg-sklv %0 Report %D 2020 %T How Accurate Are Retirees’ Assessments of Their Retirement Risk? %A Wenliang Hou %K family risk %K health risk %K longevity risk %K market risk %K policy risk %X Retirees with limited financial resources face numerous risks, including out-living their money (longevity risk), investment losses (market risk), unexpected health expenses (health risk), the unforeseen needs of family members (family risk), and even retirement benefit cuts (policy risk). This study systematically values and ranks the financial impacts of these risks from both the objective and subjective perspectives and then compares them to show the gaps between retirees’ actual risks and their perceptions of the risks in a unified framework. It finds that 1) under the empirical analysis, the greatest risk is longevity risk, followed by health risk; 2) under the subjective analysis, retirees perceive market risk as the highest-ranking risk due to their exaggeration of market volatility; and 3) the longevity risk and health risk are valued less in the subjective ranking than in the objective ranking, because retirees underestimate their life spans and their health costs in late life. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/how-accurate-are-retirees-assessments-of-their-retirement-risk/ %0 Report %D 2020 %T How Can Policymakers Close the Racial Gap in Retirement Security? %A Richard W. Johnson %K Aging %K Income and wealth %K Poverty %K race and ethnicity %X Financial insecurity at older ages is a growing policy concern. Retirement income largely depends on earnings received at working ages, which determine Social Security benefits, any employer pensions that retirees receive, and a person’s capacity to set aside additional funds for retirement. Although earnings have been growing for women, bolstering their future retirement income, earnings have stagnated over the past few decades for men in the bottom three-quarters of the earnings distribution (Machin 2016; Rose 2015), threatening their retirement security. %B Urban Institute Research Report %I Urban Institute %C Washington, D.C. %G eng %U https://www.urban.org/research/publication/how-can-policymakers-close-racial-gap-retirement-security %0 Book Section %B America’s Aging Workforce and the Future of ’Working Longer’ %D 2020 %T How Caregiving for Parents Reduces Women’s Employment: Patterns Across Sociodemographic Groups %A Sean Fahle %A Kathleen McGarry %K Caregiving %K eldercare %K female labor force participation %K female labor supply %K Informal care %K Long-term Care %X This chapter examines the social patterns of elder caregiving among women ages 50 and older in the United States. We find that women who provide personal care for parents or parents-in-law, tend to be from more advantaged sociodemographic groups, with larger differences by socioeconomic status than by race and ethnicity. Prior to initiating care, caregivers also have greater labor market attachment than non-caregivers. In contrast, although less likely to provide care, women from less advantaged groups tend to provide more time-intensive care when they do provide care, particularly in the extreme upper-end of the distribution of care hours. We find strong negative associations between caregiving and employment, hours, and earnings, both immediately and over a longer 10-year period. The relationship between care and work is similar across the sociodemographic groups that we examine. %B America’s Aging Workforce and the Future of ’Working Longer’ %I Oxford University %G eng %U https://squaredawayblog.bc.edu/wp-content/uploads/2020/12/Fahle_McGarry_Overtime.pdf %0 Journal Article %J Economics & Human Biology %D 2020 %T How Children's Education Affects Caregiving: Evidence from Parent’s Last Years of Life %A Nan Jiang %A Neeraj Kaushal %K Aging %K Caregiving %K Education %K intergenerational support %X Using data from the Health and Retirement Study (1994–2012), we studied the association between adult children’s education and financial and caregiving support they provided to their aging parents in the last years of the parents’ life. We controlled for the circumstances of parents’ death, their functional limitations, whether they were in long-term care or home-care settings in the last year of their life, and in some models, various measures of parents’ self-reported health. Estimates suggest that having a college degree and above has a significantly positive association with monetary transfers and knowledge support children provide to their parents. Estimates remained robust in models that included parent fixed effects. Evidence of children’s education on instrumental support to parents was nonlinear in that although some college education increased instrumental support, but, a college degree did not have a statistically significant effect. Gender did not play a moderating role in the relationship between offspring education and support towards parents. %B Economics & Human Biology %G eng %R https://doi.org/10.1016/j.ehb.2020.100875 %0 Government Document %D 2020 %T How Did the Reintroduction of the Social Security Statement Change Workers' Expectations and Plans? %A Philip Armour %K Social Security Benefits %X This article examines how the reintroduction of Social Security Statement mailings from September 2014 through December 2016 affected recipients' expectations about Social Security benefits and their benefit claiming decisions. During the reintroduction period, Statements were mailed to workers reaching multiple-of-5 ages, enabling a comparison of results for 2016 recipients, 2014/2015 recipients, and reintroduction-period nonrecipients. I fielded a specialized American Life Panel (ALP) survey to elicit recall of and reactions to receiving the Statement and used earlier ALP modules to control for respondents' prior Social Security knowledge. I find that recipients remember and value the information provided in the Statement, although the effects quickly diminish after receipt. Recipients were likelier than nonrecipients to expect future benefits but were also more likely to expect Congress to enact future benefit cuts. Married female recipients were more likely to expect spousal benefits, and recipients overall were more likely to change their planned claiming age. %I Office of Retirement and Disability Policy, Social Security Administration %V 80 %G eng %U https://www.ssa.gov/policy/docs/ssb/v80n4/v80n4p23.html %N 4 %0 Journal Article %J Complementary Therapies in Clinical Practice %D 2020 %T How does art making work? Testing the hypothesized mechanisms of art making on pain experience %A Kyung Soo Kim %A Kristine L Kwekkeboom %A Jee-Seon Kim %K Art making %K Holistic health %K pain %X Background and purpose: Pain is a multidimensional experience that requires a holistic pain management approach. Art making, a holistic, mind-body-spirit approach, has been used as a pain management strategy. Although findings of empirical studies point toward several potential mechanisms through which art making activity may affect the pain experience, these mechanisms have not yet been tested. Therefore, the purpose of this study is to evaluate whether perceived control, self-efficacy, spirituality, and mood mediate the effect of art making activity on pain. Materials and methods This study is a secondary analysis of cross-sectional survey data collected in 2014 for the Health and Retirement Study (HRS). Data from a national sample of 731 adults, 50 years of age or older were analyzed for the current study. Participants completed a health survey which included measures of art engagement (representing ‘effect of art making’ in this study), pain severity and interference, and proposed mediating variables (e.g., perceived control, self-efficacy, spirituality and mood). The joint significance test was used to test hypothesized mediation. Result We found that positive mood mediated the effects of art engagement on pain, but perceived control, self-efficacy, spirituality, and negative mood did not. Engagement in art making activity was associated with more positive mood (β = 0.213, p = .001). In turn, greater positive mood was associated with lower pain severity (β = -.147, p = .010) and pain interference (β = -.519, p = .034). Conclusion Results of this study provide preliminary evidence that engagement in art making activity impacts pain experience by enhancing positive mood. A large prospective study examining the hypothesized mediating relationship is necessary to confirm our findings. %B Complementary Therapies in Clinical Practice %V 40 %G eng %R 10.1016/j.ctcp.2020.101200 %0 Report %D 2020 %T How Much Taxes Will Retirees Owe on Their Retirement Income? %A Anqi Chen %A Alicia H. Munnell %K Retirement %K Taxes %X To evaluate their retirement resources, households approaching retirement will examine their Social Security statements, defined benefit pensions, defined contribution balances, and other financial assets. However, many households may forget that not all of these resources belong to them; they will need to pay some portion to federal and state government in taxes. It is unclear, however, just how large the tax burden is for the typical retired household and for households with different income levels. This project aims to shed light on the tax burdens that retirees face by estimating lifetime taxes for a group of recently retired households. The project uses data from the Health and Retirement Study (HRS) linked to administrative earnings to determine Social Security benefits and administrative records on state of residence to estimate state tax liabilities. Income is then projected over the expected retirement of each household. Federal and state taxes, are estimated with TAXSIM, for each household on its reported and projected income. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/how-much-taxes-will-retirees-owe-on-their-retirement-income/ %0 Web Page %D 2020 %T How the Affordable Care Act Is Helping Fight the Coronavirus Outbreak %A Marc A Cohen %A Jane Tavares %K Affordable Care Act %K Coronavirus %K COVID-19 %K depression %K Health Insurance %K Medicare %K Pandemic %X Ten years after the passage of the Affordable Care Act, the Trump administration is now asking the Supreme Court to overturn it. Yet it’s now clear that the ACA has brought significant improvements to the lives of millions of Americans. Today, they enjoy more health care coverage, with greater access, better outcomes and less cost. %B The Conversation: Health %I The Conversation %C Boston %G eng %U https://theconversation.com/obamacares-unexpected-bonus-how-the-affordable-care-act-is-helping-middle-aged-americans-during-the-pandemic-139267 %0 Journal Article %J Journal of Alzheimer's Disease %D 2019 %T Handgrip strength is associated with poorer cognitive functioning in aging Americans. %A Ryan P McGrath %A Sheria G Robinson-Lane %A Cook, Summer %A Brian C Clark %A Stephen D. Herrmann %A Melissa L O'Connor %A Kyle J Hackney %K Alzheimer's disease %K Cognitive Ability %K Dementia %K Physical measures %X

BACKGROUND: Measures of handgrip strength may show promise for detecting cognitive erosion during aging.

OBJECTIVE: To determine the associations between lower handgrip strength and poorer cognitive functioning for aging Americans.

METHODS: There were 13,828 participants aged at least 50 years from the 2006 wave of the Health and Retirement Study included and followed biennially for 8 years. Handgrip strength was assessed with a hand-held dynamometer and cognitive functioning was assessed with a modified version of the Mini-Mental State Examination. Participants aged <65 years with scores 7- 11 had a mild cognitive impairment, ≤6 had a severe cognitive impairment, and ≤11 had any cognitive impairment. Respondents aged ≥65 years with scores 8- 10 had a mild cognitive impairment, ≤7 had a severe cognitive impairment, and ≤10 had any cognitive impairment Separate covariate-adjusted multilevel logistic models examined the associations between lower handgrip strength and any or severe cognitive impairment. A multilevel ordered logit model analyzed the association between lower handgrip strength and poorer cognitive functioning.

RESULTS: Every 5-kg lower handgrip strength was associated with 1.10 (95% confidence interval (CI): 1.04, 1.15) and 1.18 (CI: 1.04, 1.32) greater odds for any and severe cognitive impairment, respectively. Similarly, every 5-kg lower handgrip strength was associated with 1.10 (CI: 1.05, 1.14) greater odds for poorer cognitive functioning.

CONCLUSIONS: Measurement of handgrip strength is a simple, risk-stratifying method for helping healthcare providers determine poorer cognitive functioning. Interventions aiming to prevent or delay cognitive dysfunction should also implement measures of handgrip strength as an assessment tool for determining efficacy.

%B Journal of Alzheimer's Disease %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31322562?dopt=Abstract %R 10.3233/JAD-190042 %0 Journal Article %J Psychological Science %D 2019 %T Having a Happy Spouse Is Associated With Lowered Risk of Mortality. %A Stavrova, Olga %K Aged %K Aged, 80 and over %K Exercise %K Female %K Happiness %K Humans %K Interpersonal Relations %K Longevity %K Male %K Middle Aged %K Mortality %K Personal Satisfaction %K Risk Reduction Behavior %K Self Report %K Sexual Partners %K Socioeconomic factors %K Spouses %K Survival Analysis %X

Studies have shown that individuals' choice of a life partner predicts their life outcomes, from their relationship satisfaction to their career success. The present study examined whether the reach of one's spouse extends even further, to the ultimate life outcome: mortality. A dyadic survival analysis using a representative sample of elderly couples ( N = 4,374) followed for up to 8 years showed that a 1-standard-deviation-higher level of spousal life satisfaction was associated with a 13% lower mortality risk. This effect was robust to controlling for couples' socioeconomic situation (e.g., household income), both partners' sociodemographic characteristics, and baseline health. Exploratory mediation analyses pointed toward partner and actor physical activity as sequential mediators. These findings suggest that life satisfaction has not only intrapersonal but also interpersonal associations with longevity and contribute to the fields of epidemiology, positive psychology, and relationship research.

%B Psychological Science %V 30 %P 798-803 %G eng %N 5 %R 10.1177/0956797619835147 %0 Web Page %D 2019 %T Having a paying job may help fend off Alzheimer’s disease in women %A Elizabeth R Mayeda %K Alzheimer's %K class %K women %X A new study has shed light on a possible risk factor for Alzheimer’s disease in women: not having a job. Dr. Elizabeth R. Mayeda, assistant professor of epidemiology at UCLA’s Fielding School of Public Health, conducted a study on later-life cognitive health in women and found that working women showed a slower decrease in memory than their nonworking counterparts. Mayeda and her team presented their findings at the Alzheimer’s Association International Conference recently in Los Angeles. The study was in collaboration with researchers at the UCLA Fielding School of Public Health, the University of California, San Francisco and Boston College. Using data from the National Institute on Aging’s Health and Retirement Study, Mayeda examined the memory function patterns of more than 6,000 women born between 1935 and 1956. Women reported each year between the ages of 16 and 50 whether they were working for pay or had children, and were grouped by their work and family patterns to examine changes in memory for women over age 50. %I The Seattle Times %C Seattle, United States %V 2019 %G eng %U https://www.seattletimes.com/explore/careers/having-a-paying-job-may-help-fend-off-alzheimers-disease-in-women/ %9 News %0 Report %D 2019 %T Health and Retirement Study 2016 Tracker %A HRS Staff %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor %P 1-44 %8 01/2019 %G eng %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2019 %T Health and social-physical environment profiles among older adults living alone: Associations with depressive symptoms. %A So Jung Park %A Jacqui Smith %A Ruth E Dunkle %A Ingersoll-Dayton, Berit %A Toni C Antonucci %K Depressive symptoms %K Health Conditions and Status %K Living arrangements %X

Objectives: We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts.

Method: Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms.

Results: Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment.

Discussion: Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

%B Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 74 %P 675-684 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28637214?dopt=Abstract %R 10.1093/geronb/gbx003 %0 Thesis %B Gerontology %D 2019 %T Health Consequences of Retirement Among Married Couples %A Sae Hwang Han %K Endogeneity %K Gerontology %K Health and Retirement Study %K Labor force transitions %K Multilevel models %K Older couples %K Social Sciences %X The aim of this dissertation was to contribute to our understanding of the health consequences of retirement by proposing three major theory-driven research questions, set within a life course perspective. The first and second research questions addressed whether retirement transitions are associated with subsequent health for the retiree, as well as the partner. That is, given the coupled-nature of retirement transition for many married individuals, the question of the health consequences of retirement was examined in the context of married relationships. Importantly, by focusing on married individuals, I also investigated whether there are cross-spousal health consequences of retirement. The third research question addressed whether the linkages between retirement transitions and the health vary depending on a number of contextual factors concerning the experience of retirement.This study was based on nine waves of biennial data (1998–2014) from the Health and Retirement Study (HRS). I took advantage of the household panel structure of the HRS data to examine individuals nested within couples over time, employing an actor-partner interdependence model (APIM) framework to estimate the health effects of one’s own and spouse’s retirement. To account for potential reverse causality, retirement decisions that are unrelated to health and those that are reported as caused by poor health were specified separately in the analyses. Omitted variable bias was addressed using within-between random effects models.Findings indicated that retirement transitions driven by non-health reasons were unrelated to subsequent self-rated health of both wives and husbands, whereas the transition was associated with an increased number of depressive symptoms for husband, but not wives. In contrast, retirement transitions driven by poor health were consistently associated with worse health outcomes, as assessed with self-rated health and depressive symptoms, for both wives and husbands. As for the partner effects of retirement transitions, the findings indicated that spousal retirement transitions were largely unrelated to changes in subsequent health. I further found that actor effects of retirement transitions were significantly moderated by a number of different contextual factors. The findings provide support for implementing policy measures to facilitate longer working lives of older married individuals, especially those in compromised health conditions. %B Gerontology %I University of Massachusetts Boston %V PhD %P 126 %@ 9781392238288 %G eng %U http://paa2019.populationassociation.org/abstracts/192345 %9 phd %0 Journal Article %J JOURNAL OF THE ECONOMICS OF AGEING %D 2019 %T Health disparities and the socioeconomic gradient in elderly life-cycle consumption %A Ray Miller %A Bairoliya, Neha %A Canning, David %K Aging %K Consumption inequality %K Education gradient %K health %K Life-cycle %X We quantify the importance of health disparities in explaining consumption differences at older ages by estimating a panel VAR model of elderly consumption, health, and mortality using data from the Health and Retirement Study. We use the estimated model and initial joint distribution of health and consumption to simulate elderly life-cycle paths and construct a measure of the net present value of expected remaining lifetime consumption at age sixty (NPVC). We first document a steep education gradient in elderly lifetime consumption. We then decompose the gradient in NPVC to quantify the effect of 1) differences in the health distribution at age sixty and 2) differential health and mortality transitions after age sixty. Our decomposition results suggest that roughly 10-12% of the education gradient in NPVC at age sixty could be closed by eliminating elderly health differences. %B JOURNAL OF THE ECONOMICS OF AGEING %V 14 %P UNSP 100176 %G eng %9 Article %R 10.1016/j.jeoa.2018.11.001 %0 Journal Article %J American Journal of Health Economics %D 2019 %T Health Insurance and Early Retirement Plans: Evidence from the Affordable Care Act %A Padmaja Ayyagari %K Affordable Care Act %K Employer Sponsored Retiree Health Insurance %K Job Lock %K Subjective Retirement Expectations %X Understanding how individuals make retirement plans is key to designing effective policy. In particular, access to affordable insurance during retirement can play an important role in the labor supply decisions of older adults. In this study, I examine the impact of the 2010 Affordable Care Act (ACA) on the retirement plans of older adults. The ACA includes several provisions that significantly increase access to affordable insurance not tied to employment. I find that the ACA decreased the subjective probability of working past age 62 by 5.6 percentage points, representing a 9.9 percent decline, among persons without employer sponsored retiree coverage relative to persons with employer sponsored benefits. On average, individuals expect to retire about 3.6 to 7.2 months earlier due to the ACA. %B American Journal of Health Economics %V 5 %P 533-560 %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3281097 %0 Journal Article %J Prehospital and Disaster Medicine %D 2019 %T Health Risk Behaviors after Disaster Exposure Among Older Adults %A Bell, Sue Anne %A Choi, Hwajung %A Kenneth M. Langa %A Theodore J Iwashyna %K BMI %K Health behaviors %K Risk Factors %B Prehospital and Disaster Medicine %V 34 %P 95-97 %G eng %U https://www.cambridge.org/core/product/identifier/S1049023X18001231/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1049023X18001231 %N 1 %! Prehosp. Disaster med. %R 10.1017/S1049023X18001231 %0 Journal Article %J Journal of Clinical Endocrinology and Metabolism %D 2019 %T High-density lipoprotein cholesterol and all-cause and cause-specific mortality among the elderly. %A Li, Zhi-Hao %A Lv, Yue-Bin %A Zhong, Wen-Fang %A Gao, Xiang %A Virginia Byers Kraus %A Zou, Meng-Chen %A Zhang, Xi-Ru %A Li, Fu-Rong %A Yuan, Jin-Qiu %A Shi, Xiao-Ming %A Wu, Xian-Bo %A Mao, Chen %K Cholesterol %K Health Conditions and Status %K Mortality %X

CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear.

OBJECTIVE: To examine the association of HDL-C concentrations with mortality, and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly.

DESIGN: This was a nationwide, community-based prospective cohort study.

METHODS: This study included 7,766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cause-specific mortality.

RESULTS: During a median follow-up of 5.9 years, 1,921 deaths occurred. After fully adjustment for covariates, a nonlinear (P for nonlinearity<0.001) association was found between HDL-C and all-cause mortality (minimum mortality risk at 71 mg/dL [1.84 mM]); the risk for all-cause mortality was significantly higher in the group with HDL-C concentration <61 mg/dL (1.58 mM) (HR: 1.18; 95% CI: 1.05-1.33) and in the group with HDL-C concentration >87 mg/dL (2.25 mM) (HR: 1.56; 95% CI: 1.17-2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58-2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and non-cardiovascular mortality were also observed (both P for nonlinearity<0.001).

CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.

%B Journal of Clinical Endocrinology and Metabolism %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30869791?dopt=Abstract %R 10.1210/jc.2018-02511 %0 Journal Article %J International journal of aging & human development %D 2019 %T His and Her Retirement: Effects of Gender and Familial Caregiving Profiles on Retirement Timing. %A Rachel R Stoiko %A Strough, JoNell %K Caregiving %K Gender Differences %K Retirement Planning and Satisfaction %K Women and Minorities %X Objectives: Retirement timing has been linked to a host of outcomes for individuals, families, and societies. The present study predicted retirement timing using profiles of preretirement family caregiving and gender. Method: Using longitudinal data from the Health and Retirement Study, cluster analysis was used to create profiles of preretirement family caregiving (operationalized as time and financial transfers to aging parents and adult children). These profiles, as well as gender, were used to predict later retirement timing. Result:s Four distinct preretirement caregiving profiles were evident. All profiles retired, on average, earlier than their full eligibility for Social Security benefits. A main effect of caregiving profile, but not gender, was evident. The Eldercare profile, which was characterized by high levels of time and financial transfers to aging parents, retired the earliest. There was not a significant interaction between caregiving profile and gender. Discussion: When men enacted female-typical caregiving roles, their retirement timing resembled women's. Eldercare, in particular, was associated with earlier retirement timing. Implications for individual retirement decision-making and policy are discussed. %B International journal of aging & human development %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29911387?dopt=Abstract %R 10.1177/0091415018780009 %0 Journal Article %J International Journal of Health Economics & Management %D 2019 %T The Hispanic health paradox for older Americans: an empirical note. %A Olsen, Reed %A Basuroy, Subhasree %A Tseng, Hui-Kuan %K Hispanics %K Self-reported health %X Previous researchers have found that Hispanic immigrants tend to have better health than could be reasonably explained by their socioeconomic status and other demographic variables. The main objective of this study is to re-investigate the Hispanic health paradox covering the period from 1992 to 2012. Main contributions of the paper include using a data set of older Americans from the Health and Retirement Study. More importantly, we use two new measures of health. Previous research on the paradox had primarily used mortality or morbidity to measure health. In contrast, the HRS includes a measure of self-reported poor health from which we construct a latent health variable. Using both poor health and latent health we find that even among our sample of older Americans that Hispanic Immigrants remain more healthy than could be explained by their socioeconomic status and their other health inputs. %B International Journal of Health Economics & Management %V 19 %P 33-51 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29682677?dopt=Abstract %R 10.1007/s10754-018-9241-4 %0 Journal Article %J Journal of Gerontological Social Work %D 2019 %T Home and community-based services and life satisfaction among homebound and poor older adults. %A Chen, Qingru %A Amano, Takashi %A So Jung Park %A BoRin Kim %K Community-based services %K Depressive symptoms %K Well-being %X Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction ( = -0.15, < .05), but better life satisfaction when they used HCBS ( 0.33, .10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services. %B Journal of Gerontological Social Work %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31293224?dopt=Abstract %R 10.1080/01634372.2019.1639094 %0 Journal Article %J Environment and Behavior %D 2019 %T Home Environment, Living Alone, and Trajectories of Cognitive Function Among Older Adults With Functional Limitations %A So Jung Park %A BoRin Kim %A Amano, Takashi %A Chen, Qingru %K Cognition %K Functional limitations %K home environment %K Loneliness %X This study aimed to investigate the effects of Person-Environment Fit on trajectories of cognitive function. Data came from the Health Retirement Study (1998-2010), focusing on those aged 65 and above who had at least one limitation in activities of daily living. Using longitudinal mixed-effect modeling, we analyzed the effects of living in supportive home environments on trajectories of cognitive function over time. Disabled older individuals living alone were likely to experience a decline in cognitive function over time. However, the detrimental effects of living alone were moderated when the home was equipped with supportive features and accessibility. The findings reveal the importance of home modifications for socially and physically vulnerable elders. %B Environment and Behavior %P 0013916519879772 %8 2019/10/16 %@ 0013-9165 %G eng %U https://doi.org/10.1177/0013916519879772 %! Environment and Behavior %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Home-based gait speed assessment: Normative data and racial/ethnic correlates among older adults. %A David A. Boulifard %A Emmeline Ayers %A Joe Verghese %K Gait speed %K Racial/ethnic differences %X

OBJECTIVES: To determine home-based gait speed performance and its associations with sociodemographic and health-related factors among older adults.

DESIGN: Cross-sectional analysis of a nationally representative US population sample.

SETTING AND PARTICIPANTS: Homes of Health and Retirement Study (HRS) participants.

METHODS: Walk test data measured at home over 2.5 m were aggregated for 6983 individuals, aged ≥65 years (mean age 74.8 ± 6.9 years, 54.2% women), from the 2006 and 2008 HRS waves. Means for gait speed at normal pace were determined for demographic and clinical groupings; association of gait speed with demographic, socioeconomic status, and health factors were examined. Four-year mortality was predicted from baseline slow gait status defined using demographic-based cutoff scores as well as commonly recommended cutoff scores (100 or 60 cm/s).

RESULTS: Home-based gait speed (cm/s) means were lower for female than male (9.6% difference), older than younger (18.0% difference), African American than white (20.5% difference), and Hispanic than Non-Hispanic (10.3% difference) participants. Differences by age group, race, and ethnicity remained significant within sexes (P < .001). Lower speed was associated with African American race and all health problems; higher speed was associated with higher socioeconomic status and alcohol consumption. Four-year mortality was predicted by slow gait status. Predictive validity was, in general, higher for slow gait cutoff scores defined by demographic characteristics.

CONCLUSIONS AND IMPLICATIONS: Mean gait speed measured at home differs among older (aged ≥65 years) US resident population groups defined by sex, age, race, ethnicity, health status, and combinations of these factors, and predicts 4-year mortality when substantially slower than group-based norms. These findings may assist researchers and clinicians in determining normal and abnormal gait performance in older adults in community settings.

%B Journal of the American Medical Directors Association %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31395494?dopt=Abstract %R 10.1016/j.jamda.2019.06.002 %0 Thesis %B Social Work %D 2019 %T Hope and Positive Emotions in Bereavement Among Older Adults in the United States %A Soyeon Kim %K Bereavement %K Gerontology %K Hope %K Mental Health %K Positive psychology %X This three-paper dissertation aims to enhance our understanding of the role of positive psychology constructs, hope, and positive emotions during bereavement among older adults. The study will be mainly guided by the Broaden-and-Build Theory of Positive Emotion, the Hope Theory, and the Revised Stress and Coping Theory. This dissertation is based on secondary data analysis using two different data - the Health and Retirement Study (HRS) for Paper 1 and the Complicated Grief Treatment in Older Adults Study (CGTOA) for Paper 2 and Paper 3. Paper 1 examines the level of positive and negative emotions before and after bereavement, and the impact of positive emotions on bereavement adjustment outcomes such as depression and purpose in life among a nationally representative sample of widowed older adults. Paper 1 finds that recently widowed older adults experience a significant decrease in positive emotions and an increase in negative emotions (compared to the married comparison group) after the loss of their spouse, but they still experience a considerable level of positive emotions during bereavement. The level of post-loss positive emotions was significantly associated with better adjustment outcomes, lower odds of having depression, and a higher level of purpose in life. A significantly greater impact of positive emotions on purpose in life was found among the widowed group compared to the married counterparts. However, the beneficial impact of positive emotions on depression did not differ between the widowed and married groups. Paper 2 and Paper 3 explore hope among the bereaved older adults with complicated grief using data from the CGTOA Study, a randomized clinical trial, which compared the treatment efficacy of complicated grief treatment (CGT) with interpersonal psychotherapy (IPT). Paper 2 focuses on evaluation of the psychometric properties of the Trait Hope Scale (THS) among older adults with complicated grief before proceeding to address the role of hope in CGT in Paper 3. Paper 2 suggests that overall the THS is a valid and reliable tool to measure hope among older adults with complicated grief. The THS demonstrated its sensitivity to change with treatment, showing a significantly greater increase in hope score among treatment responders (in both CGT and IPT) compared to non-responders. However, unlike the theoretically supported two-factor structure of the THS (Pathways and Agency), a different two-factor structure was identified in the study, which suggests that further validation of the factor structure of the THS in older adults with complicated grief is necessary in future studies. Paper 3 investigates the role of hope in CGT, particularly examining hope as a potential moderator and/or mediator of treatment effects. Paper 3 found that both CGT and IPT groups increased their hope scores significantly during the treatment. However, there was no significant difference in increases in hope between CGT and IPT groups. Mediation analysis showed that hope is not a mediator of treatment effects of CGT over IPT. However, significant treatment effects of CGT (over IPT) were found for reduction in the level of grief-related avoidance among those with lower baseline hope, but not for those with higher baseline hope, which confirmed hope is a moderator of treatment effects for only the grief-related avoidance outcome. The findings of this dissertation suggest that 1) positive emotions during bereavement may play a beneficial role in adaption to bereavement, 2) the Trait Hope Scale is a valid and reliable tool to measure hope among older adults with complicated grief, and 3) hope can be improved in complicated grief interventions (both CGT and IPT), and regaining hope may be an important factor associated with the resolution of complicated grief symptoms. %B Social Work %I Columbia University %C New York, NY %V Ph.D. %8 08/2019 %G eng %U https://academiccommons.columbia.edu/doi/10.7916/d8-8qnb-x083 %0 Journal Article %J Social Science Computer ReviewSocial Science Computer Review %D 2019 %T Horizontal or Vertical? The Effects of Visual Orientation of Categorical Response Options on Survey Responses in Web Surveys %A Hu, Jingwei %K categorical response options %K horizontal orientation %K vertical orientation %K web surveys %X Prior research has studied the impact of horizontal versus vertical orientation of rating scales on survey responses, but not the effects of orientation of categorical options. The present study attempts to fill this gap by investigating the orientation effects of categorical options on response burden and response quality and by studying how the effects of orientation of response categories interact with cognition capacity. The data are drawn from an experiment embedded in the 2013 Internet Survey of the Health and Retirement Study (HRS), in which respondents were randomly assigned to a question with either horizontally or vertically aligned response categories. Response burden is measured by response time, and response quality is measured by reliability, primacy effect, and item missing on the question. Horizontal orientation is found to be more burdensome than vertical orientation on the web for HRS respondents, but there is no significant difference between the two orientations on primacy effect and item missing, and the two orientations are equally reliable. The effects of cognition capacity are found to interact with orientation on both response burden and response quality on the web. Compared to vertical orientation, horizontal orientation leads to longer response time but less primacy effect for people with lower cognition capacity versus people with higher cognition capacity. However, the effects of the orientation and cognition capacity do not interact on item missing. Vertical orientation for categorical response options in web surveys is recommended in general, but more caution should be exercised if respondents are elderly and primacy effect is a main concern. %B Social Science Computer ReviewSocial Science Computer Review %V 38 %P 779 - 792 %8 2020/12/01 %@ 0894-4393 %G eng %N 6 %R https://doi.org/10.1177/0894439319834296 %0 Journal Article %J Innovation in Aging %D 2019 %T HOUSING AFFORDABILITY AND INTER-REGIONAL MOVES AMONG OLDER ADULTS %A Mawhorter, Sarah %A Jennifer A Ailshire %K Housing %K housing affordability %X Housing prices have risen in urban areas across the US since 2000, with only a brief interruption after the housing crisis of 2008. At the same time, prosperous urban areas have pulled away from declining urban and rural areas. Older adults are more likely to be affected by both increases and divergence of housing prices: owners may not be able to afford rising property taxes (though they benefit from increasing home equity), and renters are especially vulnerable. Housing affordability constraints may also affect the places where older adults can afford to move. In this paper, we compare the residential mobility patterns of adults aged 50+ living in high-cost, mid-cost, and low-cost areas from 2000-2014, using data from the Health and Retirement Study with county-level US Census and American Community Survey contextual data, as well as the Zillow Home Value Index. We find that both homeowners and renters living in high-cost areas remain in place at higher rates compared with those living in mid-cost and low-cost areas. Among those who move, older adults living in high-cost regions move towards mid-cost and low-cost regions more often than the reverse. The differences are particularly pronounced for renters. The overall outcome is a net movement of older adults away from high-cost areas towards mid-cost and low-cost areas. These shifts have consequences for the well-being of older adults facing budget constraints that may limit the areas where they can afford to live or move, and broader implications for the future of urban areas. %B Innovation in Aging %V 3 %P S276 - S276 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840162/ %N Suppl 1 %! Innov Aging %0 Thesis %D 2019 %T Housing Dynamics of Older Americans in the 21st Century %A Murray, Tim %K Household asset allocation %K Housing %K Housing Adjustments %X The Life-Cycle Hypothesis suggests that households save during their working years and then draw down those savings in retirement. Housing equity constitutes a large portion of most retiree’s savings portfolios, yet older households are not using their accumulated housing equity to help increase consumption in retirement and often die with large sums of housing equity. This dissertation explores housing equity use by older Americas in three ways. Chapter 1 looks at homeownership and moving rates of older Americans and how having a guaranteed source of income from a defined benefit plan may have mitigated some of the effects of the Great Recession. Chapter 2 investigates how a potential increase in out-of-pocket medical spending for older households may cause them to engage in precautionary using their home. Chapter 3 concludes this dissertation by exploring how forgoing time and money spent on home maintenance allows older households to extract housing equity. %I University of Connecticut %G eng %U https://opencommons.uconn.edu/dissertations/2117/ %0 Report %D 2019 %T Housing Wealth, Bequests, and the Elderly %A Nadia Greenhalgh-Stanley %A C. Lockwood Reynolds %K Home equity %K intended bequests %K pre-cautionary savings %K Wealth Shocks %X There has been little consensus on why individuals do not spend down their wealth by death. Competing theories debate whether assets are bequeathed intentionally or are unplanned. Combining data on expectations of future bequests in the Health and Retirement Study with changes in housing wealth during the housing boom, we aim to estimate whether a plausibly exogenous wealth shock changes expected bequests. We find such wealth shocks lead to an increase in the expected likelihood of leaving a large bequest. However, we do not find complete pass through of the wealth increase, and find larger responses for individuals with lower baseline wealth, health and risk aversion. Combined with evidence of other responses, the results suggest roles for both planned and pre-cautionary savings bequest motivations. %B AEA Papers and Proceedings %I American Economic Association %C Pittsburgh, PA %G eng %0 Report %D 2019 %T How Best to Annuitize Defined Contribution Assets? %A Alicia H. Munnell %A Gal Wettstein %A Wenliang Hou %K Annuitization %K contribution %X Unlike defined benefit pensions that provide participants with steady benefits for as long as they live, 401(k) plans and Individual Retirement Accounts (IRAs) provide little guidance on how to turn accumulated assets into income. As a result, retirees have to decide how much to withdraw each year and face the risk of either spending too quickly and outliving their resources or spending too conservatively and consuming too little. Surveys of individuals’ plans and several recent studies suggest that people will not draw down their accumulations for fear that they will exhaust their money and be unable to cover end-of-life health care costs. They also must consider how to invest their savings after retirement. These are difficult decisions. Better strategies are possible that will ensure a higher level of lifetime income, reduce the likelihood that people will outlive their resources, and alleviate some of the anxiety associated with post-retirement investing. Workers could use a portion of their 401(k) and IRA assets to purchase an immediate annuity that pays a fixed amount throughout their lives, typically starting at age 65. Or they could purchase an advanced life deferred annuity (ALDA) that requires a smaller share of accumulated assets and begins payments at a later age like 85. Alternatively, they could use their assets to delay claiming Social Security – essentially purchasing an inflation-indexed annuity. Right now, none of these three options is commonly used. Very few workers choose to purchase immediate or deferred annuities (the first two options). And few retirees appear to be deferring claiming in order to receive the maximum annuity income from Social Security – most people simply retire earlier and claim immediately. Increasing annuitization in a meaningful way would require embedding annuities in 401(k) plans, with annuitization as the default. Recent proposed federal legislation, such as the SECURE Act (Setting Every Community Up for Retirement Enhancement), encourages plan sponsors to offer annuities in their plans by establishing a fiduciary safe harbor when specific statutory conditions are followed in selecting an insurance company. This legislation does not address, however, the question of defaults or the possibility of using 401(k) assets to purchase additional Social Security benefits. Moving forward on these fronts would require some consensus about the appropriate share of 401(k) assets to be annuitized and the best method for annuitizing them. To address these issues, this paper compares the level of lifetime utility generated by alternative annuitization approaches – immediate annuities, deferred annuities, and additional Social Security through delayed claiming. The analysis also tests different assumptions for the share of initial wealth that participants use to purchase these products. %B Center for Retirement Research at Boston College Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-best-to-annuitize-defined-contribution-assets/ %9 Report %0 Report %D 2019 %T How cognitive ability and financial literacy shape the demand for financial advice at older ages %A Hugh Hoikwang Kim %A Maurer, Raimond %A Olivia S. Mitchell %K Cognition & Reasoning %K Financial literacy %K Social Support %X We investigate how cognitive ability and financial literacy shape older Americans’ demand for financial advice using an experimental module in the 2016 Health and Retirement Study. We show that cognitive ability and financial literacy strongly improve the quality, but not the quantity, of financial advice sought. Most importantly, the financially literate and more cognitively able tend to seek financial help from professionals rather than family members, and they are less likely to accept so-called ‘free’ financial advice that may entail conflicts of interest. Nevertheless, those with higher cognitive function also tend to distrust financial advisors, leading them to eschew their services. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-20 %8 04/2019 %G eng %U http://www.nber.org/papers/w25750.pdf %R 10.3386/w25750 %0 Report %D 2019 %T How Do Older Workers Use Nontraditional Jobs? %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Abigail N. Walters %K nontraditional jobs %X Working consistently through one’s fifties and early sixties is key to attaining retirement security. However, workers also need access to retirement plans – so they can continue to accumulate resources – and health insurance – so they can avoid withdrawing assets in the event of a health shock. Workers without access to these benefits will likely struggle as they approach retirement, both financially and perhaps emotionally, as they deal with the stress of being unprepared. Yet, despite the fact that a large literature focuses on nontraditional jobs that often lack these benefits, it is unclear how older workers use these jobs and what the consequences are. If some older workers use nontraditional work for much of their late careers, then they likely will end up worse off. If, instead, older workers use nontraditional jobs only temporarily, then it is unlikely that their situation will substantially change. This paper uses the Health and Retirement Study to identify nontraditional jobs and relies on sequence analysis to explore how workers ages 50-62 use them. The results suggest that the majority of nontraditional jobs are used by workers consistently, and that fewer workers use these jobs briefly or as a bridge to retirement. In the end, workers consistently in nontraditional jobs end up with less retirement income than other workers and are more likely to be depressed, even controlling for their financial situation and depression prior to age 50. Given this situation, policymakers may want to consider ways to expand benefits to workers in these jobs to improve their well-being in retirement. %B Center for Retirement Research at Boston College %I Boston College %8 10/2019 %G eng %U https://crr.bc.edu/working-papers/how-do-older-workers-use-nontraditional-jobs/ %0 Journal Article %J EBRI Issue Brief %D 2019 %T How Do Retirees’ Spending Patterns Change Over Time? %A Zahra Ebrahimi %K spending patterns %X Using the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS), we examine spending behavior of older Americans for the 50–64, 65–74, and 75-or-older age groups between 2005 and 2017, biennially.  Average annual total spending is lower for households in older age groups compared with those in younger age groups.  Housing is the largest spending category for every age group, and in all survey years studied except 2017, the median share of households’ budgets allocated to housing expenses was smaller for older households.  On average, households spent less on food as they grew older, and the average dollar amount spent on workrelated expenses such as transportation and clothing declined by age.  The average amount spent on entertainment declined by age, and older households allocated a larger share of their budgets to gifts and contributions.  The share of health care costs in households’ budgets increased with age. However, the average annual share of health costs for the 65–74 and 75-or-older age groups declined after 2007, the year after Medicare Part D went into effect.  Across all age groups, for low-income households, a larger share of expenses was spent on housing and food compared with high-income households. This increased spending on necessities was offset by a reduction in the average share of spending on entertainment and gifts and contributions.  Median total income was lower for households in older age groups. In addition, they had higher median spending-to-income ratios than younger age groups.  The fraction of households who spent more than their income increased with age. However, the average amount overspent was lower for older age groups compared with younger age groups.  Median non-housing wealth increased with age but leveled off and even declined as households reached ages 75 or older. In addition, it was much lower for households with deficits — those who have spent more than their income — than for households without deficits. %B EBRI Issue Brief %G eng %U https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_492_spendovertime-3oct19.pdf?sfvrsn=9f503c2f_10 %N 492 %9 Journal %0 Report %D 2019 %T How Does Contingent Work Affect SSDI Benefits? %A Matthew S. Rutledge %A Alice Zulkarnain %A Sara Ellen King %K SSDI %K SSDI benefits %K Work %X Some studies have found that contingent workers – including independent contractors, consultants, and those in temporary, on-call, and “gig economy” jobs – make up an increasing share of the labor force. How does this group of workers interact with Social Security Disability Insurance (SSDI)? This project uses the Health and Retirement Study linked to administrative data on SSDI applications and earnings to answer this question. Specifically, the paper examines how SSDI application, receipt, potential benefits, and insurance status differ for workers who hold contingent arrangements in their 50s and early 60s, compared to those who work in more traditional jobs at those ages. This study is among the first to examine how contingent work is likely to affect participation in a public program, specifically disability benefits. The study finds that SSDI application rates are about one-quarter smaller for older eligible contingent workers than for traditional workers of the same ages. Contingent workers are also about one-third less likely to be awarded disability benefits. The lower application and award rates are likely due in part to contingent workers’ lower eligibility rates and lower potential benefits. The application and award rates are also lower for contingent workers who have a chronic condition, work limitation, or limitation in their Activities of Daily Living. These results suggest that contingent workers would benefit from a greater availability of information and assistance in navigating the SSDI application process. %I Center for Retirement Research at Boston College %8 02/2019 %G eng %U https://crr.bc.edu/working-papers/how-does-contingent-work-affect-ssdi-benefits/ %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2019 %T How Does Employment-Based Insurance Coverage Relate to Health After Early Retirement? %A Ben Lennox Kail %K Activities of Daily Living %K Age Factors %K Aged %K depression %K Employment %K Female %K Health Benefit Plans, Employee %K Humans %K Male %K Middle Aged %K Retirement %K United States %B J Gerontol B Psychol Sci Soc Sci %V 74 %P 1211-1212 %8 2019 Sep 15 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/17/geronb.gbw020.short %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26988867?dopt=Abstract %4 retirement planning/public policy/transitions/insurance Coverage/employee benefits %$ 999999 %R 10.1093/geronb/gbw020 %0 Journal Article %J Innovation in Aging %D 2019 %T How Does Subjective Age Get “Under the Skin”? The Association Between Biomarkers and Feeling Older or Younger Than One’s Age: The Health and Retirement Study %A Bharat Thyagarajan %A Shippee, Nathan %A Parsons, Helen %A Vivek, Sithara %A Eileen M. Crimmins %A Jessica Faul %A Shippee, Tetyana %K Age discrepancy score %K Biological domains %K Physiological aging %X Though subjective age is a well-recognized risk factor for several chronic diseases, the biological basis for these associations remains poorly understood.We used new comprehensive biomarker data from the 2016 wave of the nationally representative Health and Retirement Study (HRS) to evaluate the association between biomarker levels and self-reported subjective age in a subset of 3,740 HRS participants who provided a blood sample. We measured biomarkers in seven biological domains associated with aging: inflammation, glycemia, lipids, liver function, endocrine function, renal function, and cardiac function. The primary outcome was the age discrepancy score (subjective age − chronological age) categorized as those who felt younger, older, or the same as their chronological age (reference group). Analyses adjusted for comprehensive psychosocial factors (chronic stress index, depression score), demographic factors (race, sex, body mass index, marital status, physical activity), and prevalence of chronic health conditions (comorbidity index).The prevalence of clinically relevant reduced levels of albumin concentrations was lower in those who felt younger (8.8\% vs. 16.0\%; p = .006) and higher in those who felt older (20.4\% vs. 16.0\%; p = .03) when compared with the reference category. The prevalence of clinically significant elevation in liver enzymes such as alanine aminotransferase was also significantly lower among those who felt younger (7.1\% vs. 8.6\%; p = .04) when compared with the reference category. Prevalence of clinically elevated levels in cystatin C was also lower among those who felt younger when compared with the reference category (50.0\% vs. 59.1\%; p = .04). There was no association between lipids, glucose, or C-reactive protein (inflammatory marker) and subjective age categories.These results suggest that people who feel younger may have favorable biomarker profiles and as a result may have lower prevalence of age-related diseases when compared with those who feel older or those who feel the same as their chronological age. %B Innovation in Aging %V 3 %P igz035 %G eng %N 4 %R 10.1093/geroni/igz035 %0 Report %D 2019 %T How Reliant are Older Americans on State and Local Government Pensions? %A Philip Armour %A Michael D Hurd %A Susann Rohwedder %X State and local government pension plans cover about 19.5 million participants, and many participants are heavily reliant on these pensions for retirement income. Most of these plans, however, are underfunded. Based on data from the Health and Retirement Study, we examined the lifetime work histories of those observed at ages 67 to 72 in 2004, 2008, or 2014. Seventy-seven percent of single persons and 61 percent of couple households had never worked for state or local (S&L) government. Among those single and couple households who did work for S&L government, we found that they have on average more years of education and more economic resources. Among currently retired and near-retirement households, we compared economic preparation for retirement according to their lifetime employment in the S&L sector, and we examined how economic preparation would be affected if pension benefits were cut. Based on stochastic simulations, which account for uncertainty about length of life and out-of-pocket medical expenditures, we found that economic preparation for retirement among those with S&L government work histories would only be modestly reduced if their pension income were cut. Under a 50 percent cut to all pension income of households with any S&L sector work, only an additional three to four percent of these households would no longer be prepared for retirement. The change is modest because households with S&L employment have better preparation than other households; some of the cuts are paid for by reduced taxes; and the affected households will bequeath less. %B MRDRC Working Paper %G eng %U https://mrdrc.isr.umich.edu/pubs/how-reliant-are-older-americans-on-state-and-local-government-pensions/ %9 Report %0 Newspaper Article %B The Washington Post %D 2019 %T How these grandparents became America’s unofficial social safety net %A Van Dam, Andrew %B The Washington Post %C Washington, DC %G eng %U https://www.washingtonpost.com/us-policy/2019/03/23/how-these-grandparents-became-americas-unofficial-social-safety-net/?utm_term=.3cafc8231380 %0 Report %D 2019 %T How will retirement saving change by 2050? Prospects for the millennial generation %A William G. Gale %A Gelfond, Hilary %A Fichtner, Jason %K Future %K Millenials %K Public Policy %K Retirement Planning and Satisfaction %X In “How Will Retirement Saving Change by 2050? Prospects for the Millennial Generation” William G. Gale, Hilary Gelfond, and Jason Fichtner consider prospects for retirement saving for members of the millennial generation, who will be between ages 54 and 69 in 2050. Adequacy of retirement saving preparation among current and near-retirees is marked by significant heterogeneity, a characteristic that will likely hold for Millennials as well. In preparing for retirement, Millennials will have several advantages relative to previous generations, such as more education, longer working lives, and more flexible work arrangements, but also several disadvantages, including having to take more responsibility for their own retirement plans and marrying and bearing children at later ages. The millennial generation contains a significantly higher percentage of minorities than previous generations. The authors find that minority households have tended to accumulate less wealth than whites in the past, even after controlling for income, education, and marital status, and the difference appears to be growing over time for black households relative to whites. Whether these trends persist is central to understanding how the Millennials will fare in retirement. %B Brookings Working Paper Series %I Brookings Institution %C Washington, DC %P 1-51 %8 03/2019 %G eng %U https://www.brookings.edu/wp-content/uploads/2019/03/How-Will-Retirement-Saving-Change-by-2050.docx.pdf %9 Working Paper %0 Conference Proceedings %B American Sociological Association %D 2019 %T HRS at the American Sociological Association 2019 %A HRS Staff %B American Sociological Association %I Health and Retirement Study %C New York City %G eng %0 Conference Proceedings %B Population Association of America %D 2019 %T HRS Presentations at PAA by Date (2019) %A HRS Staff %B Population Association of America %I Health and Retirement Study, Survey Research Center, Institute for Social Research, University of Michigan %C Austin, TX %8 04/2019 %G eng %0 Conference Proceedings %B American Geriatrics Society %D 2019 %T HRS Presentations at the American Geriatrics Society 2019 %A HRS Staff %B American Geriatrics Society %I Health and Retirement Study, Survey Research Center, Institute for Social Research, University of Michigan %C Portland, OR %P 2 %8 04/2019 %G eng %0 Journal Article %J Medicine and Science in Sports and Exercise %D 2018 %T Handgrip Strength, Function, and Mortality in Older Adults: A Time-Varying Approach. %A Ryan P McGrath %A Brenda Vincent %A Lee, I-Min %A William J Kraemer %A Mark D Peterson %K Activities of Daily Living %K Mortality %K Physical Ability %K Physical measures %X

PURPOSE: To determine the time-varying associations between 1) decreased handgrip strength and disabilities in each activity of daily living (ADL) function, and 2) disaggregated ADL limitations and time to mortality in older adults.

METHODS: A United States nationally-representative sample of 17,747 older adults from the Health and Retirement Study were followed for eight-years. Maximal handgrip strength was measured with a hand-held dynamometer. Ability to perform ADLs were self-reported. Date of death was identified by the National Death Index and exit interviews. Separate covariate-adjusted hierarchical logit models were used to examine the time-varying associations between decreased handgrip strength and each ADL outcome. Distinct covariate-adjusted Cox models were used to analyze the time-varying associations between disaggregated ADL limitations and time to mortality.

RESULTS: Every five-kilogram decrease in handgrip strength was associated with increased odds for the following ADL limitations: 20% for eating, 14% for walking, 14% for bathing, 9% for dressing, 8% for transferring, and 6% for toileting. The presence of a bathing, walking, toileting, eating, and dressing ADL disability was associated with a 47%, 43%, 32%, 30%, and 19% higher hazard for mortality, respectively. A transferring ADL disability was not significantly associated with mortality.

CONCLUSIONS: Decreased handgrip strength was associated with increased odds for each ADL limitation, and in turn, most individual ADL impairments were associated with a higher hazard for mortality in older adults. These findings provide insights into the disabling process by identifying which ADL limitations are most impacted by decreased handgrip strength and the subsequent time to mortality for each ADL disability.

%B Medicine and Science in Sports and Exercise %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29933349?dopt=Abstract %R 10.1249/MSS.0000000000001683 %0 Web Page %D 2018 %T Happy Childhood Memories May Boost Physical and Mental Health in Later Life %A Aristos Georgiou %K Childhood %K Health Conditions and Status %K News %K Positivity %B Newsweek %I Newsweek %C New York City %V 2018 %G eng %U https://www.newsweek.com/happy-childhood-memories-may-boost-physical-and-mental-health-later-life-1201315 %0 Journal Article %J Journal of Medical Internet Research %D 2018 %T The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points %A Shim, Hyunju %A Jennifer A Ailshire %A Elizabeth Zelinski %A Eileen M. Crimmins %K Accessibility %K Health Behavior %K Internet usage %K Survey Methodology %X Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. %B Journal of Medical Internet Research %V 20 %P e200 %8 Jan-01-2018 %G eng %U http://www.jmir.org/2018/5/e200/ %N 5 %! J Med Internet Res %R 10.2196/jmir.8203 %0 Conference Proceedings %B Allied Social Science Associations Meeting 2019 %D 2018 %T Health and Retirement Study Presentations at AEA/ASSA 2019 %A HRS Staff %B Allied Social Science Associations Meeting 2019 %I Health and Retirement Study %C Atlanta, GA %G eng %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2018 %T Health benefits associated with three helping behaviors: Evidence for incident cardiovascular disease. %A Jeffrey A Burr %A Sae Hwang Han %A Lee, Hyo Jung %A Jane Tavares %A Jan E Mutchler %K Caregiving %K Heart disease %K Mortality %K Volunteerism %X

Objective: The purpose of this study was to investigate the association between three helping behaviors and incident cardiovascular disease (CVD; heart attack, stroke; fatal and nonfatal), with an exploration of gender differences. The study is framed within the caregiving system model. Helping others is argued to be an evolved characteristic of humans that yields beneficial health effects.

Methods: Data were taken from the 2004-2014 waves of the Health and Retirement Study. The three forms of helping others considered were formal volunteering, informal helping, and caregiving for a parent or spouse. Cox proportional hazards models were estimated for gender-stratified samples.

Results: Women who volunteered showed a lower risk of incident CVD compared to women who did not volunteer. Men who informally helped others in the community exhibited a lower risk of incident CVD compared to men who did not provide this form of help. Caregiving status was generally not associated with incident CVD for women or men.

Discussion: The results demonstrated that specific types of prosocial behavior may be beneficial for women and men. However, tests for effect differences showed that gender did not moderate the relationships between these helping behaviors and CVD risk.

%B Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %V 73 %P 492-500 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28637329?dopt=Abstract %R 10.1093/geronb/gbx082 %0 Journal Article %J Journal of General Internal Medicine %D 2018 %T Health Equity and Hospital Readmissions: Does Inclusion of Patient Functional and Social Complexity Improve Predictiveness? %A Geoffrey J Hoffman %A Hsuan, Charleen %A Thomas M Braun %A Ninez Ponce %K Age differences %K Gender Differences %K Health Disparities %K Hospitalization %X Medicare’s Hospital Readmissions Reduction Program (HRRP) was intended to encourage hospitals to improve care for older adults. However, the program has raised health equity concerns because its risk-adjustment model does not account for patient social complexity; the concern is that HRRP may aggravate healthcare disparities by penalizing financially challenged hospitals and reducing their resources to improve care.1 While the HRRP assesses hospitals for penalties based upon readmission performance that is adjusted for patient age, sex, and clinical severity of illness, it does not account for functional and social patient factors. %B Journal of General Internal Medicine %V 34 %P 26-28 %G eng %N 1 %R 10.1007/s11606-018-4635-z %0 Journal Article %J Health Services Research %D 2018 %T Health insurance and poverty in trajectories of out-of-pocket expenditure among low-income middle-aged adults %A Kwon, Eunsun %A So Jung Park %A Timothy D McBride %K Medicare/Medicaid/Health Insurance %K Out-of-pocket payments %X Objective To assess the effects of longitudinal patterns of health insurance and poverty on out‐of‐pocket expenditures among low‐income late middle‐aged adults. Data Sources/Study Setting Six waves (2002–2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used. Study Design A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on out‐of‐pocket expenditures. Principal Findings At baseline, individuals with private insurance or unstable coverage were more likely to have out‐of‐pocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher out‐of‐pocket expenditures; private coverage holders had higher odds of financial burden. Conclusions Unstable insurance coverage had a discernible effect on the long‐term, out‐of‐pocket expenditures among low‐income adults. Findings have an important policy implication to protect poor late middle‐aged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage. %B Health Services Research %V 53 %P 4332-4352 %G eng %N 6 %! Health Serv Res %R 10.1111/hesr.2018.53.issue-610.1111/1475-6773.12974 %0 Journal Article %J Health Services Research %D 2018 %T Health Insurance and Poverty in Trajectories of Out-of-Pocket Expenditure among Low-Income Middle-Aged Adults. %A Kwon, Eunsun %A So Jung Park %A Timothy D McBride %K Low income %K Medicare/Medicaid/Health Insurance %K Out-of-pocket payments %X

OBJECTIVE: To assess the effects of longitudinal patterns of health insurance and poverty on out-of-pocket expenditures among low-income late middle-aged adults.

DATA SOURCES/STUDY SETTING: Six waves (2002-2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used.

STUDY DESIGN: A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on out-of-pocket expenditures.

PRINCIPAL FINDINGS: At baseline, individuals with private insurance or unstable coverage were more likely to have out-of-pocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher out-of-pocket expenditures; private coverage holders had higher odds of financial burden.

CONCLUSIONS: Unstable insurance coverage had a discernible effect on the long-term, out-of-pocket expenditures among low-income adults. Findings have an important policy implication to protect poor late middle-aged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage.

%B Health Services Research %V 53 %P 4332-4352 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29770438?dopt=Abstract %R 10.1111/1475-6773.12974 %0 Journal Article %J J Appl Gerontol %D 2018 %T Health Shocks and Initiation of Use of Preventive Services Among Older Adults. %A Ng, Boon Peng %A Gail A Jensen %K Aged %K Cholesterol %K Early Detection of Cancer %K Female %K Health Status %K Health Surveys %K Humans %K Influenza, Human %K Male %K Mammography %K Middle Aged %K Papanicolaou Test %K Prostatic Neoplasms %K Vaccination %K Vaginal Smears %X

This article examines whether adverse changes to health or functioning serve as an impetus to begin using preventive services among older individuals with a history of non-use. Using data from the 1998-2008 Health and Retirement Study, the use of mammograms, pap smears, prostate cancer screenings, cholesterol checks, and flu shots is examined among 2,975 self-reported non-users of such services. Older women who experience a health shock are 1.86, 1.50, 1.79, and 1.46 times more likely to begin getting mammograms, pap smears, cholesterol checks, and flu shots, respectively. Older men who experience a health shock are 2.24, 2.72, and 1.64 times more likely to begin getting prostate cancer screenings, cholesterol checks, and flu shots, respectively. All of these results are statistically significant. Thus, older adults often improve their health behaviors after experiencing an adverse health event.

%B J Appl Gerontol %V 37 %P 856-880 %8 2018 07 %G eng %U http://jag.sagepub.com/cgi/doi/10.1177/0733464816657474 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27449258?dopt=Abstract %! Journal of Applied Gerontology %R 10.1177/0733464816657474 %0 Journal Article %J Journal of Family and Economic Issues %D 2018 %T Health Trajectories of Older Americans and Medical Expenses: Evidence from the Health and Retirement Study Data Over the 18 Year Period %A Shin, Serah %A Hyungsoo Kim %K Chronic conditions %K Health Trajectories %K Medicare expenditures %K Medicare linkage %X This study investigates the long-term relationship between individuals’ health state changes over time and burdens due to out-of-pocket medical expenses (OOP) in later years. We kept track of 5540 individuals’ health trajectories and their accumulated OOP using the HRS data from 1992 to 2010. American adults between 50 and 70 years old spend on average $27,000 on OOP, and have five common health trajectory patterns (Multi-Morbidity, Co-Morbidity, Mild Disease, Late Event, and No Disease). However, their OOPs differed substantially depending on the pattern of health trajectory. The most costly pattern of Multi-Morbidity needed $18,823 more than the least costly No Disease pattern. Older adults with the most costly pattern spent most of OOP on either prescription drugs or doctor/dental visits. Additionally, we found that the OOP burden of prescription medications was substantially relieved by the Medicare Part D implementation. These findings have several important implications for individuals, financial educators, and policy makers. %B Journal of Family and Economic Issues %V 39 %P 19-33 %8 03/2018 %G eng %U http://link.springer.com/10.1007/s10834-017-9542-7http://link.springer.com/content/pdf/10.1007/s10834-017-9542-7.pdfhttp://link.springer.com/content/pdf/10.1007/s10834-017-9542-7.pdfhttp://link.springer.com/article/10.1007/s10834-017-9542-7/fulltext.html %N 1 %! J Fam Econ Iss %R 10.1007/s10834-017-9542-7 %0 Journal Article %J Am Journal of Health Behavior %D 2018 %T Healthcare satisfaction among older adults. %A Hui-Peng Liew %K Finances %K Healthcare %K Medicare/Medicaid/Health Insurance %K Nursing homes %X

OBJECTIVE: This study seeks to examine how older adults rate and identify the importance of attributes associated with healthcare seeking and utilization (eg, affordability, type of facility, and accessibility) in the United States.

METHODS: The empirical work of this cross-sectional study is based on the 2014 Health and Retirement Study. Conjoint analysis and cluster analysis are used to assess the objective.

RESULTS: There is a pressing need for sound policies that seek to reduce the cost of treatment and consultation and to improve the accessibility of care facility for older adults even though satisfaction pertaining to these attributes (ie, affordability, type of facility, and accessibility) differs across clusters.

CONCLUSION: The use of conjoint analysis in conjunction with cluster analysis can serve as a needs assessment tool to help policymakers and practitio- ners gauge older adults' expectations and priorities with respect to healthcare seeking and utilization. By taking the priorities of older adults into account, policymakers and practitioners can allocate healthcare resources more efficiently within budgetary constraints as they redesign and customize their program delivery approaches to meet the specific and relative healthcare needs of older adults in different clusters.

%B Am Journal of Health Behavior %V 42 %P 99-108 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29320343?dopt=Abstract %R 10.5993/AJHB.42.1.10 %0 Journal Article %J Research on Aging %D 2018 %T Healthy aging after age 65: A life-span health production function approach. %A Nasim B Ferdows %A Gail A Jensen %A Wassim Tarraf %K Health Behavior %K Lifecycles %X This article examines the determinants of healthy aging using Grossman's framework of a health production function. Healthy aging, sometimes described as successful aging, is produced using a variety of inputs, determined in early life, young adulthood, midlife, and later life. A healthy aging production function is estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study on 7,355 noninstitutionalized seniors. Using a simultaneous equation mediation model, we quantify how childhood factors contribute to healthy aging, both directly and indirectly through their effects on mediating adult outcomes. We find that favorable childhood conditions significantly improve healthy aging scores, both directly and indirectly, mediated through education, income, and wealth. We also find that good health habits have positive effects on healthy aging that are larger in magnitude than the effects of childhood factors. Our findings suggest that exercising, maintaining proper weight, and not smoking are likely to translate into healthier aging. %B Research on Aging %V 40 %P 480-507 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28610549?dopt=Abstract %R 10.1177/0164027517713312 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2018 %T Healthy Aging Among Older Black and White Men: What Is the Role of Mastery? %A Kenzie Latham-Mintus %A Ashley Vowels %A Huskins, Kyle %K Health Conditions and Status %K Men's health %K Racial/ethnic differences %X

Objectives: This research explores black-white differences in healthy aging and investigates whether mastery acts as a buffer against poor health for older black and white men.

Methods: Using data from the Health and Retirement Study (HRS) (2008-2012), a series of binary logit models were created to assess healthy aging over a 2-year period. Healthy aging was defined as good subjective health and free of disability at both waves. Mastery was lagged, and analyses (n = 4,892) controlled for social and health factors.

Results: Black-white disparities in healthy aging were observed, where older black men had lower odds of healthy aging. Mastery was associated with higher odds of healthy aging, and race moderated the relationship between mastery and healthy aging. The predicted probability of healthy aging was relatively flat across all levels of mastery among black men, yet white men saw consistent gains in the probability of healthy aging with higher levels of mastery. In race-stratified models, mastery was not a significant predictor of healthy aging among black men.

Discussion: High levels of mastery are linked to positive health-often acting as a buffer against stressful life events. However, among older black men, higher levels of mastery did not necessarily equate to healthy aging.

%B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 73 %P 248-257 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28977575?dopt=Abstract %R 10.1093/geronb/gbx105 %0 Newspaper Article %B Chicago Tribune %D 2018 %T Healthy resolutions for the year ahead %K News %K Optimism %K Reading %B Chicago Tribune %C Chicago, IL %P 1 %8 01/04/2018 %G eng %U http://www.chicagotribune.com/suburbs/advertising/newyearnewyou/ct-ss-nyny-healthy-resolutions-for-the-year-ahead-20180103dto-story.html %9 Advertorial %& New Year, New You %0 Report %D 2018 %T Heterogeneity in expectations, risk tolerance, and household stock shares: The attenuation puzzle %A Ameriks, John %A Kezdi, Gabor %A Lee, Minjoon %A Matthew D. Shapiro %K household portfolio choice %K Risk preference %K Subjective stock returns distribution %K Survey measurement %X This paper jointly estimates the relationship between stock share and expectations and risk preferences. The survey allows individual-level, quantitative estimates of risk tolerance and of the perceived mean and variance of stock returns. These estimates have economically and statistically significant association for the distribution of stock shares with relative magnitudes in proportion with the predictions of theories. Incorporating survey measurement error in the estimation model increases the estimated associations twofold, but they are still substantially attenuated being only about 5 percent of what benchmark finance theories predict. Because of the careful attention in the estimation to measurement error, the attenuation likely arises from economic behavior rather than errors in variables. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w25269 %0 Journal Article %J Journal of Aging and Health %D 2018 %T Heterogeneous trajectories of depressive symptoms in late middle age: Critical period, accumulation, and social mobility life course perspectives. %A Kwon, Eunsun %A BoRin Kim %A Lee, Hyunjoo %A So Jung Park %K Depressive symptoms %K Life trajectories %K Socioeconomic factors %X

OBJECTIVE: This study investigated patterns of depressive symptoms and whether socioeconomic status (SES) across the life course affects these trajectories using the critical period, accumulation, and social mobility models.

METHOD: This study uses data from 8,532 adults, age 51 to 64, collected over 12 years from the Health and Retirement Study (observations = 25,887). A latent class analysis was performed to examine distinct depressive symptom trajectories; life course models were studied with multinomial logistic regression.

RESULTS: Four heterogeneous latent classes were identified for depression: Declining, Low, Increasing, and High and Increasing. The High and Increasing group was associated with a disadvantaged childhood SES, accumulated exposure to socioeconomic risks, and persistent SES disadvantage supporting the three life course models.

DISCUSSION: There was evidence of distinct profiles of depressive symptoms in late middle age and of interrelated life course mechanisms underlying the influences of childhood SES on later life depression.

%B Journal of Aging and Health %V 30 %P 1011-1041 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/28553816?dopt=Abstract %R 10.1177/0898264317704540 %0 Journal Article %J Experimental Gerontology %D 2018 %T Hidden heterogeneity in Alzheimer's disease: Insights from genetic association studies and other analyses %A Anatoliy Yashin %A Fang, Fang %A Kovtun, Mikhail %A Wu, Deqing %A Duan, Matt %A Konstantin G Arbeev %A Akushevich, Igor %A Alexander M Kulminski %A Culminskaya, Irina %A Zhbannikov, Ilya %A Arseniy P Yashkin %A Stallard, Eric %A Svetlana Ukraintseva %K Alzheimer's disease %K Cancer screenings %K Genetics %K GWAS %X Despite evident success in clarifying many important features of Alzheimer's disease (AD) the efficient methods of its prevention and treatment are not yet available. The reasons are likely to be the fact that AD is a multifactorial and heterogeneous health disorder with multiple alternative pathways of disease development and progression. The availability of genetic data on individuals participated in longitudinal studies of aging health and longevity, as well as on participants of cross-sectional case-control studies allow for investigating genetic and non-genetic connections with AD and to link the results of these analyses with research findings obtained in clinical, experimental, and molecular biological studies of this health disorder. The objective of this paper is to perform GWAS of AD in several study populations and investigate possible roles of detected genetic factors in developing AD hallmarks and in other health disorders. The data collected in the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), Health and Retirement Study (HRS) and Late Onset Alzheimer's Disease Family Study (LOADFS) were used in these analyses. The logistic regression and Cox's regression were used as statistical models in GWAS. The results of analyses confirmed strong associations of genetic variants from well-known genes APOE, TOMM40, PVRL2 (NECTIN2), and APOC1 with AD. Possible roles of these genes in pathological mechanisms resulting in development of hallmarks of AD are described. Many genes whose connection with AD was detected in other studies showed nominally significant associations with this health disorder in our study. The evidence on genetic connections between AD and vulnerability to infection, as well as between AD and other health disorders, such as cancer and type 2 diabetes, were investigated. The progress in uncovering hidden heterogeneity in AD would be substantially facilitated if common mechanisms involved in development of AD, its hallmarks, and AD related chronic conditions were investigated in their mutual connection. %B Experimental Gerontology %V 107 %P 148-160 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0531556517304242 %! Experimental Gerontology %R 10.1016/j.exger.2017.10.020 %0 Report %D 2018 %T The Hidden Risk of Retirement: The Impact of Retirement on Mental Health %A Christopher Crouch %K Mental and Physical Health %K Mental Disorders %K Mental Health %K Retirement %X Early retirement is a popular goal for many Americans but little research has been conducted to investigate the impact of this decision. This paper estimates the effects of retirement on several mental health outcomes using an ordered-probit model. Results suggest that retirement is negatively related to mental health in four of the tested categories: cognitive skills, mental status, memory, and Alzheimer’s symptoms. This implies that early retirement may have hidden costs and that working longer may help to preserve mental health. %I SSRN %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3254547 %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T High Burden of Palliative Care Needs of Older Adults During Emergency Major Abdominal Surgery %A Cooper, Zara %A Elizabeth J Lilley %A Bollens-Lund, Evan %A Susan L Mitchell %A Christine S Ritchie %A Stuart R Lipsitz %A Amy Kelley %K Medicare %K Mortality %K Palliative care %K Surgery %X Objectives: To quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. Design: Retrospective study using data from Health and Retirement Study interviews linked to Medicare claims (2000–2012). Setting: National population-based dataset. Participants: Medicare beneficiaries who underwent EMAS. Measurements: High illness burden, defined as ≥2 of the following vulnerabilities: functional dependence, dementia, use of helpers, multimorbidity, poor prognosis, high healthcare utilization. In-hospital outcomes were complications and mortality. Postdischarge outcomes included emergency department (ED) visits, hospitalization, intensive care unit (ICU) stay, and 365-day mortality. For individuals discharged alive who died within 365 days of surgery, outcomes included hospice use, hospitalization, ICU use, and ED use in the last 30 days of life. Multivariable regression was used to determine the association between illness burden and outcomes. Results: Of 411 participants, 57% had high illness burden. More individuals with high illness burden had complications (45% vs 28% p=0.00) and in-hospital death (20% vs 9%, p=0.00) than those without. After discharge (n=349), individuals with high illness burden experienced more ED visits (57% vs 46%, P=.04) and were more likely to die (35% vs 13%, p=0.00). Of those who died after discharge (n=86), 75% had high illness burden, median survival was 67 days (range 21–141 days), 48% enrolled in hospice, 32% died in the hospital, 23% were in the ICU in the last 30 days of life and 37% had an ED visit in the last 30 days of life. Conclusion: Most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life. Concurrent surgical and palliative care may improve quality of life and end-of-life care in these people. © 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society %B Journal of the American Geriatrics Society %8 Dec-09-2019 %G eng %U http://doi.wiley.com/10.1111/jgs.15516http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15516/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15516 %! J Am Geriatr Soc %R 10.1111/jgs.15516 %0 Thesis %B Sociology %D 2018 %T Household Economies in the Context of Financialization and Population Aging %A Grigoryeva, Angelina %K Aging %K Economy %K Household Economies %X This three-study dissertation examines how financialization of the U.S. economy and population aging have reshaped the economic lives of American households and the implications for their well-being and inequality at large, with the focus on both between- and within-household differences. First, I draw on data from the Survey of Consumer Finances to examine varieties of household engagement with finance and its association with wealth in the 1980s, when financialization of the U.S. economy just started, and the late 2000s, when it was at a peak. Latent class analysis shows that in both periods, a wide range of financial practices and attitudes cohere to form distinctive configurations of investing, borrowing, and money management. Furthermore, the structure of household engagement with finance became more differentiated in the course of financialization, and the distribution of various forms of engagement with finance changed as well. Finally, engagement with finance exhibits independent associations with household wealth accumulation and wealth mobility in both periods, even after controlling for a wide range of sociodemographic attributes. Second, I propose and test a novel explanation for individual variation in financial risk-taking that operates at the organizational level. Specifically, I identify company compensation structures as an important predictor of employees’ financial risk-taking. Drawing on data from a survey of employees in fourteen American companies, I show that employees’ financial risk-taking indeed varies by company compensation structures, even after controlling for standard explanations, and the direction of association differs for different compensation plans and by attitudinal vs. behavioral risk-taking. Third, I shift the focus from economic inequality between families to gender inequality within families. Specifically, I focus on the gender division of elder care among adult children as an increasingly important component of unpaid family labor in the context of the aging of the U.S. population. Using the Health and Retirement Study, a nationally representative survey of elderly Americans, I show that caregiving to elderly parents varies not only by an adult child’s own gender, but also by the gender of the siblings with whom caregiving is shared and by the gender of the parent to whom care is provided. %B Sociology %I Princeton University %C Princeton, NJ %V PhD %P 219 %8 01/2018 %G eng %U https://dataspace.princeton.edu/jspui/handle/88435/dsp018910jx25b?mode=simple %0 Report %D 2018 %T Household Time Use Among Older Couples: Evidence and Implications for Labor Supply Parameters %A Rogerson, Richard %A Wallenius, Johanna %K Couples %K Employment and Labor Force %K Retirement Planning and Satisfaction %K Transitions %X Using the Consumption Activities Mail Survey (CAMS) module in the HRS we document how time allocations change for individuals within a household when one or more members transitions from full time work to not working. Our basic finding is that the ratio of home production to leisure time is approximately constant for both family members. We then build a model of household labor supply to understand the implications of this finding for preferences and the home production function. We conclude that this fact suggests a relatively large elasticity of substitution between the leisure of the two members. For commonly used preference specifications, this also implies a large (i.e., greater than one) intertemporal elasticity of substitution for leisure. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 01/2018 %G eng %U http://www.nber.org/papers/w24263.pdf %R 10.3386/w24263 %0 Journal Article %J Journal of Family and Economic Issues %D 2018 %T How Are Money Worries Affecting Middle-Aged, Young-Old, and Old–Old People’s Perceived Couple Relationship? %A Park, Woochul %K Age differences %K Anxiety %K Couples %K Depressive symptoms %K Financial security %K Gender Differences %X While the association between financial strain and couple interaction has been well-established in the literature on economic stress, little research has investigated the association among middle-aged and older populations. The present study examined the relationships between financial strain and couple functioning of middle-aged, young-old, and old–old people using the 2010 Health and Retirement Study. Findings show that subjective financial strain was positively associated with partner undermining and negatively with partner support, controlling for the effects of objective financial situations among middle-aged, young-old, and old–old couples. There were gender and age differences in the interaction effects of financial strain and financial control on couple functioning. For middle-aged men, financial control may have different associations with couple behaviors depending on the level of financial strain. When the level of financial strain is high, the positive effect of financial control disappears and the effect changes even in a negative way. Findings provide suggestions for practitioners and researchers. %B Journal of Family and Economic Issues %V 39 %P 34-48 %8 03/2018 %G eng %U http://link.springer.com/10.1007/s10834-017-9547-2http://link.springer.com/content/pdf/10.1007/s10834-017-9547-2.pdfhttp://link.springer.com/content/pdf/10.1007/s10834-017-9547-2.pdfhttp://link.springer.com/article/10.1007/s10834-017-9547-2/fulltext.html %N 1 %! J Fam Econ Iss %R 10.1007/s10834-017-9547-2 %0 Journal Article %J Journal of Population Ageing %D 2018 %T How Does Self-Rated Health Differ among Older Vietnamese Men and Women? %A Le, Dung Duc %A Quashie, Nekehia T. %A Prachuabmoh, Vipan %K Aging %K Gender Differences %K Health Conditions and Status %X Due to gender differences in life expectancy, women outlive their male counterparts but experience more years of poor health. Whereas the correlates of gender differences in later life health have been examined in Western countries there is a limited but growing body of research among older adults in developing countries. Utilizing data from the 2011 Vietnam National Aging Study, this study examines gender differentials in self-rated health among Vietnamese aged 60 years and over (N = 2467) within the differential exposure and differential vulnerability frameworks. Logistic regression analyses show women had higher odds of reporting poor health but this differential was significantly reduced after adjusting for socio-demographic factors. Differential exposure to socio-economic resources did not explain the gender gap in perceived health status. After controlling for health behaviors, physical and mental health conditions, the gender differential was reversed with women showing lower odds of reporting poor health than similar men. Gender specific associations were evidenced by social participation, educational attainment, and employment status, which were protective for women’s health but unrelated to men’s. Older Vietnamese men and women show many similarities in the correlates of self-rated health. Comorbidity of chronic conditions, functional limitations, symptoms of psychological distress, and living in the Central region of Viet Nam were positively associated with poor self-rated health for men and women. The findings provide insight for gender sensitive social policies and investments in health systems to address the changing health profile of the Vietnamese population. %B Journal of Population Ageing %8 Jun-04-2020 %G eng %U http://link.springer.com/10.1007/s12062-018-9223-9http://link.springer.com/content/pdf/10.1007/s12062-018-9223-9.pdfhttp://link.springer.com/content/pdf/10.1007/s12062-018-9223-9.pdfhttp://link.springer.com/article/10.1007/s12062-018-9223-9/fulltext.html %! Population Ageing %R 10.1007/s12062-018-9223-9 %0 Web Page %D 2018 %T How Much Do Retirees Really Depend on Social Security? Far Less Than You'd Think. %A Andrew G. Biggs %K News %K Op-ed %K Social Security %B #RetireWell %I Forbes %C New York City %V 2018 %G eng %U https://www.forbes.com/sites/andrewbiggs/2018/03/28/how-much-do-retirees-really-depend-on-social-security-far-less-than-youd-think/#30119e51152c %0 Report %D 2018 %T How much income do retirees actually have? Evaluating the evidence from five national datasets. %A Anqi Chen %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %K Finances %K Income %K Retirement Planning and Satisfaction %X Recent research by Bee and Mitchell (2017) has refocused attention on the fact that the Current Population Survey (CPS) underestimates retirement income. In the wake of this study, some observers have questioned whether other surveys more frequently used by retirement researchers also understate retirement income and, if so, whether prior research suggesting that many households are unprepared for retirement is accurate. This paper addresses both questions by examining retirement income data from the CPS and four other surveys: 1) the Survey of Consumer Finances (SCF); 2) the Health and Retirement Study (HRS); 3) the Panel Survey of Income Dynamics (PSID); and 4) the Survey of Income and Program Participation (SIPP). The paper compares the income measures from each survey to administrative data from tax and Social Security records, both in aggregate and across the income distribution. It then uses a common measure of retirement income adequacy, the replacement rate, to assess overall household preparedness for retirement. %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %8 11/2018 %G eng %U http://crr.bc.edu/wp-content/uploads/2018/11/wp_2018-14__.pdf %0 Report %D 2018 %T How Secure Is Employment at Older Ages? %A Richard W. Johnson %A Gosselin, Peter %K Ageism %K Discrimination %K Employment and Labor Force %K Retirement Planning and Satisfaction %X Tracking older adults in the Health and Retirement Study from 1992 to 2016, we find that about one-half of full-time, full-year workers ages 51 to 54 experience an employer-related involuntary job separation after age 50 that substantially reduces earnings for years or leads to long-term unemployment. The steady earnings that many people count on in their 50s and 60s to build their retirement savings and ensure some financial security in later life often vanishes, upending retirement expectations and creating economic hardship. This problem will likely intensify as more people realize they must work longer to enjoy a comfortable retirement. %B Research Report %I Urban Institute %C Washington, DC %P 1-30 %8 12/2018 %G eng %U https://www.urban.org/research/publication/how-secure-employment-older-ages %0 Newspaper Article %B ProPublica %D 2018 %T How We Measured Involuntary Job Losses Among Older Workers %A Gosselin, Peter %K Ageism %K Employment and Labor Force %K Retirement Planning and Satisfaction %K Survey Methodology %B ProPublica %C New York City %G eng %U https://www.propublica.org/article/how-we-measured-involuntary-job-losses-among-older-workers %0 Conference Proceedings %B Association for Public Policy Analysis & Management %D 2018 %T HRS Exhibits at APPAM 2018 %A HRS Staff %B Association for Public Policy Analysis & Management %I Health and Retirement Study, Survey Research Center, Institute for Social Research, University of Michigan %C Washington, DC %G eng %0 Conference Proceedings %B Gerontological Society of America Annual Meeting %D 2018 %T HRS Presentations at GSA 2018 %A HRS Staff %B Gerontological Society of America Annual Meeting %I Health and Retirement Study, Survey Research Center, Institute for Social Research, University of Michigan %C Boston, MA %P 1-14 %8 11/2018 %G eng %0 Journal Article %J BMC Public Health %D 2018 %T Human-animal interaction as a social determinant of health: Descriptive findings from the Health and Retirement study %A Megan K Mueller %A Nancy R Gee %A Regina M. Bures %K Depressive symptoms %K Pets %K Social Support %X Background: We focused on human-animal interaction (HAI) as an important aspect of social functioning at the individual level, framing this emerging field from a public health perspective. Methods: Using data from the Health and Retirement Study (HRS) 2012 HAI module, we describe the characteristics of pet ownership in a population of older adults, and examine the relation between pet ownership and multiple mental and physical health indicators such as health status, depression, and physical activity. Results: Of the 1657 participants in our subsample, approximately half (51.5%) reported being pet owners; the majority owned dogs or cats, and most had only one pet. Pet ownership was significantly associated with a higher likelihood of ever having had depression, with pet owners being 1.89 times more likely to have experienced depression. However, pet ownership was not associated with having experienced depression within the last week. Conclusions: The findings from this study could indicate a relationship between pet ownership and depression, but it is impossible to determine the directionality of that relationship. It is possible that owning a pet may put a person at an increased risk of developing depression, or individuals who are at risk, or who have already developed depression, may acquire a pet as a way of managing their depressive symptoms. The findings of this study provide an initial step in contributing to our understanding of the relationship between companion animals and the social, physical, and mental well-being of the HRS study population. Future research should include measures of HAI in longitudinal, population-based surveys. %B BMC Public Health %V 18 %P 305 %G eng %U https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5188-0http://link.springer.com/content/pdf/10.1186/s12889-018-5188-0.pdf %N 1 %! BMC Public Health %R 10.1186/s12889-018-5188-0 %0 Web Page %D 2017 %T Harvard researchers say this mental shift will help you live a longer, healthier life %A Zameena Mejia %K Depressive symptoms %K News %K Optimism %K Purpose in life %K Retirement Planning and Satisfaction %B CNBC %I CNBC %C Englewood Cliffs, NJ %G eng %U https://www.cnbc.com/2017/11/21/harvard-researchers-say-a-purpose-leads-to-longer-healthier-life.html %0 Book %B Encyclopedia of Geropsychology %D 2017 %T Health and Retirement Study: A Longitudinal Data Resource for Psychologists %A Amanda Sonnega %A Jacqui Smith %E Pachana, Nancy A. %K Psychosocial %K Retirement Planning and Satisfaction %K Well-being %X This encyclopedia brings together key established and emerging research findings in geropsychology. It is a comprehensive coverage of the entire breadth of the field, giving readers access to all major subareas and illustrating their interconnections with other disciplines. Entries delve deep into key areas of geropsychology such as perception, cognition, clinical, organizational, health, social, experimental and neuropsychology. In addition to that, the encyclopedia covers related disciplines such as neuroscience, social science, population health, public policy issues pertaining to retirement, epidemiology and demography and medicine. Paying careful attention to research internationally, it cites English and non-English empirical literature from around the globe. This encyclopedia is relevant to a wide audience that include researchers, clinicians, students, policy makers and nongovernmental agencies. %B Encyclopedia of Geropsychology %I Springer Singapore %C Singapore %@ 978-981-287-083-4 %G eng %U http://link.springer.com/10.1007/978-981-287-080-3http://link.springer.com/content/pdf/10.1007/978-981-287-080-3http://link.springer.com/10.1007/978-981-287-080-3_39-1http://link.springer.com/content/pdf/10.1007/978-981-287-080-3_39-1 %R 10.1007/978-981-287-080-310.1007/978-981-287-080-3_39-1 %0 Report %D 2017 %T Health, Health Insurance, and Retirement: A Survey %A Eric French %A John Bailey Jones %K Disabilities %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Older Adults %K Retirement Planning and Satisfaction %X The degree to which retirement decisions are driven by health is a key concern for both academics and policymakers. In this paper we survey the economic literature on the health-retirement link in developed countries. We describe the mechanisms through which health affects labor supply and discuss how they interact with public pensions and public health insurance. The historical evidence suggests that health is not the primary source of variation in retirement across countries and over time. Furthermore, declining health with age can only explain a small share of the decline in employment near retirement age. Health considerations nonetheless play an important role, especially in explaining cross-sectional variation in employment and other outcomes within countries. We review the mechanisms through which health affects retirement and discuss recent empirical analyses. %B Working Paper Series %I Federal Reserve Bank of Richmond %C Richmond, Virginia %8 01/2017 %G eng %U https://www.richmondfed.org/-/media/richmondfedorg/publications/research/working_papers/2017/pdf/wp17-03.pdf %0 Report %D 2017 %T Health, Longevity, and Welfare Inequality of the Elderly %A Ray Miller %A Bairoliya, Neha %K health %K Inequality %K Longevity %K Welfare %X  We propose a framework to understand the distribution of individual wellbeingand its change over time with an application to the U.S. elderly population.Using data from the Health and Retirement Study, we estimate life-cycle dynamicsand simulate individual outcome paths starting from age sixty. We use anexpected utility framework and the simulated profiles to construct a measure ofindividual welfare that incorporates differences in consumption, leisure, health,and mortality. Our measure suggests substantial variation in welfare across individualsdriven foremost by gaps in health and mortality followed by gaps inconsumption. Incorporating the utility cost of living with poor health into elderlywelfare substantially increases overall inequality. Elderly welfare inequality hasincreased over time due to growing gaps in consumption, health, and mortality.Disparity measures based on cross-sectional income or consumption at age sixtyunderestimate aggregate welfare inequality. Moreover, health at age sixty is abetter indicator of individual well-being rank than income or consumption.  %G eng %U https://scholar.harvard.edu/nbairoliya/publications/pp1-margin-00px-00px-00px-00px-font-205px-helvetica-spans1-font-145px %0 Journal Article %J Health Affairs %D 2017 %T Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age %A Choi, Hwajung %A Robert F. Schoeni %K Retirement Planning and Satisfaction %K Social Security %K Working Longer %X To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49–60, based on multiple measures of morbidity, than cohorts who could retire earlier. %B Health Affairs %V 36 %P 1815 - 1819 %8 Jan-10-2017 %G eng %U http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2017.0217https://syndication.highwire.org/content/doi/10.1377/hlthaff.2017.0217 %N 10 %! Health Aff %R 10.1377/hlthaff.2017.0217 %0 Journal Article %J Research on Aging %D 2017 %T Health Status, Health Shocks, and Asset Adequacy Over Retirement Years. %A Geoffrey L Wallace %A Haveman, Robert %A Barbara Wolfe %K Health Conditions and Status %K Health Shocks %K Older Adults %K Retirement Planning and Satisfaction %X

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

%B Research on Aging %V 39 %P 222-248 %8 2017 Jan %G eng %N 1 %R 10.1177/0164027516669567 %0 Journal Article %J J Aging Health %D 2017 %T Healthy Aging in the Context of Educational Disadvantage: The Role of "Ordinary Magic". %A Sara J McLaughlin %K Aged %K Aged, 80 and over %K Educational Status %K Female %K Health Behavior %K healthy aging %K Humans %K Logistic Models %K Male %K Middle Aged %K Social Class %K United States %X

OBJECTIVE: The objective of this study is to examine the correlates of healthy aging in the context of educational disadvantage and the extent to which identified correlates are shared with the wider, more educationally advantaged population.

METHOD: Data are from the 2012 Health and Retirement Study. The analytic sample included 17,484 self-respondents ≥50 years of age. Educational disadvantage was defined as having less than a high school diploma. Using logistic regression, healthy aging was regressed on demographic, early-life, and health-related factors by educational status.

RESULTS: Among educationally disadvantaged adults, demographic characteristics (e.g., age), health practices (e.g., physical activity), and the presence of health conditions were independently correlated with healthy aging. With few exceptions, correlates of healthy aging were similar among educationally advantaged and disadvantaged adults.

DISCUSSION: Ordinary factors are associated with healthy aging among adults without a high school diploma, suggesting that healthy aging is possible for larger numbers of adults aging in the context of educational disadvantage.

%B J Aging Health %V 29 %P 1214-1234 %8 2017 10 %G eng %U http://jah.sagepub.com/cgi/doi/10.1177/0898264316659994 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27444894?dopt=Abstract %! Journal of Aging and Health %R 10.1177/0898264316659994 %0 Web Page %D 2017 %T Healthy eating habits may preserve cognitive function and reduce the risk of dementia %A Alzheimer's Association %K Cognitive Ability %K Dementia %K Eating habits %K News %K Press releases %B AAIC 2017 %I Alzheimer's Association International Conf. Press Office %C Chicago, IL %G eng %U https://www.alz.org/aaic/releases_2017/AAIC17-Mon-Diet-Release.asp %0 Journal Article %J Demography %D 2017 %T Healthy Grandparenthood: How Long Is It, and How Has It Changed? %A Rachel Margolis %A Wright, Laura %K Adult children %K Cross-National %K Grandparents %K Mortality %X Healthy grandparenthood represents the period of overlap during which grandparents and grandchildren can build relationships, and grandparents can make intergenerational transfers to younger kin. The health of grandparents has important implications for upward and downward intergenerational transfers within kinship networks in aging societies. Although the length of grandparenthood is determined by fertility and mortality patterns, the amount of time spent as a healthy grandparent is also affected by morbidity. In this study, we estimate the length of healthy grandparenthood for the first time. Using U.S. and Canadian data, we examine changes in the length of healthy grandparenthood during years when grandparenthood was postponed, health improved, and mortality declined. We also examine variation in healthy grandparenthood by education and race/ethnicity within the United States. Our findings show that the period of healthy grandparenthood is becoming longer because of improvements in health and mortality, which more than offset delays in grandparenthood. Important variation exists within the United States by race/ethnicity and education, which has important implications for family relationships and transfers. %B Demography %V 54 %P 2073-2099 %G eng %U http://link.springer.com/10.1007/s13524-017-0620-0http://link.springer.com/content/pdf/10.1007/s13524-017-0620-0.pdfhttp://link.springer.com/article/10.1007/s13524-017-0620-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1007/s13524-017-0620-0.pdf %N 6 %! Demography %R 10.1007/s13524-017-0620-0 %0 Web Page %D 2017 %T Healthy lifestyle may increase lifespan by seven years %A Marcia Frellick %K Health Behavior %K Lifespan %K Mortality %K News %B Medscape %I WebMD %C New York, NY %G eng %U http://www.medscape.com/viewarticle/883236 %0 Conference Paper %B MedEq %D 2017 %T Hearing health equity: Social determinants of hearing aid receipts %A Michael M McKee %A Choi, Hwajung %K Hearing loss %K Restricted data %B MedEq %I Wayne State University %C Detroit, MI %8 02/2017 %G eng %0 Journal Article %J Social Science & Medicine %D 2017 %T Hearing impairment, social support, and depressive symptoms among U.S. adults: A test of the stress process paradigm. %A Jessica S West %K Depressive symptoms %K Disabilities %K Hearing loss %K Social Support %X Hearing impairment is a growing physical disability affecting older adults and is an important physical health stressor, but few studies have examined it in relation to mental health outcomes and even fewer have considered the role of social support in buffering this relationship. The current study builds on the stress process framework and uses longitudinal data from three waves of the Health and Retirement Study (2006, 2010, 2014) to examine the relationship between hearing impairment and depressive symptoms among U.S. adults aged 50 and older (n = 6075). The analysis uses fixed-effects models to assess this relationship and examine the extent to which social support mediates (buffers) or moderates (interaction) the association. The results found that worse self-rated hearing was associated with a significant increase in depressive symptoms, even after controlling for sociodemographic factors. Social support did not buffer this relationship. Instead, social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Among those with excellent self-rated hearing, low levels of social support did not increase depressive symptoms. Moreover, high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources. %B Social Science & Medicine %V 192 %P 94-101 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28963989?dopt=Abstract %R 10.1016/j.socscimed.2017.09.031 %0 Generic %D 2017 %T Heavier patients less likely to receive hospice care at end of life %A Stateside Staff %K BMI %K Hospice %K News %K Older Adults %I Michigan Radio %G eng %U http://michiganradio.org/post/heavier-patients-less-likely-receive-hospice-care-end-life %0 Journal Article %J Anales de Psicología %D 2017 %T Hedonic and eudaimonic well-being in old age through positive psychology studies: a scoping review %A Araujo, Lia %A Ribeiro, Oscar %A Paúl, Constança %K Happiness %K Literature Review %K Well-being %X The study of aging through the lens of Positive Psychology allows looking beyond the decline normally associated with advancing of age and to consider rewarding experiences and strategies to promote a meaningful aging. In order to gather evidence on the key conceptual and empirical advancements that illustrate the commitment of Positive Psychology with aging issues a scoping review was conducted. Papers having “Positive Psychology” AND “Aging” (or similar words to aging) on their title, abstract or key-words were screened across main databases and aging related terms were searched in well-known journals of positive psychology. This strategy yielded 48 articles, 33 original scientific papers and 15 reviews. Main themes, study designs and instruments are presented and the endpoints are discussed according to the hedonic or eudaimonic perspective of the studies. Future directions related with the importance of comprehensive constructs and method approaches in the study of advancing age are highlighted. %B Anales de Psicología %V 33 %P 568-577 %G eng %U http://revistas.um.es/analesps/article/view/analesps.33.3.265621http://revistas.um.es/analesps/article/viewFile/265621/215181 %N 3 %! AN PSICOL-SPAIN %R 10.6018/analesps.33.3.265621 %0 Web Page %D 2017 %T Here’s Why Your Brain Needs You to Read Every Single Day %A Brandon Specktor %K Cognitive Ability %K News %K Reading %B Reader's Digest %I Reader's Digest %C New York City, NY %G eng %U http://www.rd.com/culture/benefits-of-reading/ %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2017 %T Heterogeneous trajectories of physical and mental health in late middle age: Importance of life-course socioeconomic positions. %A Kwon, Eunsun %A So Jung Park %K Depressive symptoms %K Life trajectories %K Socioeconomic factors %X Drawing on life course and cumulative disadvantage theory, this study examines heterogeneous trajectories of functional limitations and depressive symptoms among late middle-aged individuals. This study used prospective data from 6010 adults, 51 to 64 years old, collected over a 12-year-period from the Health and Retirement Study. Considering the empirical proposition that several physical and mental trajectories may exist, Latent Class Growth Modeling was used. Five heterogeneous patterns of joint trajectories (Relatively healthy, Moderately improving, Steadily deteriorating, Steeply deteriorating, and Persistently high comorbid) were identified. Early life adversity was related to an increasing risk of declines in physical and mental health. The Persistently high comorbid class was characterized by a concentration of disadvantages over the life course. The development of public health interventions could help reduce co-existing physical and mental health problems, especially during late middle-age. %B International Journal of Environmental Research and Public Health %V 14 %8 2017 May 30 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28556801?dopt=Abstract %R 10.3390/ijerph14060582 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women. %A Bendayan, Rebecca %A Cooper, Rachel %A Elizabeth G Wloch %A Scott M Hofer %A Andrea M Piccinin %A Graciela Muñiz Terrera %K Activities of Daily Living %K Aged %K Aging %K Cross-Cultural Comparison %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Self Report %K Statistics, Nonparametric %K United Kingdom %K United States %X

Background: We aimed to identify the hierarchy of rates of decline in 16 physical functioning measures in U.S. and English samples, using a systematic and integrative coordinated data analysis approach.

Methods: The U.S. sample consisted of 13,612 Health and Retirement Study participants, and the English sample consisted of 5,301 English Longitudinal Study of Ageing participants. Functional loss was ascertained using self-reported difficulties performing 6 activities of daily living and 10 mobility tasks. The variables were standardized, rates of decline were computed, and mean rates of decline were ranked. Mann-Whitney U tests were performed to compare rates of decline between studies.

Results: In both studies, the rates of decline followed a similar pattern; difficulty with eating was the activity that showed the slowest decline and climbing several flights of stairs and stooping, kneeling, or crouching the fastest declines. There were statistical differences in the speed of decline in all 16 measures between countries. American women had steeper declines in 10 of the measures than English women. Similar differences were found between American and English men.

Conclusions: Reporting difficulties climbing several flights of stairs without resting, and stooping, kneeling, or crouching are the first indicators of functional loss reported in both populations.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 1117-1122 %8 2017 Aug 01 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27753610?dopt=Abstract %R 10.1093/gerona/glw209 %0 Journal Article %J Alzheimer Disease and Associated Disorders %D 2017 %T High Hemoglobin A1c and Diabetes Predict Memory Decline in the Health and Retirement Study. %A Jessica R Marden %A Elizabeth R Mayeda %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A M. Maria Glymour %K Cognitive Ability %K Diabetes %K Memory %K Older Adults %X

BACKGROUND: Type 2 diabetes (T2D) is an established risk factor for dementia, but evidence for T2D and memory decline is less consistent. Understanding how T2D and blood glucose relate to memory decline is crucial to elucidating the mechanisms linking T2D and dementia.

MATERIALS AND METHODS: For 8888 Health and Retirement Study participants aged 50+, glycosylated hemoglobin (HbA1c) was measured in either 2006 or 2008 and physician's diagnosis of diabetes was self-reported in the same year. Composite memory (z scored) was assessed biennially through 2012 using immediate and delayed word list recall or the Informant Questionnaire for Cognitive Decline. Marginal mean regression models for repeated outcomes were specified to predict memory decline as a function of diabetes or HbA1c, using age as the timescale and adjusting for health and social confounders.

RESULTS: Diabetes was associated with a 10% faster rate of memory decline [β=-0.04 per decade; 95% confidence interval (CI), -0.06 to -0.01). A 1 U increase in HbA1c corresponded with a 0.05 SD decrease in memory score per decade (95% CI, -0.08 to -0.03). Even among individuals with HbA1c<6.5% (threshold for diabetes), higher HbA1c was associated with memory decline (β=-0.05 per decade; 95% CI, -0.08 to -0.03).

DISCUSSION: Diabetes accelerated memory loss and higher HbA1c predicted memory decline even in nondiabetics.

%B Alzheimer Disease and Associated Disorders %V 31 %P 48-54 %8 2017 Jan-Mar %G eng %N 1 %R 10.1097/WAD.0000000000000182 %0 Journal Article %J Advances in Life Course Research %D 2017 %T His way, her way: Retirement timing among dual-earner couples %A Jonathan Jackson %K Employment and Labor Force %K Gender Differences %K Marriage %K Retirement Planning and Satisfaction %X This article examines how the retirement timing of husbands and wives has evolved in the face of women's rising economic resources. Using 11 waves of data from the Health and Retirement Study, I trace individuals into retirement, examining how spousal employment characteristics may facilitate or hinder one's own ability to retire and if such spousal influences have changed across cohorts. Results from event history models indicate that the retirement trajectories have changed for the leading baby boom cohort, as evidence implies they are delaying retirement longer than previous cohorts. Despite women's rising labor force attachment, the findings do not generally support the notion that wives are influencing their husbands' retirement timing more or that the influence of husbands on wives' retirement timing has declined across cohorts. %B Advances in Life Course Research %V 33 %P 23-37 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S104026081630051Xhttp://api.elsevier.com/content/article/PII:S104026081630051X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S104026081630051X?httpAccept=text/plain %! Advances in Life Course Research %R 10.1016/j.alcr.2016.09.002 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T The Hispanic paradox: Race/ethnicity and nativity, immigrant enclave residence and cognitive impairment among older US adults. %A Margaret M Weden %A Jeremy Miles %A Esther M Friedman %A José J Escarce %A Peterson, Christine %A Kenneth M. Langa %A Regina A Shih %K Cognitive Ability %K Racial/ethnic differences %K Socioeconomic factors %K Women and Minorities %X Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the "Hispanic Paradox". Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially "paradoxical" advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N = 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population. %B Journal of the American Geriatrics Society %V 65 %P 1085-1091 %G eng %N 5 %R 10.1111/jgs.14806 %0 Journal Article %J Journal of Aging and Health %D 2017 %T Hispanics' retirement transitions and differences by nativity. %A Mudrazija, Stipica %A Richard W. Johnson %A Wang, Claire Xiaozhi %K Hispanics %K Racial/ethnic differences %K Retirement Planning and Satisfaction %X

OBJECTIVE: This study examines differences in retirement decisions between older Hispanics and non-Hispanics, with a special focus on the role of nativity.

METHODS: We use 1998-2012 waves of the Health and Retirement Study. We estimate survival models of retirement and compare retirement transitions for U.S.-born Hispanics, foreign-born Hispanics, non-Hispanic Whites, and non-Hispanic Blacks.

RESULTS: Foreign-born Hispanics retire significantly later than other racial and ethnic groups. Controlling for personal characteristics, their risk of retirement is 39% lower compared with non-Hispanic Whites. Retirement transitions do not differ significantly between U.S.-born Hispanics and non-Hispanic Whites.

DISCUSSION: Difference in retirement timing between U.S.- and foreign-born Hispanics may partly be due to lower incomes and wealth accumulation of foreign-born Hispanics. Workforce development initiatives, policy initiatives promoting retirement savings, and Social Security reforms could improve future retirement security for older Hispanics, and make retirement a viable option for more foreign-born Hispanics.

%B Journal of Aging and Health %V 29 %P 1096-1115 %8 09/2017 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28569096?dopt=Abstract %R 10.1177/0898264317711608 %0 Journal Article %J Home Health Care Serv Q %D 2017 %T Home and community-based service and other senior service use: Prevalence and characteristics in a national sample. %A Amanda Sonnega %A Kristen N Robinson %A Helen G Levy %K Aged %K Aged, 80 and over %K Community Health Services %K Female %K Home Care Services %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Prevalence %K Senior Centers %K United States %X

We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a "gateway" to HCBS that can help keep older adults living in the community.

%B Home Health Care Serv Q %V 36 %P 16-28 %8 2017 Jan-Mar %G eng %U https://www.tandfonline.com/doi/full/10.1080/01621424.2016.1268552 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27925859?dopt=Abstract %! Home Health Care Services Quarterly %R 10.1080/01621424.2016.1268552 %0 Report %D 2017 %T Homeownership, Social Insurance, and Old-Age Security in the United States and Europe %A Mudrazija, Stipica %A Barbara A Butrica %K Debt %K Europe %K Homeownership %K Retirement Planning and Satisfaction %K SHARE %X Relatively few Americans have accumulated substantial savings outside of their employer-sponsored retirement plans, yet most own their homes. The traditional view of the retirement income system as a three-legged stool supported by Social Security, private pensions, and savings may be better viewed as being supported by Social Security, pensions, and homeownership. Country-specific economic, social, and political developments throughout modern history mean that homeownership rates and the relative importance of homeownership for old-age security vary widely across developed countries. Many countries, however, are increasingly promoting homeownership as an effective way of building assets, a de facto self-insurance mechanism for old-age security, and a substitute for various social transfers. This paper uses data from the Health and Retirement Study (HRS) in the United States and the Survey of Health, Ageing, and Retirement in Europe (SHARE) to better understand the role of homeownership in retirement before and after the Great Recession for the United States and nine Western European countries: Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Spain, and Sweden. It begins by comparing trends in homeownership rates among older adults and the key characteristics of housing-related policies and regulations that potentially impact home acquisition. It then examines home equity trends, the prevalence and burden of housing debt, and the relative importance of housing as a source of retirement wealth. Next it provides an overview of equity release options and estimates how much older households could increase their incomes by fully monetizing their housing equity. Finally, the paper discusses the prospects for and limits of home equity release and asset-based welfare policies. The paper found that: Most older adults are homeowners, and homeownership rates generally increased between 2006 and 2012; however, there is substantial variation across countries.Housing-related policies in the Netherlands, Sweden, and Denmark provide comparatively high levels of support to both homeowners and non-homeowners, while those in Italy and Spain provide little support to either group. In contrast, housing policies in the United States provide some of the highest levels of support for homeowners and lowest levels of support for non-homeowners.Older American homeowners have substantial housing wealth, but compared with their European peers, housing represents a somewhat smaller part of their net total wealth.While the prevalence of housing debt among older adults is somewhat lower in the United States than in the Netherlands, Denmark, and Sweden, among older homeowners with housing debt, Americans have the highest loan-to-value ratios and the highest proportion of homeowners whose homes may be at risk of going underwater.If the housing equity of older Americans were completely monetized, median household income would increase by over a third – more than in countries like Sweden and Denmark, but well below countries like Spain and Italy. Across all countries in this study, tapping into housing equity could substantially reduce the share of older adults with household incomes below 50 percent of the median – the threshold for relative poverty.However, even after annuitizing housing wealth, the share of poor older Americans would remain as high as, or higher than, the share of poor older Europeans before accounting for annuitized housing wealth.Despite the potentially large impact of monetizing home equity on household incomes and the economic security of older Americans and Europeans, there remain impediments to tapping into home equity that may explain its low use. Objective obstacles include the high costs of withdrawing housing equity, uncertainty about life expectancy and the amount of financial resources required to support retirement, the adverse impact on eligibility for social benefits, and the concentration of housing wealth among (upper) middle- and higher-income individuals who are less likely to need additional resources in old age. Subjective obstacles include an aversion toward assuming additional debt in old age, different (often emotional) attitudes to housing compared with other types of wealth, bequest motives, and a lack of trust in financial institutions. The policy implications of the findings are: Home equity has a potentially important yet limited role in supporting old-age security. Even if objective obstacles related to the design and pricing of home equity release products were fully addressed, subjective reasons for avoiding home equity withdrawal and compositional differences in the concentration of housing wealth would still limit the scope of asset-based welfare.These limitations notwithstanding, using home equity to supplement retirement incomes and improve retirement security remains a potentially attractive option for a substantial number of older adults who have built housing wealth over their life course, but may either have insufficient retirement incomes or face unexpected and expensive life events (e.g. long-term care needs).What remains more uncertain and difficult to predict, though, are the long-run prospects for using home equity to support old-age security since younger generations of Americans and Europeans may find it more difficult to build home equity than their parents’ generation. %B Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %P 2-40 %8 10/2017 %G eng %U http://crr.bc.edu/wp-content/uploads/2017/10/wp_2017-15.pdf %0 Journal Article %J J Occup Environ Med %D 2017 %T Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? %A Maren W Voss %A Wendy Church Birmingham %A Lori Wadsworth %A Wei Chen %A Bounsanga, Jerry %A Gu, Yushan %A Hung, Man %K Age Factors %K Aged %K Chronic disease %K depression %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Mental Health %K Middle Aged %K Personal Satisfaction %K Retirement %K Unemployment %K United States %K Work %X

OBJECTIVE: Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes.

METHODS: A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status.

RESULTS: Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status.

CONCLUSIONS: Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.

%B J Occup Environ Med %V 59 %P 184-190 %8 2017 02 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00043764-900000000-98945 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28002355?dopt=Abstract %! Journal of Occupational and Environmental Medicine %R 10.1097/JOM.0000000000000933 %0 Hearing %D 2017 %T House Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights and International Organizations Hearing %K Alzheimer's disease %K Global Health %K Government %K HCAP %K Testimony %B House Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights and International Organizations %I Federal Information & News Dispatch, Inc. %C Washington, D.C. %G eng %U http://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/1970242679?accountid=14667 %0 Journal Article %J Economics Bulletin %D 2017 %T Household demand for private long term care insurance: An exploratory note %A Chatterjee, Swarnankur %K Financial literacy %K Long-term Care %K Medicare/Medicaid/Health Insurance %K Risk Factors %X This study uses the most recent wave of the Health and Retirement Study (HRS) to examine participation of aging households in the long-term care insurance market. Results suggest that households who perceived a need to move to a nursing home within the next five years and households with higher preference for risk management through insurance were more likely to have long-term care coverage. Interestingly, the households with higher levels of risk tolerance were less likely to have long-term care coverage. Conversely, households with a bequest motive were more likely to have long-term care coverage. Additionally, the empirical results of this study indicate that the probability of having long-term care coverage was higher for women. Households with greater educational attainment and greater net worth were also more likely to have long-term care coverage. %B Economics Bulletin %V 37 %P 1975-1981 %G eng %N 3 %0 Report %D 2017 %T Household finance in China %A Cooper, Russell %A Zhu, Guozhong %K CHARLS %K Cross-National %K Finances %X This paper studies household finance in China, focusing on the high savings rate, the low participation rate in the stock market, and the low stock share in household portfolios. These salient features are studied in a lifecycle model in which households receive both income and medical expense shocks and decide on stock market participation and portfolio adjustment. The structural estimation explicitly takes into account important regime changes in China, such as the re-opening of the stock market, the privatization of the housing market and the labor market reforms that changed household income processes. The paper also compares household finance patterns in China to those in the US, and shows that between-country differences in financial choices are driven by both institutional factors (e.g. higher costs associated with stock market participation and a lower consumption floor in China) and preferences (e.g. higher discount factors of Chinese households). %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 08/2017 %G eng %U http://www.nber.org/papers/w23741.pdf %R 10.3386/w23741 %0 Report %D 2017 %T Household Retirement Saving: The Location of Savings Between Spouses %A Carman, Katherine %A Hung, Angela %K Consumption and Savings %K Marriage %K Retirement Planning and Satisfaction %X Retirement planning is often a joint household decision-making process, and therefore the household is often the more appropriate unit of analysis. However, retirement savings in tax advantaged accounts are held in the name of one individual. While spouses have rights to these assets in the case of divorce and in most cases of death, the separation of accounts in name may cause couples to treat their accounts as separate, with each spouse making decisions separately. In order to optimize retirement planning, couples should consider the entire household portfolio together, accounting for the characteristics of the retirement accounts, the age of the spouses, and income differences between spouses. With separate accounts, one spouse may not be aware of the contributions or assets accumulated in the other spouse's accounts. This may lead to sub-optimal decision-making, as individuals in a couple may not fully optimize across all available retirement accounts. Little is known about how households divide retirement contributions and assets between spouses. In this project, we investigate how households locate contributions across tax deferred savings accounts that are nominally held in one spouse's name and how these decisions may impact accumulated assets. In particular we first document who within a couple nominally holds retirement assets. Using data from the Health and Retirement Study and Survey of Consumer Finances, we find that household retirement assets and contributions are more likely to be located in accounts held in the husband's name or the primary earner's name. In our regression analysis, we find that the location of contributions is largely driven by the distribution of earnings within couples. %I RAND Corporation %C Santa Monica, CA %G eng %U http://www.rand.org/pubs/working_papers/WR1166.html %R 10.7249/WR1166 %0 Report %D 2017 %T Housing, Mortgages, and Retirement %A Mayer, Christopher %K Housing %K Retirement Planning and Satisfaction %G eng %U https://65ac4f78-a-62cb3a1a-s-sites.googlegroups.com/site/gwfedrealestateseminar/home/papers-2/Housing-Retirement-Chicago-Mayer-v5.pdf?attachauth=ANoY7codd-XYk6fDKmYhPJI35zkYhPhbPQCWEMB3Xd0_zU0eLdoVlk2Npv3_kjRhvel6diK-ZI-UGjtT4RN43znY6MStRma5FizGtNpCjsSiI %0 Government Document %D 2017 %T How Couples Approach Portfolio Allocation %A Fessenden, Helen %A Lazaryan, Nika %A Neelakantan, Urvi %K Decision making %K Marriage %K Older Adults %K Retirement Planning and Satisfaction %K Risk Aversion %X The classical theory of household portfolio allocation finds that the share of household wealth invested in risky assets is independent of the level of household wealth. However, this prediction is at odds with empirical observations. This Economic Brief presents findings that reconcile the two. A model in which a household's portfolio allocation reflects the preferences of both spouses, adjusted for the bargaining power of each spouse, predicts that the wealthier a household becomes, the greater the share of its wealth will be invested in risky assets. %I Federal Reserve Bank of Richmond %V 17 %G eng %U https://www.richmondfed.org/-/media/richmondfedorg/publications/research/economic_brief/2017/pdf/eb_17-02.pdf %N 2 %& Economic Brief %0 Web Page %D 2017 %T How Debt Is Threatening Retirement Dreams %K Debt %K News %K Retirement Planning and Satisfaction %K Socioeconomic factors %B Forbes %I Forbes %C New York City, NY %G eng %U https://www.forbes.com/sites/nextavenue/2017/09/20/how-debt-is-threatening-retirement-dreams/#7bf0119dadd5 %0 Unpublished Work %D 2017 %T How Does the Level of Household Savings Affect Preference for Immediate Annuities? %A Sudipto Banerjee %B EBRI Issue Brief %I Employee Benefit Research Institute %C Washington, DC %8 02/2017 %G eng %U https://www.ebri.org/pdf/briefspdf/EBRI_IB_430_Annuiities.08.Feb17.pdf %0 Report %D 2017 %T How job changes affect retirement timing by socioeconomic status %A Geoffrey T. Sanzenbacher %A Sass, Steven A. %A Gillis, Christopher M. %K job changes %K Retirement %K socioeconomic status %X The brief’s key findings are: Workers in their 50s today, compared to previous generations, are more likely to switch jobs voluntarily. The question is whether such job changes lengthen or shorten a worker’s career. The results suggest that job changes lengthen careers: those who switch jobs are much more likely to still be in the labor force at age 65 than those who stay put. This effect is somewhat larger for better-educated workers than for less-educated workers. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/how-job-changes-affect-retirement-timing-by-socioeconomic-status/ %0 Report %D 2017 %T How Much Consumption Insurance in the U.S.? %A Iourii Manovskii %A Dmytro Hryshko %K consumption %K Consumption and Savings %K Insurance %X Most of what the profession knows about joint income and consumption dynamics at the household level in the U.S. is based on the data from the Panel Study of Income Dynamics (PSID). We find that there are two sets of households in the PSID that differ dramatically in the dynamics of their income and consumption. Households headed by the original PSID males and their sons have a highly persistent income process, and permanent shocks to their income almost fully pass through to consumption. Household headed by males who marry daughters of the original PSID members have a much less persistent income process and a dramatically higher degree of insurance. These differences are surprising but highly robust. Conditional on income dynamics, the degree of insurance in each subsample is consistent with the prediction of the standard incomplete-markets model. This is in contrast to the famous puzzle in Blundell, Pistaferri, and Preston (2008) of excess insurance of permanent income shocks for the combined sample. %I Society for Economic Dynamics %G eng %U https://ideas.repec.org/p/red/sed017/1584.html %0 Report %D 2017 %T How Much Does Motherhood Cost Women in Social Security Benefits? %A Matthew S. Rutledge %A Alice Zulkarnain %A Sara Ellen King %K Labor force participation %K Motherhood %K Social Security %K Women and Minorities %X The increase in female labor force participation coupled with a higher number of women reaching retirement unmarried has increased the share of women claiming Social Security benefits earned through their own job histories. But they still bear the lion’s share of caregiving responsibilities, and the previous literature has provided clear evidence that motherhood reduces earnings during the childbearing and child-rearing years. What remains understudied is the extent to which mothers face lower lifetime earnings and, consequently, lower Social Security income. This paper uses the Health and Retirement Study (HRS) linked to administrative earnings records to answer three questions. First, how much less do mothers earn over their careers compared to childless women, and how much less do they earn for each additional child? Second, how do Social Security benefits differ between mothers and non-mothers? Third, how does each of the existing elements of the Social Security system that indirectly help mothers – namely, spousal benefits and the progressivity of the benefit formula – contribute to reducing the motherhood penalty? %B Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %P 2-22 %8 10/2017 %G eng %U http://crr.bc.edu/wp-content/uploads/2017/10/wp_2017-14.pdf %0 Report %D 2017 %T How much does Out-of-Pocket Medical Spending Eat Away at Retirement Income? %A Melissa McInerney %A Matthew S. Rutledge %A Sara Ellen King %K Gender Differences %K Income %K Medicare %K Social Security %X The adequacy of retirement income – from Social Security benefits and other sources – is substantially reduced by Medicare’s high out-of-pocket (OOP) costs. This project uses the 2002-2014 Health and Retirement Study to calculate post-OOP benefit ratios, defined as the share of either Social Security benefits or total income available for non-medical spending. The project decomposes the share of income that is going toward premium payments and services delivered and examines how these post-OOP benefit ratios differ by age, gender, income, supplemental insurance coverage, and health status. The project also updates previous studies’ estimates to document how OOP spending and the post-OOP income ratios changed following the introduction of Medicare Part D prescription drug coverage in 2006 and the closing of the “donut hole” coverage gap in 2010, which decreased OOP costs under Part D for those spending moderate amounts on prescriptions. %B Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %P 2-31 %8 10/2017 %G eng %U http://crr.bc.edu/working-papers/how-much-does-out-of-pocket-medical-spending-eat-away-at-retirement-income/ %0 Newspaper Article %B The Washington Post %D 2017 %T How much would you pay to live pain-free? %A Christopher Ingraham %K Chronic pain %K Consumption and Savings %K News %B The Washington Post %C Washington, DC %8 08/07/2017 %G eng %U https://www.washingtonpost.com/news/wonk/wp/2017/08/07/how-much-would-you-pay-to-live-pain-free/ %0 Journal Article %J The Geneva Papers on Risk and Insurance - Issues and Practice %D 2017 %T How the growing gap in life expectancy may affect retirement benefits and reforms %A Auerbach, Alan %A Kerwin K. Charles %A Courtney Coile %A William G. Gale %A Dana P Goldman %A Lee, Ronald %A Lucas, Charles %A Orszag, Peter R. %A Sheiner, Louise %A Tysinger, Bryan %A Weil, David %A Wolfers, Justin %A Rebeca Wong %K Life Expectancy %K Mortality %K Retirement Planning and Satisfaction %K Social Security %B The Geneva Papers on Risk and Insurance - Issues and Practice %V 42 %P 475-499 %8 Jan-07-2017 %G eng %U http://link.springer.com/10.1057/s41288-017-0057-0http://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdfhttp://link.springer.com/article/10.1057/s41288-017-0057-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdf %N 3 %! Geneva Pap Risk Insur Issues Pract %R 10.1057/s41288-017-0057-0 %0 Web Page %D 2017 %T How The Lives Of Seniors In The U.S. Match Up Against The Rest Of The World %A Gleckman, Howard %K Cross-National %K News %B Forbes %I Forbes %V 2017 %G eng %U https://www.forbes.com/sites/howardgleckman/2017/08/16/how-the-lives-of-seniors-in-the-us-match-up-against-the-rest-of-the-world/#67f280f43030 %0 Newspaper Article %B Daily Mail %D 2017 %T How your personality affects your HEALTH: From extroverts to romantics to neurotic types, we reveal the issues tied to each trait - and what to do about it %A De Graff, Mia %K News %K Personality %B Daily Mail %C London, UK %G eng %U http://www.dailymail.co.uk/health/article-5125041/How-does-personality-affect-HEALTH.html %0 Report %D 2017 %T HRS Institutional Review Board Information %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 10/2017 %G eng %0 Report %D 2017 %T HRS Polygenic Scores: 2006-2010 Genetic Data %A Erin B Ware %A Lauren L Schmitz %A Jessica Faul %K PGS %B HRS Documentation Report %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 07/2017 %G eng %0 Report %D 2017 %T HRS Psychosocial and Lifestyle Questionnaire 2006-2016 %A Jacqui Smith %A Lindsay H Ryan %A Gwenith G Fisher %A Amanda Sonnega %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %1 Please note that this replaces an earlier version of this report. %0 Journal Article %J Aging %D 2017 %T Human longevity: 25 genetic loci associated in 389,166 UK biobank participants %A Luke C Pilling %A Kuo, Chia-Ling %A Sicinski, Kamil %A Tamosauskaite, Jone %A George A Kuchel %A Lorna W. Harries %A Herd, Pamela %A Robert B Wallace %A Luigi Ferrucci %A David Melzer %K Cross-National %K Genetics %K Genome %K GWAS %K Longevity %X We undertook a genome-wide association study (GWAS) of parental longevity in European descent UK Biobank participants. For combined mothers' and fathers' attained age, 10 loci were associated (p<5*10(-8)), including 8 previously identified for traits including survival, Alzheimer's and cardiovascular disease. Of these, 4 were also associated with longest 10% survival (mother's age >= 90 years, father's >= 87 years), with 2 additional associations including MC2R intronic variants (coding for the adrenocorticotropic hormone receptor). Mother's age at death was associated with 3 additional loci (2 linked to autoimmune conditions), and 8 for fathers only. An attained age genetic risk score associated with parental survival in the US Health and Retirement Study and the Wisconsin Longitudinal Study and with having a centenarian parent (n=1,181) in UK Biobank. The results suggest that human longevity is highly polygenic with prominent roles for loci likely involved in cellular senescence and inflammation, plus lipid metabolism and cardiovascular conditions. There may also be gender specific routes to longevity. %B Aging %V 9 %P 2504-2520 %G eng %U http://www.aging-us.com/article/101334/texthttp://www.aging-us.com/article/101334/text?_escaped_fragment_= %N 12 %! aging %R 10.18632/aging.101334 %0 Web Page %D 2017 %T Hybrid MIND diet may preserve cognition, cut dementia risk %A Anderson, Pauline %K Cognitive Ability %K Dementia %K Dieting %B Medscape %I Medscape Medical News %C New York, NY %G eng %U http://www.medscape.com/viewarticle/883133 %0 Book %B Handbooks in Economics %D 2016 %T Handbook of the Economics of Population Aging %A Piggott, John %A Woodland, Alan %K Aging %K Economics %X Ten papers provide perspectives from economists concerning population aging, explore the economic causes and consequences of demographic change, and analyze policy responses that have emerged. Papers discuss retirement incentives and labor supply; investing and portfolio allocation for retirement; conflict and cooperation within the family, and between the state and the family, in the provision of old-age security; complex decision making—the roles of cognitive limitations, cognitive decline, and aging; taxation, pensions, and demographic change; social security and public insurance; workplace-linked pensions for an aging demographic; poverty and aging; health and long-term care; and the Health and Retirement Study around the world surveys. Papers in volume 1A also provide perspectives from economists concerning population aging, explore the economic causes and consequences of demographic change, and analyze policy responses that have emerged. Piggott is with the ARC Centre of Excellence in Population Ageing Research at the University of New South Wales. Woodland is with the School of Economics and the ARC Centre of Excellence in Population Ageing Research at the University of New South Wales. Index. %B Handbooks in Economics %I Elsevier, North-Holland %C Boston and Amsterdam %V 1B %@ 978–0–444–53840–6 %G eng %0 Book %D 2016 %T Handbook of Theories of Aging %A Vern L. Bengtson %A Richard A. Settersten Jr. %E Brian K. Kennedy %E Morrow-Howell, Nancy %E Jacqui Smith %K Aging %K Older Adults %7 Third %I Springer Publishing Company %C New York City, NY %P 752 %G eng %0 Magazine Article %D 2016 %T Happy People Make Their Spouses Healthier %A TIME %K Happiness %K Marriage %K News %K Older Adults %B TIME Magazine %G eng %U http://time.com/4506490/happy-people-make-their-spouses-healthier/ %0 Journal Article %J Journal of Finance %D 2016 %T Health and Mortality Delta: Assessing the Welfare Cost of Household Insurance Choice %A Koijen, Ralph S. J. %A Van Nieuwerburgh, Stijn %A Yogo, Motohiro %K Health Conditions and Status %K Insurance %K Net Worth and Assets %K Pensions %X We develop a pair of risk measures, health and mortality delta, for the universe of life and health insurance products. A life-cycle model of insurance choice simplifies to replicating the optimal health and mortality delta through a portfolio of insurance products. We estimate the model to explain the observed variation in health and mortality delta implied by the ownership of life insurance, annuities including private pensions, and long-term care insurance in the Health and Retirement Study. For the median household aged 51 to 57, the lifetime welfare cost of market incompleteness and suboptimal choice is 3.2 of total wealth. %B Journal of Finance %I 71 %V 71 %P 957-1010 %G eng %N 2 %4 mortality/life Insurance/annuities/pensions %$ 999999 %R 10.1111/jofi.12273 %0 Report %D 2016 %T Health and Retirement Study Imputations for Employer-Sponsored Pension Wealth from Current Jobs in 2010: Data Description and Usage %A Fang, Chichun %A Amy Butchart %A Helena Stolyarova %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 03/2016 %G eng %U http://hrsonline.isr.umich.edu/modules/meta/xyear/penswealth2010/desc/PWI10A.pdf %0 Thesis %B Public Health %D 2016 %T Health and wellbeing of older adults in the United States and Japan: A comparative study %A Suzuki, Yukari %K Comorbidity %K Cross-National %K Health Conditions and Status %K JSTAR %K Older Adults %K Racial/ethnic differences %X The global population is projected to reach 9.1 billion in 2050 due to an increase in the number of older adults. Older adults are living longer; however, life expectancy values vary by country. While a country’s degree of economic development is a contributor to the health of its national population, life expectancy varies among economically developed countries as well. Social engagement has been studied as a factor contributing to longevity and the health of older adults. According to the convoy model of social relations, family members begin to play an increasingly integral role in the lives of older adults as they age. Literature has demonstrated preventive benefits of family engagement for the physical, psychological, and cognitive health of older adults. However, family engagement has also been linked to low health among older adults as a means of accommodating functional decline. Cultural values and attitudes have been shown to influence family engagement behaviors as well in both individualist and collectivist nations. This study examined the association of family engagement and self-rated health status (SHS) of older adults (ages 50 to 75 years) in the United State and Japan through a secondary cross-sectional analysis of the 2008 wave of the Health and Retirement Study and the 2007 Japanese Study of Aging and Retirement. Logistic regression found SHS, frequency of family engagement, and proximity of children’s residence to be significantly associated with the survey country. In the combined sample, family contact of at least once a week (OR: 1.9, 95% CI: 1.0-3.5), residence within 10 miles of their children (OR: 0.8, 95% CI: 0.7-1.0), and residence with children (OR: 0.6, 95% CI: 0.5-0.7) were significantly associated with SHS, even after controlling for age, gender, ethnicity, marital status, income, and comorbidities. Future research may consider a longitudinal analysis to observe whether family engagement demonstrates protective factors for maintaining high SHS over time. While these national surveys had been modeled after each other, increasing alignment of survey instruments for improved equivalence and comparability would strengthen the internal and external validity of findings. %B Public Health %I San Diego State University %V M.P.H. %P 86 %@ 9781339861340 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1809116978?accountid=14667 %9 Thesis %0 Thesis %B Epidemiological Science %D 2016 %T The Health Consequences of Negative Wealth Shock During Late Middle Age %A Lindsay R Pool %K Health Conditions and Status %K Health Shocks %K Income %K Medicare/Medicaid/Health Insurance %K Older Adults %K Wealth Shocks %X There is robust empirical evidence for a link between lower economic status and adverse health outcomes, but little is known about whether a sudden, unplanned loss of assets – a negative wealth shock – has long-term health consequences. Previous research has shown associations between negative wealth shocks and short-term health declines, primarily from losses of housing and investment wealth, with macroeconomic recession presumed to have triggered these shocks. Even during better economic times, however, negative wealth shocks arise frequently from more individualized circumstances, such as high medical expenses, but causal mechanisms linking subsequent health outcomes to these endogenous shocks can be difficult to establish due to the potential for reverse causality and residual confounding. Using data from the Health and Retirement Study, a nationally representative study of US adults aged 50 and older, this dissertation examined markers of short-term changes in stress and health care consumption after negative wealth shock in late middle age, a time of particular vulnerability. Then, differences by whether an individual experienced negative wealth shock in late middle age were assessed for three long-term aging-related trajectories – cognitive decline, physical function limitation accumulation, and all-cause mortality. Design and analytic methods addressed bidirectional and time-dependent causation in the relationship between negative wealth shock and health outcomes. Over 15 percent of late middle-aged adults with existing assets experienced negative wealth shock. The main findings indicated that experiencing a negative wealth shock during late middle age was associated with a higher risk of elevated depressive symptoms, a marker of increased stress, as well as long-term risk of mortality and cognitive decline. However, there was no significant association between negative wealth shock and risk of cost-related medication non-adherence – a marker of reduced health-related consumption, nor accelerated physical function limitation accumulation. With a substantial proportion of the late middle-aged population experiencing negative wealth shock, targeted interventions to prevent of the occurrence of these shocks and the health consequences thereafter may have a large impact on the health of older Americans %B Epidemiological Science %I University of Michigan %C Ann Arbor %V Ph.D. %P 143 %@ 9781369082029 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1817658414?accountid=14667 %9 Dissertation %0 Journal Article %J Health Econ %D 2016 %T Health Effects of Short-Term Fluctuations in Macroeconomic Conditions: The Case of Hypertension for Older Americans. %A Marco Angrisani %A Jinkook Lee %K Aged %K Commerce %K Economic Recession %K Female %K Health Status %K Humans %K Hypertension %K Longitudinal Studies %K Male %K Middle Aged %K Socioeconomic factors %K Stress, Psychological %K Surveys and Questionnaires %K Unemployment %K United States %X

We investigate the health effects of short-term macroeconomic fluctuations as described by changes in unemployment rate, house, and stock market price indexes. The 'Great Recession' provides the opportunity to conduct this analysis as it involved contemporaneous shocks to the labor, housing, and stock markets. Using panel data from the Health and Retirement Study over the period 2004-2010, we relate changes in hypertension status to changes in state-level unemployment rate and house prices and to changes in stock market prices. We consider hypertension, a disease related to stress and of high prevalence among older adults, that has received little attention in the literature linking macroeconomic conditions to individual health. Our analysis exploits self-reports of hypertension diagnosis as well as directly measured blood pressure readings. Using both measures, we find that the likelihood of developing hypertension is negatively related to changes in house prices. Also, decreasing house prices lower the probability of stopping hypertension medication treatment for individuals previously diagnosed with the condition. We do not observe significant associations between hypertension and either changes in unemployment rate or stock market prices. We document heterogeneity in the estimated health effects of the recession by gender, education, asset ownership, and work status. Copyright © 2016 John Wiley & Sons, Ltd.

%B Health Econ %V 25 Suppl 2 %P 113-125 %8 2016 11 %G eng %U http://doi.wiley.com/10.1002/hec.3374https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3374http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3374/fullpdf %1 http://www.ncbi.nlm.nih.gov/pubmed/27870298?dopt=Abstract %! Health Econ. %R 10.1002/hec.3374 %0 Journal Article %J Journal of Health Communication %D 2016 %T Health Literacy and Access to Care. %A Helen G Levy %A Alexander T Janke %K Aging %K Health Literacy %K Healthcare %K Older Adults %X

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

%B Journal of Health Communication %V 21 Suppl 1 %P 43-50 %8 2016 %G eng %R 10.1080/10810730.2015.1131776 %0 Journal Article %J Developmental Psychology %D 2016 %T Health sensitivity: Age differences in the within-person coupling of individuals’ physical health and well-being. %A Schöllgen, Ina %A Morack, Jennifer %A Frank J Infurna %A Ram, Nilam %A Denis Gerstorf %K Age differences %K Health Conditions and Status %K Marriage %K Mortality %K Older Adults %X Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals’ well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50–109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity—on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect—and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record (c) 2016 APA, all rights reserved) %B Developmental Psychology %V 52 %P 1944 - 1953 %8 Jan-01-2016 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/dev0000171 %N 11 %! Developmental Psychology %R 10.1037/dev0000171 %0 Journal Article %J American Journal of Preventive Medicine %D 2016 %T Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study. %A Cleopatra M Abdou %A Adam W. Fingerhut %A James S Jackson %A Felicia V Wheaton %K Age Factors %K Aged %K Ageism %K Attitude of Health Personnel %K depression %K Female %K Health Status %K Humans %K Hypertension %K Male %K Mental Health %K Middle Aged %K Overweight %K Physician-Patient Relations %K Physicians %K Prejudice %K Racism %K Sex Factors %K Socioeconomic factors %K Stereotyping %X

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

%B American Journal of Preventive Medicine %I 50 %V 50 %P 191-198 %G eng %N 2 %2 PMC4755717 %4 HEALTH CARE/Stereotypes/PHYSICIAN TRUST/Social identity/Social identity %$ 999999 %R 10.1016/j.amepre.2015.07.034 %0 Journal Article %J Survey Research Methods %D 2016 %T Helping Respondents Provide Good Answers in Web Surveys %A Mick P. Couper %A Zhang, Chan %K Methodology %X This paper reports on a series of experiments to explore ways to use the technology of Web surveys to help respondents provide well-formed answers to questions that may be difficult to answer. Specifically, we focus on the use of drop-down or select lists and JavaScript lookup tables as alternatives to open text fields for the collection of information on prescription drugs. The first two experiments were conducted among members of opt-in panels in the U.S. The third experiment was conducted in the 2013 Health and Retirement Study Internet Survey. Respondents in each of the studies were randomly assigned to one of three input methods: text field, drop box, or JavaScript lookup, and asked to provide the names of prescription drugs they were taking. We compare both the quality of answers obtained using the three methods, and the effort (time) taken to provide such answers. We examine differences in performance on the three input format types by key respondent demographics and Internet experience. We discuss some of the technical challenges of implementing complex question types and offer some recommendations for the use of such tools in Web surveys. %B Survey Research Methods %I 10 %V 10 %G eng %N 1 %4 Web survey/Instrument design/methodology %$ 999999 %R 10.18148/srm/2016.v10i1.6273 %0 Newspaper Article %B The Los Angeles Times %D 2016 %T Here's why dementia rates are falling across U.S. %A Szabo, Liz %K Dementia %K Health Conditions and Status %K News %K Older Adults %X The decline in dementia rates translates to about one million fewer Americans suffering from the condition, said John Haaga, director of behavioral and social research at the National Institute on Aging, part of the National Institutes of Health, which funded the new study. %B The Los Angeles Times %C Los Angeles %V 27 Nov 2016 %8 27 Nov 2016 %G eng %U http://www.dailynews.com/health/20161127/heres-why-dementia-rates-are-falling-across-us %0 Journal Article %J J Pain Symptom Manage %D 2016 %T High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. %A Christine S Ritchie %A Amy Kelley %A Irena Cenzer %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged, 80 and over %K Dementia %K depression %K Female %K Hip Fractures %K Humans %K Interviews as Topic %K Male %K multimorbidity %K pain %K Palliative care %K Patient Acceptance of Health Care %K Prodromal Symptoms %K Vulnerable Populations %X

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

%B J Pain Symptom Manage %V 52 %P 533-538 %8 2016 10 %G eng %U http://www.sciencedirect.com/science/article/pii/S0885392416302214 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27521282?dopt=Abstract %R 10.1016/j.jpainsymman.2016.07.003 %0 Journal Article %J Journal of Psychosomatic Research %D 2016 %T History of major depression as a barrier to health behavior changes after a chronic disease diagnosis %A Xiang, Xiaoling %K Demographics %K Health Conditions and Status %K Other %X Objective: To examine whether changes in smoking, drinking, and physical activity after a chronic disease diagnosis differ between middle-aged and older adults with and without a history of major depression. Methods: Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Chronic disease diagnosis was ascertained from self-reports of physician diagnosed diseases. Major depression was assessed by the short-form Composite International Diagnostic Interview. Mixed-effects logistic regressions were performed to estimate the potential moderating effect of a history of major depression. Results: Baseline major depression was associated with a more than 3-fold increase (OR = 4.48, 95 CI = 2.27 8.86) in the odds of smoking and 37 decrease (OR = 0.63, 95 CI = 0.52 0.75) in the odds of staying physically active, but not with odds of excessive drinking. After a chronic disease diagnosis, the odds of smoking was reduced by 75 (OR = 0.25, 95 CI = 0.20 0.32), the odds of excessive drinking was reduced by 47 (OR = 0.53, 95 CI = 0.47 0.61), and the odds of staying physically active was reduced by 30 (OR = 0.70, 95 CI = 0.63 0.78). There was a significant interaction effect for smoking such that the decline in the odds of smoking was smaller among adults with a history of major depression. Conclusion: Chronic disease diagnosis may be an important teachable moment for health behavior change, but the behavior changing effect may be smaller for those with a history of major depression especially when it comes to smoking. %B Journal of Psychosomatic Research %I 85 %V 85 %P 12-18 %G eng %U http://www.sciencedirect.com/science/article/pii/S0022399916301799 %4 health Behavior/Chronic Disease/Major depression/Teachable moment/Health behavior/Older adults %$ 999999 %R 10.1016/j.jpsychores.2016.04.001 %0 Journal Article %J Cesifo Economic Studies %D 2016 %T Housing Wealth and Retirement Timing %A Martin P. Farnham %A Purvi Sevak %K Employment and Labor Force %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Labor-supply effects of changes in house value are potentially important but empirically neglected. Using the panel Health and Retirement Study merged to local house prices from the Federal Housing Finance Agency, we estimate the effect of house-price changes on actual and planned retirement timing. While we find no effect of house-price changes on the annual probability of retiring, we find that people respond to rising house prices by revising down their expected retirement age. We estimate that a 10 real increase in house value reduces expected retirement age by about 4 months. Our findings suggest that movements in the housing market may have important labor supply implications, especially in areas experiencing steep price declines. %B Cesifo Economic Studies %I 62 %V 62 %P 26-46 %G eng %N 1 %4 retirement planning/labor Supply/House price fluctuations/labor Force Participation %$ 999999 %R 10.1093/cesifo/ifv015 %0 Magazine Article %D 2016 %T How Childhood Trauma Can Cause Premature Aging %A Jeffrey T Kullgren %K Aging %K Childhood adversity %K Health Conditions and Status %K Premature Aging %K Telomeres %B TIME %8 10/2016 %G eng %U http://time.com/4516605/telomeres-aging-childhood/ %0 Report %D 2016 %T How Do Job Skills That Decline With Age Affect White-Collar Workers? %A Belbase, Anek %A Geoffrey T. Sanzenbacher %A Gillis, Christopher M. %K Job Skills %K White Collar %K Work %X As people age, their reaction times slow, flexibility diminishes, and strength declines. These changes in physical and sensory abilities are easy to spot. Thus, research on retirement timing assumes that people in blue-collar jobs, which often rely on these abilities, will retire relatively early. Conversely, researchers often assume that white-collar workers can retire later. But the cognitive abilities needed for many white-collar jobs, like memory and mental speed, also decline with age. And some white-collar jobs also rely on physical or sensory abilities – for example, oral surgeons must have dexterous fingers, steady hands, and excellent eyesight. These observations raise an obvious question: can all white-collar workers remain productive well into their sixties and, if not, which jobs are most vulnerable to age-related decline? %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/how-do-job-skills-that-decline-with-age-affect-white-collar-workers/ %0 Journal Article %J Social Science and Medicine %D 2016 %T How does dementia onset in parents influence unmarried adult children's wealth %A Arora, Kanika %K Adult children %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %X There is a growing concern that long-term care (LTC) needs of older adults lead to negative financial consequences for their family members. This paper examines whether the onset of dementia in parents influences wealth change among unmarried adult children regardless of their status as informal caregivers. Longitudinal data from seven waves (1998-2010) of the Health and Retirement Study (1540 person-wave observations) are used to analyze this question. Unconditional quantile regressions demonstrate that as a result of parental dementia diagnosis, unmarried adult children have lower wealth accumulation above the median of the wealth change distribution. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent period as well. Both losses in labor income and nursing home expenditures may play a role in leading to wealth declines. %B Social Science and Medicine %I 152 %V 152 %P 156-165 %G eng %4 Long Term Care/Dementia/adult Children/informal caregiver/wealth Accumulation %$ 999999 %R 10.1016/j.socscimed.2016.01.042 %0 Journal Article %J Review of Financial Studies %D 2016 %T How Family Status and Social Security Claiming Options Shape Optimal Life Cycle Portfolios %A Hubener, Andreas %A Maurer, Raimond %A Olivia S. Mitchell %K Gender Differences %K Older Adults %K Retirement Planning and Satisfaction %K Social Security %X We show how optimal household decisions regarding work, retirement, saving, portfolio allocations, and life insurance are shaped by the complex financial options embedded in U.S. Social Security rules and uncertain family transitions. Our life cycle model predicts sharp consumption drops on retirement, an age-62 peak in claiming rates, and earlier claiming by wives versus husbands and single women. Moreover, life insurance is mainly purchased on men's lives. Our model, which takes Social Security rules seriously, generates wealth and retirement outcomes that are more consistent with the data, in contrast to earlier and less realistic models %B Review of Financial Studies %V 29 %P 937 - 978 %8 Jul-04-2016 %G eng %U http://rfs.oxfordjournals.org/lookup/doi/10.1093/rfs/hhv070 %N 4 %! Rev. Financ. Stud. %R 10.1093/rfs/hhv070 %0 Report %D 2016 %T How Has Pension Income Changed Between 1992 and 2010? %A Alicia H. Munnell %A Wenliang Hou %A Anthony Webb %A Yinji Li %X Using data from the 1992, 1998, 2004, and 2010 waves of the Health and Retirement Study (HRS), this paper compares pension participation, pension wealth, projected retirement income, and replacement rates attributable to past service, by pension type for households ages 51-56. The analysis includes workers’ pension coverage during both current and past jobs. Defined contribution (DC) wealth is simply the current account balance. DC income is calculated by projecting current plan balances to retirement, assuming no further contributions, and assuming that households then annuitize. Defined benefit (DB) wealth and income are calculated by apportioning projected benefits to past and future service. %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U http://crr.bc.edu/wp-content/uploads/2016/07/wp_2016-3.pdf %0 Newspaper Article %B The Washington Post %D 2016 %T How medical marijuana could help boomers get the most out of retirement %A Christopher Ingraham %K Baby Boomers %K Cannabis %K Older Adults %K Prescription Medication %K Retirement Planning and Satisfaction %B The Washington Post %8 10/04/2016 %G eng %U https://www.washingtonpost.com/news/wonk/wp/2016/10/04/how-medical-marijuana-could-help-boomers-get-the-most-out-of-retirement/ %0 Thesis %D 2016 %T How Might Differences in Immigration Experiences for Men and Women Lead to Gender Disparities in Functional Limitations for Older Mexican Immigrants in the U.S.? %A Stepler, Renee A. %Y Jones, Antwan %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %X A number of studies have shown that across all races and ethnicities women tend to have higher levels of functional limitations than men despite lower rates of mortality (Warner and Brown 2011; Solé-Auró et al. 2014). While several studies do incorporate Mexican-Americans and include nativity as a control, it is possible that Mexican-born immigrants' experiences differ from their U.S.-born counterparts in ways that may affect health later in life. Using longitudinal data from the Health and Retirement Study, this study investigates the factors that may account for differences in the strength and mobility limitations between older men and women who are Mexican immigrants living in the United States. These data indicate that socioeconomic status, chronic disease, and depressive symptoms serve as predictors for functional limitations later in life for Mexican-born men and women, and that each of these predictors serves as an explanation for differences in the functional status of these men and women. These findings extend research of gender disparities in morbidity by examining this subpopulation and highlight the importance of focusing on preventing comorbidities and depression, especially for women. %I The George Washington University %C Washington, DC %V 1606805 %P 63 %8 2016 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1758795190?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: %9 M.A. %M 1758795190 %4 0493:Aging %! How Might Differences in Immigration Experiences for Men and Women Lead to Gender Disparities in Functional Limitations for Older Mexican Immigrants in the U.S.? %0 Journal Article %J J Aging Health %D 2015 %T Harmonizing Measures of Cognitive Performance Across International Surveys of Aging Using Item Response Theory. %A Kitty S. Chan %A Alden L Gross %A Liliana E Pezzin %A Jason Brandt %A Judith D Kasper %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Female %K Humans %K Internationality %K Longitudinal Studies %K Male %K Psychological Theory %K Reproducibility of Results %K Surveys and Questionnaires %K United Kingdom %K United States %X

OBJECTIVE: To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies.

METHOD: Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items.

RESULTS: Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels.

DISCUSSION: IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items.

%B J Aging Health %I 27 %V 27 %P 1392-414 %8 2015 Dec %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/26526748?dopt=Abstract %4 ELSA_/item response theory/cognitive performance/Public Policy/Cognitive ability/Aging/cross-national comparison %$ 999999 %R 10.1177/0898264315583054 %0 Audiovisual Material %D 2015 %T The Health and Retirement Study: An Introduction %A Amanda Sonnega %K Meta-analyses %I Survey Research Center, University of Michigan %C Ann Arbor %G eng %U http://hrsonline.isr.umich.edu/index.php?p=trainvid1 %1 An online training video, available here. %6 11:54 %0 Thesis %D 2015 %T Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification %A Ndao-Brumblay, Sokhna Khady %K Health Conditions and Status %K Healthcare %K Methodology %X The current study focuses exclusively on middle-aged and old-aged adults with incident diabetes, and describes the course of diabetes in late adulthood in terms of physical, mental, and cognitive health change. To do this, it utilizes time-varying diabetes duration as the measure of time to define health trajectories after diabetes diagnosis. The study consists of three empirical analyses of the Health and Retirement Study, an ongoing representative biennial panel survey of Americans age 50 and older. Each study covers a different domain of health, and together they provide a comprehensive and dynamic view of people's experiences with diabetes. Hierarchical linear models of health change with longer diabetes duration (used as the measure of time), reveals that the course of diabetes is characterized by a quadratic acceleration in physical disability and a linear decline in mental and cognitive health. People who are older at the time of diagnosis, younger cohorts, women (due to lower socioeconomic status), blacks and Hispanics (partly due to socioeconomic disadvantage and health disparities before diagnosis) are generally at increased risk of a poor course of diabetes, when compared to their counterparts. Cumulative or persistent socioeconomic disadvantages were found for all outcomes, with worse health trajectories among older adults whose socioeconomic status was lower, with the exception of those in the top two income quartiles, who experienced a faster decline in mental health despite better scores at diagnosis. The study results confirm that diabetes cannot be viewed as a time-constant individual characteristic. Rather, the clinical course of diabetes in terms of physical, mental, and cognitive health changes with longer diabetes duration. Social variations in these changes need to be better understood so that effective healthcare and policy interventions can be devised to ensure successful and equitable aging with late-onset diabetes. %I University of Michigan %C Ann Arbor %G eng %4 Sociocultural Factors %! Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification %0 Journal Article %J J Gen Intern Med %D 2015 %T Health literacy and the digital divide among older Americans. %A Helen G Levy %A Alexander T Janke %A Kenneth M. Langa %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Digital Divide %K Female %K Health Literacy %K Humans %K Internet %K Male %K Prospective Studies %K Retrospective Studies %K Surveys and Questionnaires %K United States %X

BACKGROUND: Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy.

OBJECTIVE: The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older.

DESIGN: We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans.

PARTICIPANTS: Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users).

MAIN MEASURES: Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms.

KEY RESULTS: Only 9.7% of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9% of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR = 0.36 [95% CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR = 0.60 [95% CI 0.47 to 0.77]).

CONCLUSION: Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Web-based health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.

%B J Gen Intern Med %V 30 %P 284-9 %8 2015 Mar %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25387437?dopt=Abstract %4 health literacy/health literacy/electronic health records/internet use/sociodemographic characteristics/sociodemographic characteristics %$ 999999 %& 284 %R 10.1007/s11606-014-3069-5 %0 Journal Article %J Journal of Sociology and Social Welfare %D 2015 %T Health Status, Medicare Part D Enrollment, and Prescription Drug Use among Older Adults %A Jin H. Kim %K Medicare/Medicaid/Health Insurance %K Public Policy %X To account for potential selection factors in the observed relationship between Medicare Part D coverage and prescription drug use, this study uses data from the 2010 and 2012 waves of the Health and Retirement Study (HRS) to first examine the determinants of Medicare Part D enrollment, paying particular attention to the role of functional health status on the enrollment decision. Next, the study assesses whether and to what extent Medicare Part D coverage moderates the effect of functional health status on prescription drug use and monthly out-of-pocket spending among older adults. As prior studies indicate, the findings reveal that individuals who take up Medicare Part D have poorer (functional) health relative to nonparticipants, and thus, exhibit greater demand for prescription drugs. Taking functional health status into account, Medicare Part D coverage is significantly associated with greater prescription drug use among those with few health limitations, and is also significantly associated with greater out-of-pocket spending among those with the most health limitations. Thus, while prior studies have compared Medicare eligible- to non-eligible individuals to find that Medicare Part D coverage significantly lowers out-ofpocket costs, and therefore, increases prescription drug use, this study compared Medicare Part D enrollees to eligible non-enrollees to generate findings that imply that the presumed effect of Medicare Part D coverage on prescription drug use may be spurious. In turn, advocacy efforts may be best directed at ensuring that the existing coverage gaps in Medicare Part D are continually addressed. %B Journal of Sociology and Social Welfare %I 42 %V 42 %P 163-184 %G eng %N 1 %4 health insurance/access to and utilization of services/health care policy/medicare Part D %$ 999999 %0 Journal Article %J The Gerontologist %D 2015 %T HEALTHY AGING IN OLDER ADULTS: THE ROLE OF CHILDHOOD CIRCUMSTANCES AND LIFECYCLE FACTORS %A Nasim B Ferdows %A Gail A Jensen %A Wassim Tarraf %K childhood effects %K healthy aging %K lifecycle factors %X Objectives. We examine the direct and indirect effects of childhood and later-life circumstances on “healthy aging” among U.S adults ages 65-years and older. Methods. Using 2010 Health and Retirement Study data, we estimate “healthy aging” as the output of a health production function, produced by childhood health and socioeconomic status, adult socioeconomic achievements, health habits and pertinent demographics. In addition to the direct effects of these factors on healthy aging, we examine the indirect effects of childhood factors that operate through adult achievements. Results. The proportion of respondents satisfying our criteria for “healthy aging” was 0.12. Good childhood health status (vs. average) had both a positive direct effect (0.0461; p\<0.01) and indirect effect (0.0026; p\<0.05) on healthy aging, for a total effect of 0.0487. The direct effect of father’s education (0.0166; p=0.161) and mother’s education (0.0177; p=0.128) were not significant. However, having a father with a high-school or above education (0.0047; p\<0.05), having a mother with a high-school or above education (0.0054; p\<0.05) had clear indirect positive effects on healthy aging. Finally, respondent’s own education, personal finances, and all current period health habits were also strongly associated with healthy aging. Conclusion. Our findings complement available research on the health of US older adults by showing that healthy aging is a function of both childhood and adult factors and later life habits. The pathways from childhood factors to healthy aging, however, could be more complex than previously reported. %B The Gerontologist %V 55 %P 576-577 %8 10 %G eng %U https://doi.org/10.1093/geront/gnv287.05 %R 10.1093/geront/gnv287.05 %0 Journal Article %J Dev Psychol %D 2015 %T Historical improvements in well-being do not hold in late life: Birth- and death-year cohorts in the United States and Germany. %A Hülür, Gizem %A Ram, Nilam %A Denis Gerstorf %K Aged %K Aging %K Cohort Effect %K depression %K Epidemiologic Research Design %K Female %K Germany %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Propensity Score %K United States %X

One key objective of life span research is to examine how individual development is shaped by the historical time people live in. Secular trends favoring later-born cohorts on fluid cognitive abilities have been widely documented, but findings are mixed for well-being. It remains an open question whether secular increases in well-being seen in earlier phases of life also manifest in the last years of life. To examine this possibility, we made use of longitudinal data obtained from the mid-1980s until the late 2000s in 2 large national samples in the United States (Health and Retirement Study [HRS]) and Germany (German Socio-Economic Panel [SOEP]). We operationally defined historical time from 2 complementary perspectives: birth-year cohorts based on the years in which people were born (earlier: 1930s vs. later: 1940s) and death-year cohorts based on the years in which people died (earlier: 1990s vs. later: 2000s). To control for relevant covariates, we used case-matched groups based on age (at death) and education and covaried for gender, health, and number of observations. Results from both countries revealed that well-being in old age was indeed developing at higher levels among later-born cohorts. However, for later-deceased cohorts, no evidence for secular increases in well-being was found. To the contrary, later-dying SOEP participants reported lower levels of well-being at age 75 and 2 years prior to death and experienced steeper late-life declines. Our results suggest that secular increases in well-being observed in old age do not manifest in late life, where "manufactured" survival may be exacerbating age- and mortality-related declines.

%B Dev Psychol %I 51 %V 51 %P 998-1012 %8 2015 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26098582?dopt=Abstract %2 PMC4654950 %4 life span research/Cognitive ability/cross-national comparison/well being %$ 999999 %R 10.1037/a0039349 %0 Journal Article %J Journal of Urban Economics %D 2015 %T Home safety, accessibility, and elderly health: Evidence from falls %A Michael D. Eriksen %A Nadia Greenhalgh-Stanley %A Gary V. Engelhardt %K Demographics %K Health Conditions and Status %K Housing %X This article presents estimates of the impact of home safety and accessibility features on the prevention of serious, non-fatal falls for elderly widowed individuals. As these features are not randomly assigned across homes, we develop an instrumental variable (IV) strategy that relies on the differential decline in the health and functional status of spouses to identify impacts. Specifically, we use the deceased spouse's functional status when alive, as measured by limits to Activities of Daily Living (ADLs), as an IV for the presence of home safety and accessibility features for the surviving spouse in the years after widowhood, and then estimate the effect of these features on the likelihood of a serious fall for the widow using rich longitudinal data from the Health and Retirement Study. The presence of such features reduces the likelihood of a fall requiring medical treatment by 20 percentage points, a substantial effect. However, falls are not the type of health shock that is a main driver of housing tenure transitions among the elderly. Although somewhat speculative, cost-benefit estimates suggest that investments in home safety for the elderly may generate in the short run as much as a dollar-for-dollar reduction in medical expenditures. 2015 Elsevier Inc. %B Journal of Urban Economics %I 87 %V 87 %P 14-24 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84925115488andpartnerID=40andmd5=23c0b0e89704119885a5a625aeca4bc0 %4 ADL/IADL/Elderly/Health/Housing %$ 999999 %R 10.1016/j.jue.2015.02.003 %0 Journal Article %J Am J Respir Crit Care Med %D 2015 %T Hospitalization Type and Subsequent Severe Sepsis. %A Hallie C Prescott %A Dickson, R. P. %A Mary A M Rogers %A Kenneth M. Langa %A Lwashyna, T. J. %K Aged %K Aged, 80 and over %K Anti-Bacterial Agents %K Clostridioides difficile %K Dysbiosis %K Enterocolitis, Pseudomembranous %K Female %K Hospitalization %K Humans %K Incidence %K Information Storage and Retrieval %K Longitudinal Studies %K Male %K Medicare %K Patient Readmission %K Retrospective Studies %K Risk Factors %K Sepsis %K United States %X

RATIONALE: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials.

OBJECTIVES: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge.

METHODS: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998-2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non-infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison.

MEASUREMENTS AND MAIN RESULTS: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study-Medicare participants. In the 90 days following non-infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8-4.4%), 7.1% (95% CI, 6.6-7.6%), and 10.7% (95% CI, 7.7-13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non-infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI.

CONCLUSIONS: There is a strong dose-response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present for rehospitalization for nonsepsis diagnoses.

%B Am J Respir Crit Care Med %I 192 %V 192 %P 581-8 %8 2015 Sep 01 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26016947?dopt=Abstract %4 humans/microbiota/self-controlled case series/patient readmission/dysbiosis/CLOSTRIDIUM-DIFFICILE INFECTION/RESPIRATORY SYSTEM/COMMUNITY/PNEUMONIA/CRITICAL CARE MEDICINE/METAANALYSIS/INTESTINAL MICROBIOTA/GUT MICROBIOTA/ANTIBIOTIC-TREATMENT/DISEASE/PREMATURE-INFANTS/FECAL MICROBIOTA TRANSPLANTATION/Enterocolitis, Pseudomembranous - epidemiology/Dysbiosis - epidemiology/Sepsis - epidemiology/Anti-Bacterial Agents - therapeutic use/Hospitalization - statistics/numerical data/Patient Readmission - statistics/numerical data %$ 999999 %R 10.1164/rccm.201503-0483OC %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study. %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Activities of Daily Living %K African Continental Ancestry Group %K Disability Evaluation %K European Continental Ancestry Group %K Hispanic Americans %K Homes for the Aged %K Humans %K Nursing homes %K Proportional Hazards Models %K Socioeconomic factors %K United States %X

OBJECTIVES: This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups.

METHOD: We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952).

RESULTS: Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups.

DISCUSSION: Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 628-38 %8 2015 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/09/08/geronb.gbu114.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25204311?dopt=Abstract %2 PMC4462672 %4 Hispanic ethnicity/Long-term care/Nursing homes/ethnicity/race/ethnic differences %$ 999999 %R 10.1093/geronb/gbu114 %0 Journal Article %J Journal of Gerontological Social Work %D 2015 %T How Large Is the Gap Between Self-Report and Assessed Mental Health and Does It Impact Older Adult Mental Health Service Utilization? %A Lee, Hyo Jung %A Dugan, Elizabeth %K Demographics %K Health Conditions and Status %X We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N=9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization. %B Journal of Gerontological Social Work %I 58 %V 58 %P 3-19 %G eng %U http://dx.doi.org/10.1080/01634372.2014.919978 %N 1 %4 depression/memory problem/mental health service utilization/patient self-report/older adults %$ 999999 %R 10.1080/01634372.2014.919978 %0 Journal Article %J Journal of Pension Economics and Finance %D 2015 %T How much do respondents in the health and retirement study know about their contributions to tax-deferred contribution plans? A cross-cohort comparison %A Irena Dushi %A Honig, Marjorie %K Employment and Labor Force %K Pensions %K Social Security %X We use information from Social Security earnings records to examine the accuracy of survey responses regarding participation in tax-deferred pension plans. As employer-provided defined benefit pensions are replaced by voluntary contribution plans, employees' understanding of the link between their annual contributions and their post-retirement wealth is becoming increasingly important. We examine the extent to which wage-earners in the Health and Retirement Study (HRS) correctly report their inclusion in tax-deferred contribution plans and, conditional on inclusion, their annual contributions. We use three samples representing different cohorts in three different periods: the original HRS cohort interviewed in 1992 at ages 51-56, the War Babies cohort interviewed in 1998 at ages 51-56, and the Early Baby Boomer cohort interviewed in 2004 at the same ages. Our findings indicate that while respondents interviewed in 1998 and 2004 were more likely to correctly report whether they were included in defined contribution plans, they were no more accurate when reporting whether they had contributed to their plans than respondents interviewed in 1992. Contributors in the three cohorts, moreover, overstated their annual contributions and thus would be likely to realize lower than expected account balances at retirement. The magnitude of this error is not negligible. In all three cohorts, the mean reporting error (the absolute difference between respondent-reported and Social Security earnings record contributions) was approximately 1.5 times larger than the mean contribution in the W-2 earnings record. Copyright Cambridge University Press 2014 This is a work of the U.S. Government and is not subject to copyright protection in the United States. %B Journal of Pension Economics and Finance %I 14 %V 14 %P 203-239 %G eng %N 3 %4 DC plans/employee knowledge/tax-deferred contributions/W-2 records %$ 999999 %R 10.1017/S1474747214000237 %0 Report %D 2015 %T How Much Longer Do People Need to Work? %A Alicia H. Munnell %A Anthony Webb %A Anqi Chen %K Consumption and Savings %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Working longer is a powerful lever to enhance retirement security. Individuals should be able to extend the number of years they work because, on average, they are healthier, live longer, and face less physically demanding jobs. But averages are misleading when discrepancies in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). To understand the magnitude of the problem, this paper, using data from the Health and Retirement Study (HRS), specifies how much longer households in each SES quartile would need to work to maintain their pre-retirement standard of living and compares those optimal retirement ages with their planned retirement ages to calculate a retirement gap. It then uses regression analysis to explore whether the gaps reflect poor circumstances or poor planning that is, the extent to which the retirement gap results from health, employment, and marital shocks that occur before the HRS interview but too late for the household to adjust saving (between ages 50 and 58), as opposed to a gap resulting from inadequate foresight. The analysis shows that households in lower-SES quartiles have larger retirement gaps, and this pattern remains true even after controlling for late-career shocks. In short, the most vulnerable have the largest retirement gaps, and these gaps arise from poor planning rather than late-career shocks. %I Boston, Center for Retirement Research at Boston College %G eng %4 retirement planning/labor Force Participation/retirement security/retirement security/socioeconomic Status/Standard of living/Standard of living/health shocks %$ 999999 %0 Journal Article %J PLoS One %D 2015 %T How old do you feel? The role of age discrimination and biological aging in subjective age. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Aerobiosis %K Aged %K Aged, 80 and over %K Aging %K Cardiovascular Physiological Phenomena %K Cellular Senescence %K Discrimination, Psychological %K Emotions %K Female %K Humans %K Male %K Middle Aged %K Muscle Strength %K Perception %X

Subjective age, or how young or old individuals experience themselves to be relative to their chronological age, is a crucial construct in gerontology. Subjective age is a significant predictor of important health outcomes, but little is known about the criteria by which individuals' subjectively evaluate their age. To identify psychosocial and biomedical factors linked to the subjective evaluation of age, this study examined whether perceived age discrimination and markers of biological aging are associated with subjective age. Participants were 4776 adults (Mage = 68) from the 2008 and 2010 waves of the Health and Retirement Study (HRS) who completed measures of subjective age, age discrimination, demographic variables, self-rated health and depression, and had physical health measures, including peak expiratory flow, grip strength, waist circumference, systolic and diastolic blood pressure. Telomere length was available for a subset of participants in the 2008 wave (n = 2214). Regression analysis indicated that perceived age discrimination, lower peak expiratory flow, lower grip strength, and higher waist circumference were associated with an older subjective age, controlling for sociodemographic factors, self-rated health, and depression. In contrast, blood pressure and telomere length were not related to subjective age. These findings are consistent with the hypothesis that how old a person feels depends in part on psychosocial and biomedical factors, including the experiences of ageism and perceptible indices of fitness and biological age.

%B PLoS One %I 10 %V 10 %P e0119293 %8 2015 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25738579?dopt=Abstract %2 PMC4349738 %4 subjective age/health outcomes/psychosocial factors/psychosocial factors/biomedical factors/Biological aging %$ 999999 %R 10.1371/journal.pone.0119293 %0 Thesis %D 2015 %T How socioeconomic status shapes health: Essays on the biological and social determinants of human welfare at older ages %A Lauren L Schmitz %Y Teresa Ghilarducci %K Demographics %K Employment and Labor Force %K Genetics %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %X Economic and epidemiological research has long established that socioeconomic status (SES) and the core characteristics that define it--education, earnings, and occupation--are strongly associated with health and mortality. However, the actual pathway these interventions and life circumstances take to affect health is not well known, and more research is needed to identify how socioeconomic-related health disparities develop and "get underneath the skin." This dissertation considers the influence of early- and late-life occupational stressors in tandem with genetic inheritances and other elements of SES to better understand how biological and social determinants cumulate over the life span and affect the health of greying populations. The first chapter explores whether characteristics of the physical and psychosocial work environment shape the health gradient in the years leading up to retirement. Dynamic panel and instrumental variable (IV) methods are used in combination with a rich data set that combines demographic information from the Health and Retirement Study (HRS), expert ratings on job characteristics from the Occupational Information Network (O*NET), and W-2 earnings records to draw more robust connections between workplace demands and health at older ages. Results indicate physical demands, environmental hazards, and conditions of the psychosocial work environment are all associated with health outcomes after age 50. In particular, there is a strong relationship between the degree of control and influence exercised on the job and improved self-reported health status, blood pressure, musculoskeletal conditions, cognitive function, and depression. The second two chapters use IV methods that exploit an exogenous shock to occupation at a young age--the Vietnam-era draft lotteries--to investigate genotype-by-environment interactions. Instrumented veteran status is interacted with polygenic scores for smoking initiation and educational attainment to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on health behaviors, educational attainment, earnings, and labor force participation at older ages. Results reveal conscription both amplified polygenic risk for smoking and moderated the socioeconomic attainment of veterans, indicating genetic inheritances further mediate the gestation of health disparities across the life course. %I The New School %C New York %V 3707744 %P 163 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1696935312?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ %9 Ph.D. %M 1696935312 %4 0501:Economics %! How socioeconomic status shapes health: Essays on the biological and social determinants of human welfare at older ages %0 Journal Article %J Journal of Housing Economics %D 2015 %T How well do individuals predict the selling prices of their homes? %A Hugo Benítez-Silva %A Selçuk Eren %A Frank Heiland %A Jimenez-Martin, Sergi %K Housing %K Methodology %X The accuracy of property values estimated by homeowners is an open empirical question that requires an evaluation of the reported values using a market assessment. Using information on selling prices from the Health and Retirement Study and the American Housing Survey, and after accounting for possible measurement error in reporting and selection regarding those who we observe selling, we find evidence that homeowners overestimate the value of their properties by around 8 with an estimated range between 3.4 and 12.7 (95 CI). 2015. %B Journal of Housing Economics %I 29 %V 29 %P 12-25 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84936102548andpartnerID=40andmd5=17ba0e3e060e90bbe8714681ba524863 %4 American Housing Survey/Health and Retirement Study/Housing prices/Instrumental variables/Panel data/Self-reported housing values %$ 999999 %R 10.1016/j.jhe.2015.04.001 %0 Thesis %D 2014 %T Health and Living Arrangements among Older Adults in Diverse Social and Cultural Contexts %A BoRin Kim %K Adult children %K Cross-National %K Demographics %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %X 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. %I University of Michigan %C Ann Arbor, MI %G eng %4 social isolation %$ 999999 %! Health and Living Arrangements among Older Adults in Diverse Social and Cultural Contexts %0 Journal Article %J Open Health Data %D 2014 %T The Health and Retirement Study: A Public Data Resource for Research on Aging %A Amanda Sonnega %A David R Weir %K Data methods %K Survey Methodology %X The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37,000 individuals in 23,000 households over age 50 in the United States. Fielded biennially since 1992, it was established to provide a national resource for data on the changing health and economic circumstances associated with aging. HRS covers four broad topic areas—income and wealth; health, cognition, and use of health care services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran’s Administration, the National Death Index, and employer-provided pension plan information. In 2006, data collection expanded to include biomarkers and genetics and greater depth in psychosocial well-being and social context. This blend of economic, health, and psychosocial information provides unprecedented potential to study increasingly complex questions about aging and retirement. HRS prioritizes rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data—public, sensitive, and restricted—can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu). %B Open Health Data %V 2 %8 Apr-10-2015 %G eng %U http://openhealthdata.metajnl.com/articles/10.5334/ohd.am/ %N 1 %R 10.5334/ohd.am %0 Journal Article %J Journal of Human Resources %D 2014 %T The Health Consequences of Retirement %A Insler, Michael %K health %K Retirement %X This paper examines the impact of retirement on individuals’ health. Declines in health commonly compel workers to retire, so the challenge is to disentangle the simultaneous causal effects. The estimation strategy employs an instrumental variables specification. The instrument is based on workers’ self-reported probabilities of working past ages 62 and 65, taken from the first period in which they are observed. Results indicate that the retirement effect on health is beneficial and significant. Investigation into behavioral data, such as smoking and exercise, suggests that retirement may affect health through such channels. With additional leisure time, many retirees practice healthier habits. %B Journal of Human Resources %V 49 %P 195-233 %G eng %N 1 %R doi: 10.3368/jhr.49.1.195 %0 Journal Article %J PLoS One %D 2014 %T The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease? %A Stefan Walter %A M. Maria Glymour %A Mauricio Avendano %K Aged %K Cardiovascular Diseases %K Female %K Geography %K Humans %K Incidence %K Insurance Benefits %K Insurance, Health %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Unemployment %K United States %X

OBJECTIVE: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk.

METHODS: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk.

RESULTS: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models.

CONCLUSION: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

%B PLoS One %I 9 %V 9 %P e101193 %8 2014 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25025281?dopt=Abstract %2 PMC4098914 %4 Unemployment insurance/Cardiovascular disease/unemployment insurance %$ 999999 %R 10.1371/journal.pone.0101193 %0 Thesis %D 2014 %T Health insurance coverage and personal behavior %A Chen, Tianxu %Y Ellis, Randall P. %K Adult children %K Medicare/Medicaid/Health Insurance %K Methodology %X Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause "marriage lock," in which couples stay married for the sake of health insurance coverage, and marriage lock may change under the Affordable Care Act. In the first two chapters, marriage lock is examined in the context of two key health insurance decisions: divorce decisions upon qualification for Medicare at age 65, and marriage and divorce decisions associated with the introduction of the Massachusetts insurance mandate and health insurance exchange market reforms in 2006. In the first chapter, using the Health and Retirement Study data, I find evidence of a 7 percentage point increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. In the second chapter, using the American Community Survey data, I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchange market relative to control states. Specifically, the Massachusetts reform appears to have reduced the divorce rate by 0.5 percentage point and increased marriage rate by 1.4 percentage points. In the third chapter, I use data from the China Household Finance Survey (CHFS) to explore three decisions potentially affected by the implementation of Medical Savings Accounts (MSAs). First, I find that individuals with MSAs incur 17 RMB more medical expenses per 1000 RMB increase in their MSAs balance, while I find no significant effect of after-tax income on medical expenses. Second, I study preference heterogeneity as revealed by three types of risky behaviors. I find undertaking risky investments is associated with 23% more medical expenditures, while always using a seatbelt and obeying traffic signals are associated with 16% and 22% higher medical expenditures, respectively. Finally, I find evidence suggesting that individuals become more risk adverse with MSAs than without, specifically by increasing their use of seatbelts and obeying traffic signals. These findings, using recent Chinese data, suggest that MSAs play an important role when consumers make health expenditure decisions, and that preferences involving risk and prevention also appear to be influenced by the MSA scheme. %I Boston University %C Boston %V 3626040 %P 115 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1556761296?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: %9 Ph.D. %M 1556761296 %4 Preference heterogeneity %$ 999999 %! Health insurance coverage and personal behavior %0 Thesis %D 2014 %T Health Literacy and Related Psychosocial Factors and Measurement Issues: A Qualitative Study and a Secondary Analysis of the Health and Retirement Study %A Dena M. Fernandez %K Health Conditions and Status %K Methodology %X 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. %I University of Michigan %C Ann Arbor, MI %G eng %4 cognitive interviews %! Health Literacy and Related Psychosocial Factors and Measurement Issues: A Qualitative Study and a Secondary Analysis of the Health and Retirement Study %0 Journal Article %J Med Decis Making %D 2014 %T Health numeracy: the importance of domain in assessing numeracy. %A Helen G Levy %A Peter A. Ubel %A Amanda J. Dillard %A David R Weir %A Angela Fagerlin %K Aged %K Humans %K Mathematics %K Middle Aged %K Self Efficacy %K Surveys and Questionnaires %K Task Performance and Analysis %X

BACKGROUND AND OBJECTIVE: Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain.

METHODS: Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

RESULTS: We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

CONCLUSIONS: These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

%B Med Decis Making %I 34 %V 34 %P 107-15 %8 2014 Jan %G eng %U http://mdm.sagepub.com/content/34/1/107.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23824401?dopt=Abstract %4 Health Numeracy/Health Literacy/Health Literacy/Cognition %$ 999999 %R 10.1177/0272989X13493144 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2014 %T Heterogeneity in healthy aging. %A David J Lowsky %A S Jay Olshansky %A Bhattacharya, Jay %A Dana P Goldman %K Aged %K Aged, 80 and over %K Aging %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Population Surveillance %K Quality of Life %K Retrospective Studies %K United States %X

For a surprisingly large segment of the older population, chronological age is not a relevant marker for understanding, measuring, or experiencing healthy aging. Using the 2003 Medical Expenditure Panel Survey and the 2004 Health and Retirement Study to examine the proportion of Americans exhibiting five markers of health and the variation in health-related quality of life across each of eight age groups, we find that a significant proportion of older Americans is healthy within every age group beginning at age 51, including among those aged 85+. For example, 48% of those aged 51-54 and 28% of those aged 85+ have excellent or very good self-reported health status; similarly, 89% of those aged 51-54 and 56% of those aged 85+ report no health-based limitations in work or housework. Also, health-related quality of life ranges widely within every age group, yet there is only a comparatively small variation in median quality of life across age groups, suggesting that older Americans today may be experiencing substantially different age-health trajectories than their predecessors. Patterns are similar for medical expenditures. Several policy implications are explored.

%B J Gerontol A Biol Sci Med Sci %I 69 %V 69 %P 640-9 %8 2014 Jun %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2013/11/13/gerona.glt162.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24249734?dopt=Abstract %2 PMC4022100 %4 Healthy Aging/Quality of Life/Compression of Morbidity %$ 999999 %R 10.1093/gerona/glt162 %0 Book Section %B Essential Demographic Methods %D 2014 %T Heterogeneous Risks %A Kenneth W. Wachter %K Demographics %K Methodology %K Public Policy %X ...uses themes from the individual lifecourse, history, and global change to convey the meaning of concepts such as exponential growth, cohorts and periods, lifetables, population projection, proportional hazards, parity, marity, migration flows, and stable populations. %B Essential Demographic Methods %I Harvard University Press %C Cambridge, MA %P 174-200 %@ 9780674045576 %G eng %4 demography/Demographic aspects/Public Health/social sciences %$ 999999 %! Heterogeneous Risks %& 8 %0 Journal Article %J Am J Geriatr Psychiatry %D 2014 %T History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study. %A Kuźma, Elżbieta %A David J Llewellyn %A Kenneth M. Langa %A Robert B Wallace %A Iain A Lang %K Alcohol-Related Disorders %K Cognition Disorders %K Diagnosis, Dual (Psychiatry) %K Female %K Humans %K Incidence %K Male %K Memory Disorders %K Middle Aged %K Prospective Studies %K Risk Factors %K United States %X

OBJECTIVE: To assess the effects of a history of alcohol use disorders (AUDs) on risk of severe cognitive and memory impairment in later life.

METHODS: We studied the association between history of AUDs and the onset of severe cognitive and memory impairment in 6,542 middle-aged adults born 1931 through 1941 who participated in the Health and Retirement Study, a prospective nationally representative U.S. cohort. Participants were assessed at 1992 baseline and follow-up cognitive assessments were conducted biannually from 1996 through 2010. History of AUDs was identified using the three-item modified CAGE questionnaire. Cognitive outcomes were assessed using the 35-item modified Telephone Interview for Cognitive Status at last follow-up with incident severe cognitive impairment defined as a score ≤ 8, and incident severe memory impairment defined as a score ≤ 1 on a 20-item memory subscale.

RESULTS: During up to 19 years of follow-up (mean: 16.7 years, standard deviation: 3.0, range: 3.5-19.1 years), 90 participants experienced severe cognitive impairment and 74 participants experienced severe memory impairment. History of AUDs more than doubled the odds of severe memory impairment (odds ratio [OR] = 2.21, 95% confidence interval [CI] = 1.27-3.85, t = 2.88, df = 52, p = 0.01). The association with severe cognitive impairment was statistically non-significant but in the same direction (OR = 1.80, 95% CI = 0.97-3.33, t = 1.92, df = 52, p = 0.06).

CONCLUSION: Middle-aged adults with a history of AUDs have increased odds of developing severe memory impairment later in life. These results reinforce the need to consider the relationship between alcohol consumption and cognition from a multifactorial lifespan perspective.

%B Am J Geriatr Psychiatry %I 22 %V 22 %P 1047-54 %8 2014 Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S1064748114001675 %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25091517?dopt=Abstract %2 PMC4165640 %4 Alcohol use disorders/memory impairment/cognitive impairment/cognitive ability/alcohol consumption %$ 999999 %R 10.1016/j.jagp.2014.06.001 %0 Thesis %D 2014 %T A holistic approach to understanding retirement preparedness %A Yook, Miyoung %Y Britt, Soyna %K Adult children %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %K Social Security %X 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. %I Kansas State University %C Manhattan, KS %V 3639324 %P 258 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1621575221?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: %9 Ph.D. %M 1621575221 %4 individual and family studies %$ 999999 %! A holistic approach to understanding retirement preparedness %0 Journal Article %J Health Affairs %D 2014 %T Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death %A Feng, Zhanlian %A Coots, Laura A. %A Kaganova, Yevgeniya %A Joshua M Wiener %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X Hospitalizations and emergency department (ED) visits for people with Alzheimer s disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000 08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable. %B Health Affairs %I 33 %V 33 %P 683-690 %G eng %U http://content.healthaffairs.org/content/33/4/683.abstract %N 4 %4 Hospitalization/Emergency department/Alzheimers dementia/Long-Term Care/Medicare/Medicaid/Chronic Care %$ 999999 %R 10.1377/hlthaff.2013.1179 %0 Journal Article %J The journals of gerontology. Series B, Psychological sciences and social sciences %D 2014 %T Housing wealth, psychological well-being, and cognitive functioning of older Americans %A Hamoudi, Amar %A Jennifer B Dowd %K Demographics %K Health Conditions and Status %K Housing %K Other %X 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. %B The journals of gerontology. Series B, Psychological sciences and social sciences %I 69 %V 69 %P 253-62 %G eng %N 2 %4 Core clinical journals/Index Medicus/Cognition/Housing/Mental health/Psychological health/Socioeconomic status/Geography %$ 999999 %R 10.1093/geronb/gbt114 %0 Journal Article %J EBRI Notes %D 2014 %T How Does Household Expenditure Change With Age for Older Americans? %A Sudipto Banerjee %K Consumption and Savings %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %K Retirement Planning and Satisfaction %X 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. %B EBRI Notes %I 35 %V 35 %P 2-11 %G eng %N 9 %4 Consumption/Health care costs/Household expenditure/Household income/Retirement planning/Spending %$ 999999 %0 Report %D 2014 %T How Does Increased Longevity for Men Affect Well-Being for Their Wives in Old Age? %A Matthew S. Rutledge %A April Yanyuan Wu %A Orlova, Natalia S. %K gender %K Longevity %K Marital Relations %X The marked increase in male longevity and the shrinking gap in male-female life expectancy in recent decades should improve the financial outcomes of older women, but this improvement may be dampened if the growth in medical spending and the incidence of disability translates to living husbands burdening the family’s budget. Using the Health and Retirement Study and an endogenous switching model to account for non-random selection into widowhood, we find that widows are worse off than non-widows, and that women whose husbands die young have worse financial outcomes. But his survival, if accompanied by ill health, hurts women’s financial well-being substantially: women married to men in poor health or with limitations in their daily activities have lower income and are more likely to fall below the poverty line, especially while the husband is still alive. We also find that high end-of-life health care costs deplete the wealth that the husband leaves his widow. Finally, we find that being poor in the past is more closely correlated with financial outcomes for married women than it is for widows, suggesting that widowhood may actually break the poverty cycle for some women. The results emphasize the importance of policies like Social Security survivor benefits and Medicaid but also suggest that older couples may need further help to better manage an aging husband’s care needs. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/how-does-increased-longevity-for-men-affect-well-being-for-their-wives-in-old-age/ %0 Thesis %D 2014 %T How does personality contribute to retirement savings? %A Chan, Wai %Y Christ, Sharon L. Mroczek Daniel K. %K Adult children %K Health Conditions and Status %K Methodology %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %X 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. %I Purdue University %C West Lafayette, IN %V 3668774 %P 189 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1645735812?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/Dissertations+%26+Theses+%40+CIC+Institutions&rft_val_fmt=info:of %9 Ph.D. %M 1645735812 %4 public Policy %$ 999999 %! How does personality contribute to retirement savings? %0 Journal Article %J Journal of health economics %D 2014 %T How does retiree health insurance influence public sector employee saving? %A Robert Clark %A Olivia S. Mitchell %K Demographics %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %X Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: %B Journal of health economics %I 38 %V 38 %P 109-18 %G eng %4 Benefit/wealth tradeoff/Retiree health insurance/State and local employees/Federal employees/Retiree medical costs/retirement planning/Public Policy %$ 999999 %R 10.1016/j.jhealeco.2014.03.014 %0 Journal Article %J Journal of Pension Economics and Finance %D 2014 %T How is economic hardship avoided by those retiring before the Social Security entitlement age? %A Kevin Milligan %K Health Conditions and Status %K Income %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %K Social Security %X 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. %B Journal of Pension Economics and Finance %I 13 %V 13 %P 420-438 %G eng %N 4 %4 pensions/poverty/retirement/Social Security/old age pensions/pension income/annuity income/household income %$ 999999 %R 10.1017/S1474747214000171 %0 Thesis %D 2014 %T Human, Social and Cultural Capital Predictors of Early Baby Boomer Productivity in Mid- to Late Life: An Examination of Formal Volunteering Behavior %A Nowell, William Benjamin %Y Burnette, Jacqueline D. %K Adult children %K Demographics %K Healthcare %K Net Worth and Assets %K Other %K Public Policy %X Productive activity supports successful aging by helping to maintain older adults' cognitive and physical functioning and active engagement in life. This study examines the human, social and cultural resources that contribute to productive activity, specifically formal volunteering, among Early Baby Boomers (EBB) during the transition from mid-life to late life. Four time points across 6 years from a sample of 2,684 EBBs aged 51 and older from the Health and Retirement Study (2004-2010) were analyzed using logistic regression and generalized estimating equations. Baseline and longitudinal human, social and cultural capital factors and demographic variables functioned as predictors of formal volunteer engagement and its intensity. High levels of cultural capital, defined as religiosity, significantly increased the likelihood of both formal volunteer engagement and high intensity volunteering. Greater human capital and some forms of social capital also boosted the probability of volunteer engagement, but higher levels of one component of social capital (paid employment) significantly reduced the likelihood of high intensity volunteering. Volunteer engagement and intensity were stable during the observed period, in spite of the Great Recession during the latter waves of data. Gender appeared to have no effect on the likelihood of volunteer engagement or intensity. The distribution of human, social and cultural resources was associated with differences in mid- to late life productivity among EBBs, and productive activities of formal volunteering and paid employment appear to compete for their time. Exploring the unique contributions of aspects of education and religion to volunteerism in future research may lead to more inclusive public policy and programs that facilitate the participation of individuals from a wider array of backgrounds. Such efforts can increase opportunities for formal volunteering among persons transitioning from mid- to late life. %I Columbia University %C New York %V 3617751 %P 178 %8 2014 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1527486354?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat %9 Ph.D. %M 1527486354 %4 Social work %$ 999999 %! Human, Social and Cultural Capital Predictors of Early Baby Boomer Productivity in Mid- to Late Life: An Examination of Formal Volunteering Behavior %0 Journal Article %J Californian Journal of Health Promotion %D 2013 %T Health and Functional Limitations Predict Depression Scores in the Health and Retirement Study: Results Straight from MARS %A Robert F. Kennison %A Cox, John %K Health Conditions and Status %K Methodology %X To examine the effects of chronic health conditions and functional status limitations on depression scores in a large representative sample of Americans. Method: The data included 27,461 respondents ages 50 to 90 who completed up to eight test occasions from the Health and Retirement Study. Multivariate adaptive regression splines (MARS) modeling was applied. Possible covariates of depression included arthritis, lung disease, back pain, diabetes, heart disease, high blood pressure, cancer, 28 pairwise combinations of the aforementioned conditions, ADL functional limitations, age, education and being female, being white, and being Hispanic. Results: The best fitting model had a GRSq of 0.18 (comparable to R2) and included 12 of 42 covariates. Depression score was predicted by: 1) ADL limitations, 2) education, 3) back pain, 4) lung disease, 5) being female, 6) being Hispanic, 7) heart disease, 8) being white, 9) high blood pressure plus stroke, 10) age, 11) back pain plus arthritis, and 12) back pain plus diabetes. Conclusions: Functional limitations was the strongest predictor of depression; reporting one limitation increased depression scores by nearly double the increase associated with two or more limitations. Back pain and lung disease were the strongest chronic disease predictors of depression; both are associated with considerable discomfort. %B Californian Journal of Health Promotion %I 11 %V 11 %P 97-108 %G eng %N 1 %4 Aging/functional limitations/Depression/Multivariate adaptive regression splines/Chronic disease/Health Status/Back pain/Lung disease %$ 69256 %0 Book Section %B Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health %D 2013 %T Health and Wealth in Early Retirement %A Geoffrey L Wallace %A Haveman, Robert %A Karen C. Holden %A Barbara Wolfe %E Kenneth A. Couch %E Mary C. Daly %E Julie M Zissimopoulos %K Health Conditions and Status %K Income %K Retirement Planning and Satisfaction %X Retirement years are a precarious time for many older Americans. Even if successful in accumulating resources expected to be sufficient to maintain their pre-retirement standard of living, many retirees face unexpected adverse health shocks after retirement. Because of the uncertainty of shocks to physical and cognitive health, there exists the potential for significant deterioration in resource adequacy both at the time of retirement and into the retirement years due to their occurrence. In this study, we select a sample of new retirees constructed from the Health and Retirement Study (HRS) data and follow them during the first decade of their retirement. Using these data, we identify the nature of shocks to physical and cognitive health for which individuals are at risk during their retirement years, and estimate both the absolute and relative risk of these shocks. We then estimate the impact of the occurrence of these shocks on wealth-based measures of retirement adequacy. %B Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health %I Stanford University %C Stanford, CA %P 261-279 %G eng %4 health shocks/retirement planning/retirement adequacy/physical health/cognitive health %$ 999999 %! Health and Wealth in Early Retirement %0 Report %D 2013 %T Health, Education, and the Post-Retirement Evolution of Household Assets %A James M. Poterba %A Steven F Venti %A David A Wise %K Demographics %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper explores the relationship between education and the evolution of wealth after retirement. Asset growth following retirement depends in part on health capital and financial capital accumulated prior to retirement, which in turn are strongly related to educational attainment. These initial conditions for retirement can have a lingering effect on subsequent asset evolution. Our aim is to disentangle the effects of education on post-retirement asset evolution that operate through health and financial capital accumulated prior to retirement from the effects of education that impinge directly on asset evolution after retirement. We consider the indirect effect of education through financial resources in particular Social Security benefits and defined benefit pension benefits and through health capital that was accumulated before retirement. We also consider the direct effect of education on asset growth following retirement, emphasizing the correlation between education and the returns households earn on their post-retirement investments. Households with different levels of education invest, on average, in different assets, and they may consequently earn different rates of return. Finally, we consider the additional effects of education that are not captured through these pathways. Our empirical findings suggest a substantial association between education and the evolution of assets. For example, for two person households the growth of assets between 1998 and 2008 is on average much greater for college graduates than for those with less than a high school degree. This difference ranges from about 82,000 in the lowest asset quintile to over 600,000 in the highest. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 education/wealth/asset accumulation/household finances/retirement planning/health capital/health capital %$ 69270 %0 Journal Article %J Biodemography and Social Biology %D 2013 %T Health, retirement, and migration from metro counties: evidence from the health and retirement study %A Nan E. Johnson %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Event history analyses and difference-in-proportions tests are used to analyze 1994-2003 data from the Health and Retirement Survey. For young-old metropolitan adults who had never retired, self-rated health (SRH) was unrelated to the odds of becoming a migrant, but for those who had retired, better SRH raised the odds. Neither SRH nor its interwave change was related to the risk of a nonmetro or metro destination. Metro-metro and metro-nonmetro migrants were indistinguishable in their recalled reasons for migration. The implications of the findings for theory and future research are discussed. %B Biodemography and Social Biology %I 59 %V 59 %P 127 %G eng %N 2 %4 DEMOGRAPHY/NET MIGRATION/retirement planning/Self assessed health/Migration/event history %$ 69330 %0 Thesis %D 2013 %T Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement study %A Adrienne M. Gilligan %Y Grant H Skrepnek %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %K Other %K Public Policy %K Retirement Planning and Satisfaction %X Objectives: Evaluate the association of cancer on net worth, consumer debt, mortgage debt, home equity and changes in retirement trends. Methods: Data from the Health and Retirement Study from 1998-2010 was used. Persons had to have a diagnosis of cancer. The index date was the corresponding HRS wave of the year of the first diagnosis of cancer. The pre-index date was 2 years and a 2-year and 4-year post index was observed. Primary outcomes of interest were zero/negative net worth and net worth. Multiple logistic regression was used to test for the association between demographic, economic, human capital, and cancer-related variables on outcomes. Generalized linear models were conducted to assess the association of cancer on net worth, consumer debt, mortgage debt, and home equity. Multinomial logistic regression was performed to assess the association of cancer on retirement. Results: A total of 6,055,110 individuals (weighted) qualified. The majority of patients in this sample were male (53.8%), non-Hispanic (95.5%), and white (90.3%). Marital status (p<0.05), alcohol consumption (p=0.046), hypertension (p = 0.034), private insurance (p=0.001), cancer status (p<0.001), and cancer treatment (p=0.022) were significant predictors of zero/negative net worth 4-years after cancer diagnosis. Patients receiving treatment for their cancer were 71% more likely to have consumer debt 4-years post diagnosis (p=0.006). Patients who reported their cancer improving 4-years post diagnosis were significantly less likely (p=0.008) to have consumer debt (OR=0.59; 95%CI: 0.41-0.87). Cancer treatment and cancer status were significant predictors of mortgage debt (p<0.001 and 0.024, respectively). For individuals whose cancer either improved (OR=1.46; 95%CI: 1.04-2.06) or worsened (OR=4.09; 95%CI: 1.38-12.15), both groups were significantly more likely (p=0.030 and 0.011, respectively) to have home equity 4-years post diagnosis. Cancer status was a significant predictor of individuals transitioning from working to retired (p=0.022). Conclusion: This nationally representative investigation of 6.1 million patients over 50 years of age with cancer found that approximately 65% of cancer patients reported zero/negative net worth of cancer and almost 45% of cancer patients reported consumer debt four-years post diagnosis. Cancer-related characteristics explain a significant amount of the change in net worth four-years post diagnosis of cancer. %I The University of Arizona %V Ph.D. %P 267 %8 2013 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1354473932?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/fmt:kev:mtx:disse %9 Dissertation %M prod.academic_MSTAR_1354473932 %4 mortgage debt %$ 69014 %! Health shocks in patients with cancer: A longitudinal analysis of financial and retirement trends using the Health and Retirement study %0 Journal Article %J Journal of Aging and Health %D 2013 %T Health Shocks in the Family: Gender Differences in Smoking Changes %A Rachel Margolis %K Demographics %K Health Conditions and Status %K Healthcare %K Other %K Women and Minorities %X This study estimates the likelihood of starting and stopping smoking when respondents and their partners report new chronic illnesses. Analysis of longitudinal data from the Health and Retirement Study tests whether starting or stopping smoking is more likely when (a) the respondent, (b) their partner, (c) or both report a new chronic condition, and whether these patterns differ by gender. Both men and women are more likely to quit smoking when reporting a new chronic condition, relative to when reporting none. However only women are more likely to quit smoking when their partners fall ill. Women are also more likely than men to start smoking at this time. Among older couples, women's smoking changes are more sensitive to health shocks in the partnership. Interventions aimed at preventing unhealthy behaviors should pay attention to how each partner deals with the stress of health shocks. %B Journal of Aging and Health %I 25 %V 25 %P 882 %G eng %N 5 %4 Chronic illnesses/Smoking/Gender differences/Health behavior/Intervention/Older people/women/Spousal care %$ 69108 %0 Journal Article %J Journal of Global Health Care Systems %D 2013 %T Health spending during Medicare coverage and associated health change %A Yi-Sheng Chao %A Chao-Jung Wu %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X Introduction: Medicare spending growth is creating financial and fiscal issues in the US, but health returns from the spending under Medicare were not clear. This study aims to quantify the returns to mortality, self-rated health status and mental health, from the spending on health care in the first four years of Medicare coverage. Method: Eligible Medicare enrollees in the Health and Retirement Study (HRS) from 1992 to 2008 were chosen to understand the returns to health after four years of Medicare coverage, while controlling for individual characteristics before Medicare coverage (pre-Medicare characteristics). Ordered logit models were used for 4,099 eligible Medicare enrollees. Results: Health spending was associated with a higher likelihood of mortality in total spending model (n=1752, odds ratio OR =1.0044 per 1,000, p 0.01); out-of-pocket spending was not significant (n=4032, OR=1.0027 per 1,000, p=0.12). For health status, total and out-of-pocket spending were associated with worsening (n=1731, OR=1.0056, p=0.001; n=4029, OR=1.0154, p 0.01), while this association was confirmed for mental health only in total spending model (n=1658, OR=1.0018, p 0.001 and n=3922, OR=1.0029, p=0.06). Conclusion: there is an association between health spending and worsening of three health dimensions after first four years of Medicare coverage, as pre-Medicare characteristics also play a role in these health outcomes. Medicare could be more efficient in improving health outcomes if there are incentives to adopt effective care and a focus on the temporal externality from pre-Medicare health coverage and pre-Medicare characteristics. %B Journal of Global Health Care Systems %I 13 %V 13 %G eng %N 2 %4 Medicare/Health returns/Mortality/Health status/Mental health/health expenditures/CESD scale %$ 69278 %0 Journal Article %J J Aging Health %D 2013 %T Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. %A Emma Aguila %A José J Escarce %A Leng, Mei %A Morales, Leo %K Aged %K Emigrants and Immigrants %K Emigration and Immigration %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Mexican Americans %K Mexico %K Middle Aged %K Risk Factors %K Risk-Taking %K Social Class %K United States %X

OBJECTIVE: Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status.

METHOD: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome.

RESULTS: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators.

DISCUSSION: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

%B J Aging Health %I 25 %V 25 %P 136-58 %8 2013 Feb %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663916/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23264441?dopt=Abstract %2 PMC3663916 %R 10.1177/0898264312468155 %0 Journal Article %J Population Research and Policy Review %D 2013 %T Healthier, Wealthier, and Wiser: A Demonstration of Compositional Changes in Aging Cohorts Due to Selective Mortality %A Zajacova, Anna %A Sarah A. Burgard %K Health Conditions and Status %K Methodology %K Net Worth and Assets %X The gradual changes in cohort composition that occur as a result of selective mortality processes are of interest to all aging research. We present the first illustration of changes in the distribution of specific cohort characteristics that arise purely as a result of selective mortality. We use data on health, wealth, education, and other covariates from two cohorts (the AHEAD cohort, born 1900-1923 and the HRS cohort, born 1931-1941) included in the Health and Retirement Survey, a nationally representative panel study of older Americans spanning nearly two decades (N = 14,466). We calculate sample statistics for the surviving cohort at each wave. Repeatedly using only baseline information for these calculations so that there are no changes at the individual level (what changes is the set of surviving respondents at each specific wave), we obtain a demonstration of the impact of mortality selection on the cohort characteristics. We find substantial changes in the distribution of all examined characteristics across the nine survey waves. For instance, the median wealth increases from about 90,000 to 130,000 and the number of chronic conditions declines from 1.5 to 1 in the AHEAD cohort. We discuss factors that influence the rate of change in various characteristics. The mortality selection process changes the composition of older cohorts considerably, such that researchers focusing on the oldest old need to be aware of the highly select groups they are observing, and interpret their conclusions accordingly. PUBLICATION ABSTRACT %B Population Research and Policy Review %I 32 %V 32 %P 311-324 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1356972849?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl %N 3 %4 Mortality/Aging/selective mortality processes/cohort composition/wealth %$ 69006 %R http://dx.doi.org/10.1007/s11113-013-9273-x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis. %A Kandauda Wickrama %A Jay A. Mancini %A Kwag, Kyunghwa %A Kwon, Josephine %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K depression %K Female %K Health Status %K Health Transition %K Humans %K Longitudinal Studies %K Male %K Marriage %K Memory Disorders %K Middle Aged %K Socioeconomic factors %X

OBJECTIVES: This study examines (a) the heterogeneity in individual multidimensional health trajectories and (b) the socioeconomic stratification of individual multidimensional health trajectories during the late older years.

METHOD: This study used prospective data from 1,945 adults, 75 to 85 years old, collected over an 8-year period from the Health and Retirement Study. To examine inconsistent findings in the research literature, a latent trajectory class analysis was performed.

RESULTS: Multidimensional overall health trajectories showed three heterogeneous latent classes (maintaining, persistently high, and deteriorating), and profiles of ascribed and achieved socioeconomic characteristics of multidimensional health trajectory classes showed a significant social and racial/ethnic stratification in late older years.

DISCUSSION: Past adverse socioeconomic circumstances, including childhood and adulthood adversity, are potential sources of unobserved heterogeneity of multidimensional health trajectories even in late older years. The identification of members of latent trajectory health classes and the associated antecedents linked to health class membership are consistent with a life-course conceptual framework. Thus, multidimensional health capturing the full range of health problems needs to be investigated for proper examination of socioeconomic correlates of health. This facilitates the understanding of the associations between life-course experiences and health in late old age that ultimately have implications for prevention and intervention.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 290-7 %8 2013 Mar %G eng %U http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23197341?dopt=Abstract %3 23197341 %4 health trajectories/health trajectories/Socioeconomic Differences/life Course/life Events/prevention/Public Policy/social Welfare %$ 69816 %R 10.1093/geronb/gbs111 %0 Journal Article %J Journal of the Economics of Ageing %D 2013 %T Heterogeneity in spending change at retirement. %A Michael D Hurd %A Susann Rohwedder %K Older Adults %K Retirement Planning and Satisfaction %X

The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates at retirement, rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. We find substantial heterogeneity in spending change at retirement: in the upper half of the wealth distribution spending increased. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be early retirement due to poor health, possibly augmented by a short planning horizon by a minority of the population.

%B Journal of the Economics of Ageing %V 1-2 %P 60-71 %8 2013 Nov %G eng %R 10.1016/j.jeoa.2013.09.002 %0 Journal Article %J Health Affairs %D 2013 %T Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay %A Amy Kelley %A Deb, Partha %A Qingling Du %A Carlson, Melissa D. Aldridge %A R Sean Morrison %K Consumption and Savings %K Healthcare %K Medicare/Medicaid/Health Insurance %K Public Policy %X Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death. Using data from the Health and Retirement Study, 2002-2008, and individual Medicare claims, and overcoming limitations of previous work, we found 2,561 in savings to Medicare for each patient enrolled in hospice 53-105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: 2,650, 5,040, and 6,430 per patient enrolled 1-7, 8-14, and 15-30 days prior to death, respectively.Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit. %B Health Affairs %I 32 %V 32 %P 552-61 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1316561537?accountid=14667 %N 3 %4 Experiment/theoretical treatment/Quality of care/Hospice care/Social policy/Health care industry/Medicare/Cost reduction/Public Health And Safety %$ 68996 %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2013 %T Hospital and nursing home use from 2002 to 2008 among U.S. older adults with cognitive impairment, not dementia in 2002. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %A Kenneth M. Langa %A Frederick W Unverzagt %A Christopher M. Callahan %K Aged %K Aged, 80 and over %K Aging %K Cognition Disorders %K Dementia %K Female %K Homes for the Aged %K Hospitalization %K Humans %K Male %K Nursing homes %K United States %X

Little is known about health care use in the cognitive impairment, not dementia (CIND) subpopulation. Using a cohort of 7130 persons aged 71 years or over from the Health and Retirement Survey, we compared mean and total health care use from 2002 to 2008 for those with no cognitive impairment, CIND, or dementia in 2002. Cognitive status was determined using a validated method based on self or proxy interview measures. Health care use was also based on self or proxy reports. On the basis of the Health and Retirement Survey, the CIND subpopulation in 2002 was 5.3 million or 23% of the total population 71 years of age or over. Mean hospital nights was similar and mean nursing home nights was less in persons with CIND compared with persons with dementia. The CIND subpopulation, however, had more total hospital and nursing home nights--71,000 total hospital nights and 223,000 total nursing home nights versus 32,000 hospital nights and 138,000 nursing home nights in the dementia subpopulation. A relatively large population and high health care use result in a large health care impact of the CIND subpopulation.

%B Alzheimer Dis Assoc Disord %V 27 %P 372-8 %8 2013 Oct-Dec %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002093-201310000-00012 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/23151595?dopt=Abstract %! Alzheimer Disease & Associated Disorders %R 10.1097/WAD.0b013e318276994e %0 Journal Article %J BMC Public Health %D 2013 %T How do couples influence each other's physical activity behaviours in retirement? An exploratory qualitative study %A Barnett, Inka %A Guell, Cornelia %A Ogilvie, David %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Other %K Public Policy %K Retirement Planning and Satisfaction %X Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other's physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other's physical activity behaviour in retirement. A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis. Three themes emerged: spousal attitude towards physical activity, spouses' physical activity behaviour and spousal support. While spouses' attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise. Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport. %B BMC Public Health %I 13 %V 13 %P 1197 %G eng %N 1 %4 OLDER-ADULTS/INTERVENTIONS/SPOUSES/INACTIVITY/TRANSITION/Physical activity/COMMUNITY/PARENTHOOD/Social aspects/Exercise/Retirement/Couples/HEALTH BEHAVIOR/MARRIAGE/Behavior/Health aspects/MARITAL-STATUS/PUBLIC, ENVIRONMENTAL/OCCUPATIONAL HEALTH/Qualitative study/Indexing in process %$ 999999 %0 Report %D 2013 %T How Do People Form Longevity Predictions? The Effect of Parents and Parents-in-law s Death on Beliefs about Mortality Risk %A Chen, Lizi %A Economics %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X In this paper, we use data from the Health and Retirement Study (HRS) panel, which surveys a representative sample of US seniors about their longevity prospects to examine whether the Bayesian assumption holds. Specifically, I test for (1) whether people s longevity predictions are responsive to new information, e.g., recent parental death which conveys information about genetic risks, lifestyle-related health risks, etc; (2) whether people s longevity predictions respond more to the arrival of precise information (parental death) than less clear information (parent-in-law s death); (3) whether the magnitudes of these updates are in accordance with theoretical predictions. We find that individuals longevity predictions are responsive to new health-related information, and consistently more responsive to precise information (parental death) than imprecise information (parent-in-law s death). The magnitudes of these updates lie between the predicted lower and upper bounds of rational updates, but do not perfectly coincide with the predicted values and are sensitive to model specifications. We conclude that there is no strong evidence against the Bayesian assumption. We point out that the Bayesian assumption is only one aspect of the rationality hypothesis. From qualitative survey data, We find evidence of inattention to government subsidy of long-term care insurance, mistaken beliefs that long-term care is covered by Medicare and tendency to procrastinate on long-term care insurance purchasing decision. The evidence suggests irrationality may cause individuals to under-insure through these other venues. %I Wellesley, MA, Wellesley College %G eng %U http://repository.wellesley.edu/thesiscollection/93 %4 Bayesian Analysis/longevity predictions/Long Term Care/retirement planning/health risk %$ 69316 %0 Report %D 2013 %T How Do the Changing Labor Supply Behavior and Marriage Patterns of Women Affect Social Security Replacement Rates? %A April Yanyuan Wu %A Nadia S. Karamcheva %A Alicia H. Munnell %A Patrick J. Purcell %K Adult children %K Employment and Labor Force %K Social Security %K Women and Minorities %X This paper seeks to determine the impact of the changing lives of women increased labor force participation/earnings and reduced marriage rates on Social Security replacement rates. First, our estimates, based on the Health and Retirement Study and Modeling Income in the Near Term, show that Social Security replacement rates have dropped sharply at both the household- and individual-level, and the decline will continue for future retirees. Our second finding is that this aggregate change masks a complex relationship between replacement rates and the marital status and income levels of individuals. The decline in replacement rates over time is largest for married couples with husbands whose earnings are in the top tercile. Decomposing the reasons for the overall decline shows that increases in the labor supply and earnings of women explain more than one-third of the change. In contrast, the impact of changing marital patterns is relatively small. Much of the remaining explanation rests with the increased Full Retirement Age and changing claiming behaviors. %I Chestnut Hill, MA, Center for Retirement Research at Boston College %G eng %4 women/labor force participation/marriage/social security/claiming behavior/claiming behavior %$ 999999 %0 Journal Article %J Social Security Bulletin %D 2013 %T How do trends in women's labor force activity and marriage patterns affect social security replacement rates? %A April Yanyuan Wu %A Nadia S. Karamcheva %A Alicia H. Munnell %A Patrick J. Purcell %K Adult children %K Employment and Labor Force %K Methodology %K Women and Minorities %X This article examines how women's increased labor force participation, increased earnings, and reduced marriage rates affect Social Security replacement rates over time. Based on data from the Health and Retirement Study and Modeling Income in the Near Term, our estimates show that Social Security replacement rates have dropped sharply at both the household and individual levels, and the declines will continue for future retirees. We also find that this aggregate change masks a complex relationship between replacement rates and the marital status and income levels of individuals. The decline in replacement rates over time is largest for married couples with husbands having higher earnings. Increases in the labor force activity and earnings of women explain more than one-third of the change. By contrast, the impact of changing marital patterns is relatively small. Changes to the full retirement age and the timing of benefit claiming explain much of the remaining decline. %B Social Security Bulletin %I 73 %V 73 %P 1-24 %G eng %N 4 %4 women/labor Force Participation/marriage/replacement rate %$ 999999 %0 Journal Article %J The Journal of Law and Economics %D 2013 %T How Does Bankruptcy Law Impact the Elderly' s Business and Housing Decisions? %A Nadia Greenhalgh-Stanley %A Rohlin, Shawn %K Housing %K Net Worth and Asset %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %X The elderly are the population most likely to file for bankruptcy, with filings increasing by 150 percent from 1991 to 2007. This is likely because they live with relatively flat incomes and high medical expenses, and their retirement and housing assets are typically exempt from bankruptcy filings. In addition, nine states adopted higher asset exemptions specifically for the elderly. Using the Health and Retirement Study and recent state-by-time variation in homestead exemptions, we are the first to test whether the benefits of partial wealth insurance or the cost of supply-side credit constraints are predominant for the elderly. Using pooled cross-sectional analysis, we find that an increase in a state' s homestead exemption increases the elderly' s home equity and business ownership; however, the credit constraint is dominant in unlimited-exemption states, which decreases home and business ownership. Panel analysis reveals that an increase in the homestead exemption positively affects home ownership rates and home equity. %B The Journal of Law and Economics %I 56 %V 56 %P 417-451 %G eng %U http://www.jstor.org/stable/10.1086/670911 %N 2 %4 home equity/bankruptcy/Retirees/retirement planning/homestead exemption/Public Policy/assets/Housing %$ 69086 %R 10.1086/670911 %0 Report %D 2013 %T How Does Retiree Health Insurance Influence Public Sector Employee Saving? %A Robert Clark %A Olivia S. Mitchell %K Insurance %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %X Economic theory predicts that employer-provided retiree health insurance benefits crowd-out household wealth accumulation. Nevertheless, there is little research on the impacts of retiree health insurance on wealth accruals, so this paper utilizes a unique data file on three baseline cohorts from the Health and Retirement Study to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. We find that most full-time public sector employees who anticipate receiving employer-provided health insurance coverage in retirement save less than their private sector uncovered counterparts. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 retiree health insurance/household wealth/Public Sector/employer-provided health insurance %$ 999999 %0 Report %D 2013 %T How Important Is Medicare Eligibility in the Timing of Retirement? %A Norma B Coe %A Khan, Mashfiqur R. %A Matthew S. Rutledge %K Medicare/Medicaid/Health Insurance %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X Eligibility for Medicare at age 65 is widely viewed as an important factor in retirement decisions. However, it has been difficult to quantify the influence of Medicare because eligibility for Medicare came at the same age as Social Security s Full Retirement Age (FRA). The recent rise in the FRA, along with other changes, has decoupled the age-related incentives in the two programs, making it easier to estimate the effect of Medicare eligibility on the timing of retirement. This brief, based on a recent study, provides such estimates of the importance of Medicare on retirement decisions. %I Boston, Center for Retirement Research at Boston College %G eng %4 Medicare/retirement planning/social Security/Public Policy %$ 69314 %0 Journal Article %J Journal of Aging and Health %D 2013 %T How Representative Is the ACTIVE Sample? A Statistical Comparison of the ACTIVE Sample and the HRS Sample %A John J. Prindle %A John J McArdle %K Demographics %K Methodology %X Objective: This research is designed to examine demographic differences between the ACTIVE sample and the larger, nationally representative Health and Retirement Study (HRS) sample. Method: After describing some relevant demographics (age, education, sex, and race/ethnicity), we use three statistical methods to determine sample differenceslogistic regression modeling (LRM), decision tree analysis (DTA), and post-stratification and raking methods. When some differences are found, we create sample weights that other researchers can use to adjust these differences. Results: The ACTIVE sample is younger, more likely to be female, Black, and more highly educated than the HRS sample. Sample weights were created. Discussion: By using the resulting sample weights, all results of ACTIVE analyses can be said to be nationally representative based on HRS demographics. %B Journal of Aging and Health %I 25 %V 25 %P 85S-102S %G eng %N 8 %4 Statistical Methods/Sample Weights/Nationally Representative Sample/Older-Adults/Post-Stratification %$ 69360 %0 Journal Article %J Health Aff (Millwood) %D 2012 %T Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. %A Alexander K Smith %A Ellen P McCarthy %A Ellen Weber %A Irena Cenzer %A W John Boscardin %A Jonathan Fisher %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Emergency Service, Hospital %K Female %K Hospital Mortality %K Hospitalization %K Humans %K Insurance Claim Review %K Male %K Terminal Care %K Terminally Ill %K United States %X

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

%B Health Aff (Millwood) %I 31 %V 31 %P 1277-85 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22665840?dopt=Abstract %2 PMC3736978 %4 elderly/Medicare/Primary Care/public policy/Health care policy/emergency department service use/emergency department service use %$ 69508 %R 10.1377/hlthaff.2011.0922 %0 Report %D 2012 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study: Cognition %A Regina A Shih %A Jinkook Lee %A Lopamudra Das %K CHARLS %K Cross-National %K ELSA %K IFLS %K JSTAR %K KLoSA %K LASI %K Methodology %K MHAS %K SAGE %K SHARE %K TILDA %X This paper summarizes and compares measures of cognitive health and decline in the Health and Retirement Study (HRS) and its sister surveys from other countries: the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing, and Retirement in Europe (SHARE), the Korean Longitudinal Study of Aging (KLoSA), the Japanese Study on Aging and Retirement (JSTAR), the Chinese Health and Retirement Longitudinal Study (CHARLS), the Mexican Health and Aging Study (MHAS), the Indonesian Family Life Survey (IFLS), The Irish Longitudinal Study on Aging (TILDA), Study on Global Aging (SAGE), and the Longitudinal Aging Study in India (LASI). The authors analyze and discuss the extent to which these measures are comparable, the methodological differences in the way information was collected for these measures, and the implications for secondary data analysis. This paper is one in a series of similar papers, each comparing different domains (e.g., chronic medical conditions, employment and retirement, expectations, transfers, income, and wealth) across these surveys with an aim to encourage rigorous, cross-national and international comparison research on aging populations %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA %G eng %4 cross-national comparison/ELSA_/SHARE/CHARLS/KLOSA/JSTAR/TILDA/Methodology %$ 69600 %R 10.7249/WR861.7 %0 Report %D 2012 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study: Income Measures %A Marco Angrisani %A Jinkook Lee %K CHARLS %K Cross-National %K ELSA %K IFLS %K JSTAR %K KLoSA %K LASI %K Methodology %K SHARE %K TILDA %X This paper summarizes and compares measures of household and individual income in the Health and Retirement Study (HRS) and its sister surveys from other countries: the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing, and Retirement in Europe (SHARE), the Korean Longitudinal Study of Aging (KLoSA), the Japanese Study on Aging and Retirement (JSTAR), the Indonesian Family Life Survey (IFLS), The Irish Longitudinal Study on Aging (TILDA), the Chinese Health and Retirement Longitudinal Study (CHARLS), and the Longitudinal Aging Study in India (LASI). The authors analyze and discuss the extent, to which these measures are comparable, the methodological differences in the way information was collected for these measures, and the implications for secondary data analysis. This paper is one in a series of similar papers, each comparing different domains (e.g., chronic medical conditions, cognition, expectations, transfers, and wealth) across these surveys with an aim to encourage rigorous, cross-national and international comparison research on aging populations. %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA, %G eng %4 cross-national comparison/ELSA_/SHARE/CHARLS/KLOSA/JSTAR/TILDA/Methodology %$ 69602 %R 10.7249/WR861.5 %0 Report %D 2012 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study: Financial Transfer %A Julie M Zissimopoulos %A Jinkook Lee %A Joanna Carroll %K CHARLS %K Cross-National %K ELSA %K JSTAR %K KLoSA %K LASI %K Methodology %K SHARE %X This paper summarizes and compares measures of financial transfers in the Health and Retirement Study (HRS) and its sister surveys from other countries: the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing, and Retirement in Europe (SHARE), the Korean Longitudinal Study of Aging (KLoSA), the Japanese Study on Aging and Retirement (JSTAR), the Chinese Health and Retirement Longitudinal Study (CHARLS), and the Longitudinal Aging Study in India (LASI). The authors analyze and discuss the extent, to which these measures are comparable, the methodological differences in the way information was collected for these measures, and the implications for secondary data analysis. This paper is one in a series of similar papers, each comparing different domains (e.g., chronic medical conditions, cognition, employment and retirement, expectations income, and wealth) across these surveys with an aim to encourage rigorous, cross-national and international comparison research on aging populations. %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA %G eng %4 cross-national comparison/ELSA_/SHARE/CHARLS/KLOSA/JSTAR/Methodology %$ 69598 %R 10.7249/WR861.2 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2012 %T Health behavior change following chronic illness in middle and later life. %A Jason T Newsom %A Nathalie Huguet %A Michael J. McCarthy %A Pamela Ramage-Morin %A Mark S Kaplan %A Julie Bernier %A Bentson McFarland %A Jillian Oderkirk %K Age Factors %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Chi-Square Distribution %K Chronic disease %K Diabetes Mellitus %K Exercise %K Female %K Health Behavior %K Heart Diseases %K Humans %K Longitudinal Studies %K Lung Diseases %K Male %K Middle Aged %K Neoplasms %K Smoking %K Stroke %K Time Factors %X

OBJECTIVES: Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS: Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS: Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

%B J Gerontol B Psychol Sci Soc Sci %I 67B %V 67 %P 279-88 %8 2012 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21983040?dopt=Abstract %2 PMC3325087 %4 Lifestyles/Lifestyles/Health behavior/Intervention/Quality of life/Medical diagnosis/Chronic illnesses/smoking Cessation %$ 62854 %R 10.1093/geronb/gbr103 %0 Thesis %D 2012 %T Health Disparities among the U.S. Elderly %A Heesoo Joo %Y Kajal Chatterji Lahiri %K Demographics %K Health Conditions and Status %K Healthcare %K Women and Minorities %X This dissertation examines health disparities related to race/ethnicity and socioeconomic status among the U.S. elderly taking into account empirical challenges including: (1) self-selection and unobserved factors; (2) subjective and objective measures of disease; and (3) attrition bias. Using the 2006 Health and Retirement Study, we find that current estimates of racial/ethnic disparities in awareness of chronic disease are sensitive to self-selection and unobserved factors. Contrary to prior studies reporting that African-Americans are more aware of having hypertension than non-Latino whites, we do not find this conclusion to be true after controlling for self-selection and disease severity. Likewise, prior studies show mixed evidence of racial/ethnic disparities in awareness of diabetes, but after accounting for selection, we find that African-Americans and Latinos are less aware of having diabetes compared to non-Latino whites. Using the National Health and Nutrition Examination Survey from 1999-2008, we find that education is not associated with self-reported measures of diabetes and hypertension, and it is positively associated with self-reported high cholesterol. However, there is a strong negative association between education and diabetes and hypertension when we use objective measures. There is no association between education and objective measures of high cholesterol. When we account for the possibility of shared, unmeasured determinants of disease prevalence and diagnosis that are correlated with education, we find that education is negatively associated with having undiagnosed hypertension and diabetes. In addition, we find that trends in cardiovascular disease (CVD) risk factors, including (1) high blood glucose, (2) high blood pressure, (3) high cholesterol, and (4) smoking, improved over the past two decades among individuals with diabetes, but racial/ethnic and education-related disparities have emerged in some areas. Finally, we estimate income-related health inequality, measured by the concentration index with an unbalanced panel dataset, explicitly accounting for attrition due to mortality, using the RAND version of HRS. We find that income-related health inequality improves as people age, but this improvement primarily comes from the high mortality rate among poorer individuals. A balanced panel dataset analysis generates misleading results of progressive health deterioration, while an unbalanced panel dataset analysis brings out this regressive deterioration. %I State University of New York at Albany %C Albany, NY %V Ph.D. %G English %M 1027764303 %4 racial differences %$ 69542 %0 Thesis %D 2012 %T Health Insurance Decision Making in an Aging Population: A Medicare Part D Study %A Lin, Iris L. %Y Sewin Chan %K Demographics %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Public Policy %X A consumer-driven health care system with greater competition and choice has been welcomed as a policy solution, both to control costs and improve quality. In this more consumer-centric environment, the individual bears greater responsibility to obtain, understand, and act upon health information. However, researchers have observed a range of scenarios under which individuals struggle with understanding health information and do not make what are generally considered optimal decisions. This is particularly a concern for older adults who have a higher volume of medical needs and who may experience declining cognition. There is limited understanding about how the elderly make health-related decisions and what methods are most effective in providing support. This dissertation aims to investigate health related decision making in an aging population, specifically, how adults 65 years or older select their Medicare Prescription Drug Coverage (Part D). The study uses plan-level data from the Centers for Medicare and Medicaid Services and individual-level longitudinal survey data from the Health and Retirement Study. The first chapter of this dissertation examines the role of individual preferences and non-cost related plan attributes in Part D plan selection. The second chapter provides evidence of how aspects of an individual's social environment and use of information resources factor into selecting a plan. The final chapter analyzes potential motivators for individuals to switch plans. %I New York University %C New York, New York %V Ph.D. %G English %M 1151907965 %4 social Environment %$ 69800 %0 Journal Article %J J Health Econ %D 2012 %T Health investment decisions in response to diabetes information in older Americans. %A Alexander N Slade %K Adult %K Age Factors %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Weight %K Decision making %K Diabetes Mellitus %K Empirical Research %K Exercise %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Models, Psychological %K Smoking %K United States %X

Diabetes is a very common and serious chronic disease, and one of the fastest growing disease burdens in the United States. Further, health behaviors, such as exercise, smoking, drinking, as well as weight status, are instrumental to diabetes management and the reduction of its medical consequences. Nine waves of the Health and Retirement Study are used to model the role of a recent diabetes diagnosis and medication on present and subsequent weight status, exercise, drinking and smoking activity. Several non-linear dynamic population average probit models are estimated. Results suggest that compared to non-diagnosed individuals at risk for high blood sugar, diagnosed diabetics respond initially in terms of increasing exercise, losing weight, and curbing smoking and drinking behavior, but the effect diminishes after diagnosis. Evidence of recidivism is also found in these outcomes, especially weight status and physical activity, suggesting that some behavioral responses to diabetes may be short-lived.

%B J Health Econ %I 31 %V 31 %P 502-20 %8 2012 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22591712?dopt=Abstract %3 22591712 %4 Studies/Diabetes/Health behavior/Physical fitness/Disease management/Public health/WEIGHT %$ 69484 %R 10.1016/j.jhealeco.2012.04.001 %0 Journal Article %J Health Econ %D 2012 %T Health service use among the previously uninsured: is subsidized health insurance enough? %A Decker, Sandra L %A Jalpa A Doshi %A Amy E. Knaup %A Daniel Polsky %K Aged %K Female %K Health Care Surveys %K Health Services %K Health Status %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Socioeconomic factors %K United States %X

Although it has been shown that gaining Medicare coverage at age 65 years increases health service use among the uninsured, difficulty in changing habits or differences in the characteristics of previously uninsured compared with insured individuals may mean that the previously uninsured continue to use the healthcare system differently from others. This study uses Medicare claims data linked to two different surveys--the National Health Interview Survey and the Health and Retirement Study--to describe the relationship between insurance status before age 65 years and the use of Medicare-covered services beginning at age 65 years. Although we do not find statistically significant differences in Medicare expenditures or in the number of hospitalizations by previous insurance status, we do find that individuals who were uninsured before age 65 years continue to use the healthcare system differently from those who were privately insured. Specifically, they have 16% fewer visits to office-based physicians but make 18% and 43% more visits to hospital emergency and outpatient departments, respectively. A key question for the future may be why the previously uninsured seem to continue to use the healthcare system differently from the previously insured. This question may be important to consider as health coverage expansions are implemented.

%B Health Econ %I 21 %V 21 %P 1155-68 %8 2012 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/22945812?dopt=Abstract %3 22945812 %4 Medicare/health Services/ utilization/health Services/ utilization/health Insurance/Uninsured people/Public policy %$ 69654 %R 10.1002/hec.1780 %0 Thesis %B Public Health Studies %D 2012 %T Health services use and health status among people with diabetes mellitus and cardiovascular diseases %A Li, Chien-Ching %Y Romeis, James %K Health Conditions and Status %K Healthcare %K Public Policy %X In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. This study adopted the Andersen's Behavioral Model of Health Services Utilization as a framework to examine health services uses and to further identify the association of health services uses and subsequent health outcomes within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that less discretionary health services use (hospitalization and home health care) was more likely to be influenced by need factors. More discretionary health services use (doctor visits) was more likely to be influenced by predisposing factors. Although most health services uses were associated with worse or declined status in activities of daily living (ADL), instrumental activities of daily living (IADL), or self-rated health, certain health services use were found to be associated with less worse or not declined health status. The use of outpatient surgery among people with CVD only and the use of home health care among people with DM and CVD were associated with not declined IADL and self-rated health, respectively. In addition, the association between nursing home care and ADL, prescription drug use and IADL, and home health care and self-rated health was found to be different by health groups. Most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S. %B Public Health Studies %I Saint Louis University %C Saint Louis, MO %V Ph.D. %@ 9781267642875 %G eng %4 Mortality %$ 69674 %0 Journal Article %J The Journal of Consumer Affairs %D 2012 %T Health Shocks, Out-of-Pocket Medical Expenses and Consumer Debt Among Middle-Aged and Older Americans %A Hyungsoo Kim %A Yoon, Wonah %A Karen A. Zurlo %K Consumption and Savings %K Demographics %K Healthcare %K Net Worth and Assets %X We examine two important issues related to health and financial burden in middle-aged and older Americans: (1) whether or not new health events affect a consumer's unsecured debt, and (2) to what extent the associated out-of-pocket medical expenses (OOP) contribute to unsecured debt. We use six biennial waves (1998, 2000, 2002, 2004, 2006 and 2008) from the Health and Retirement Study (HRS). We estimated fixed effects models and conducted mediation analyses. We find that new health events affect the accumulation of unsecured debt. Our estimates suggest that new health events increase unsecured debt by 6.3 ( 230) to 9.3 ( 339); approximately 20 of the increase in unsecured consumer debt comes from OOP when experiencing new health events. New severe health events increase debt for the 50-64 age group, but do not increase it for the 65 group. PUBLICATION ABSTRACT %B The Journal of Consumer Affairs %I 46 %V 46 %P 357-380 %G eng %N 3 %4 Health care expenditures/Consumer credit/Middle age/Older people/Personal finance/Investment analysis and personal finance/Experiment/theoretical treatment/Out of pocket costs %$ 69682 %R 10.1111/j.1745-6606.2012.01236.x %0 Journal Article %J PLoS One %D 2012 %T Higher rates of Clostridium difficile infection among smokers. %A Mary A M Rogers %A M. Todd Greene %A Sanjay Saint %A Carol E Chenoweth %A Preeti N Malani %A Itishree Trivedi %A David M. Aronoff %K Clostridioides difficile %K Enterocolitis, Pseudomembranous %K Female %K Humans %K Male %K Middle Aged %K Smoking %K United States %X

OBJECTIVES: Cigarette smoking has been shown to be related to inflammatory bowel disease. We investigated whether smoking affected the probability of developing Clostridium difficile infection (CDI).

METHODS: We conducted a longitudinal study of 16,781 older individuals from the nationally representative Health and Retirement Study. Data were linked to files from the Centers for Medicare and Medicaid Services.

RESULTS: Overall, the rate of CDI in older individuals was 220.6 per 100,000 person-years (95% CI 193.3, 248.0). Rates of CDI were 281.6/100,000 person-years in current smokers, 229.0/100,000 in former smokers and 189.1/100,000 person-years in never smokers. The odds of CDI were 33% greater in former smokers (95% CI: 8%, 65%) and 80% greater in current smokers (95% CI: 33%, 145%) when compared to never smokers. When the number of CDI-related visits was evaluated, current smokers had a 75% increased rate of CDI compared to never smokers (95% CI: 15%, 167%).

CONCLUSIONS: Smoking is associated with developing a Clostridium difficile infection. Current smokers have the highest risk, followed by former smokers, when compared to rates of infection in never smokers.

%B PLoS One %I 7 %V 7 %P e42091 %8 2012 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/22848714?dopt=Abstract %2 PMC3407081 %4 cigarette smoking/inflammatory bowel disease/clostridium difficile infection/medicare %$ 69668 %R 10.1371/journal.pone.0042091 %0 Journal Article %J Chicago Fed Letter %D 2012 %T How do the risks of living long and facing high medical expenses affect the elderly's saving behavior? %A Mariacristina De Nardi %A Eric French %A John Bailey Jones %K Adult children %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Although the elderly have a lot of wealth, people still do not fully understand their patterns of saving behavior. Many elderly individuals keep large amounts of wealth even as they near the ends of their lives. Furthermore, as one study shows, income-rich households are especially frugal. Among the motivations for saving are the risks of living long and having high medical expenses in old age. In recent research, the authors quantify the importance of forces by estimating and simulating a rich model of saving behavior. Life spans vary greatly in both predictable and unpredictable ways. Using mortality rates estimated from the AHEAD, they find that rich people, women, and healthy people live much longer than their poor, male, and sick counterparts. The risk of living far past one's expected life span is large and, under incomplete annuitization, a potentially important reason why so many elderly people run down their assets so slowly. %B Chicago Fed Letter %I 294 %V 294 %P 1-4 %G eng %U https://www.chicagofed.org/publications/chicago-fed-letter/2012/january-294 %4 transfers/saving behavior/wealth/retirement planning/mortality %$ 69536 %0 Report %D 2012 %T How is Economic Hardship Avoided by Those Retiring Before the Social Security Entitlement Age %A Kevin Milligan %K Consumption and Savings %K Income %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %K Women and Minorities %X Governments around the world are reacting to extended lifespans and troubled pension finances by increasing the age of retirement benefit entitlement. One concern that arises is how those who are not working before reaching entitlement age are able to bridge their consumption to the age of entitlement. This paper studies those who retire before the age of full pension entitlement in the United States 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 is important while for women, spousal income helps most to get them over the line. Reaching the early retirement entitlement age at 62 also has a significant impact on poverty avoidance. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 Retirement/Retirement Policies/Economics of the Elderly/Economics of the Handicapped/retirement planning/early Retirement/poverty/social Security/entitlement age %$ 69054 %R 10.3386/w18051 %0 Journal Article %J J Gen Intern Med %D 2012 %T How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. %A Vivien K Sun %A Irena Cenzer %A Helen Kao %A Cyrus Ahalt %A Brie A Williams %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Perception %K Residence Characteristics %K Safety %K Surveys and Questionnaires %X

BACKGROUND: Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.

OBJECTIVE: To determine the relationship between perceived neighborhood safety and functional decline in older adults.

DESIGN/SETTING: Longitudinal, community-based.

PARTICIPANTS: 18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study.

MAIN MEASURES: The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).

KEY RESULTS: At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.

CONCLUSION: Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.

%B J Gen Intern Med %V 27 %P 541-7 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22160889?dopt=Abstract %2 PMC3326109 %4 neighborhood Characteristics/Safety/Functional decline/Functional decline/Activities Of Daily Living/Mobility/HEALTH %$ 62672 %R 10.1007/s11606-011-1943-y %0 Journal Article %J J Gerontol Soc Work %D 2011 %T Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples. %A Gaines, Jean M %A Judith L Poey %A Marx, Katherine A %A J. M. Parrish %A Resnick, Barbara %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Case-Control Studies %K Chronic disease %K depression %K Female %K Geriatric Assessment %K Health Services %K Health Services for the Aged %K Health Status %K Home Care Services %K Hospitalization %K Humans %K Interview, Psychological %K Male %K Middle Aged %K Multivariate Analysis %K Psychometrics %K Retirement %X

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

%B J Gerontol Soc Work %I 54 %V 54 %P 788-802 %8 2011 Nov %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22060005?dopt=Abstract %3 22060005 %4 health Status/Continuing care retirement communities/COMORBIDITY/Self assessed health %$ 62690 %R 10.1080/01634372.2011.595476 %0 Book Section %B Investigations in the Economics of Aging %D 2011 %T "Healthy, Wealthy and Wise?" Revisited: An Analysis of the Causal Pathways from Socioeconomic Status to Health %A Till Stowasser %A Florian Heiss %A Daniel McFadden %A Joachim Winter %K health %K socioeconomic status %X In health economics, there is little dispute that the socioeconomic status (SES) of individuals is positively correlated with their health status. The size of the body of literature documenting that wealthy and well- educated people generally enjoy better health and longer life is impressive.1 The robustness of this association is underscored by the fact that the so- called health- wealth gradient has been detected in different times, countries, populations, age structures, and for both men and women. Moreover, the results are largely insensitive to the choice of SES measures (such as wealth, income, education, occupation, or social class) and health outcomes. %B Investigations in the Economics of Aging %I University of Chicago Press %P 267-317 %G eng %U http://www.nber.org/chapters/c12443 %0 Journal Article %J Journal of Social Policy %D 2011 %T Helping the Poorest Help Themselves? Encouraging Employment Past 65 in England and the USA %A Lain, David %K Cross-National %K Demographics %K Employment and Labor Force %K Public Policy %K Retirement Planning and Satisfaction %X In the context of population ageing and low retirement incomes, the UK government is encouraging delayed retirement. However, the OECD has argued that UK means-tested benefits disincentivise employment for the poorest, and Vickerstaff (2006b) has suggested managers have typically controlled opportunities to work beyond 65. In the US, contrastingly, benefits are meagre and difficult to access, and age discrimination legislation protects individuals from forced retirement. Would a US 'self-reliance' policy approach increase employment amongst the poorest over 65s in the UK and enhance or diminish their financial position? The evidence suggests that extending UK age discrimination legislation and restricting benefits would increase overall employment past 65, although not necessarily to US levels. Analysis of the English Longitudinal Study of Ageing and the US Health and Retirement Study finds the poorest over 65s were more likely to work in the USA than in England in 2002. However, within the USA, employment amongst the poorest was still low, especially compared with wealthier groups; logistic regression analysis primarily attributes this to lower levels of health and education. A US policy approach would therefore most likely damage the financial position of the poorest in the UK, as increased employment would not sufficiently compensate for lost benefits %B Journal of Social Policy %I 40 %V 40 %P 493-512 %G eng %N 3 %4 Public policy/Older people/Low income groups/Employment/Retirement benefits/Age discrimination/ELSA_ %$ 62380 %R https://doi.org/10.1017/S0047279410000942 %0 Journal Article %J Eur J Epidemiol %D 2011 %T Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. %A Mieke Reuser %A Frans J Willekens %A Luc G Bonneux %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cognition Disorders %K Educational Status %K Female %K Health Surveys %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Prevalence %K Proportional Hazards Models %K Retirement %K Sex Factors %K Smoking %K Time Factors %K United States %X

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

%B Eur J Epidemiol %I 26 %V 26 %P 395-403 %8 2011 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract %2 PMC3109265 %4 Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups %$ 69390 %R 10.1007/s10654-011-9553-x %0 Report %D 2011 %T Household Stock Market Beliefs and Learning %A Kezdi, Gabor %A Robert J. Willis %K Consumption and Savings %K Expectations %K Methodology %K Net Worth and Assets %X This paper characterizes heterogeneity of the beliefs of American households about future stock market returns, provides an explanation for that heterogeneity and establishes its relationship to stock holding behavior. We find substantial belief heterogeneity that is puzzling since households can observe the same publicly available information about the stock market. We propose a simple learning model where agents can invest in the acquisition of financial knowledge. Differential incentives to learn about the returns process can explain heterogeneity in beliefs. We check this explanation by using data on beliefs elicited as subjective probabilities and a rich set of other variables from the Health and Retirement Study. Both descriptive statistics and estimated relevant heterogeneity of the structural parameters provide support for our explanation. People with higher lifetime earnings, higher education, higher cognitive abilities, defined contribution as opposed to defined benefit pension plans, for example, possess beliefs that are considerably closer to what historical time series would imply. Our results also suggest that a substantial part of the reduced form relationship between stock holding and household characteristics is due to differences in beliefs. Our methodological contribution is estimating relevant heterogeneity of structural belief parameters from noisy survey answers to probability questions. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 Multiple or Simultaneous Equation Models/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Information, Knowledge, and Uncertainty: General/Information, Knowledge, and Uncertainty: General/Subjective Probabilities/Stock Market %$ 62802 %R 10.3386/w17614 %0 Report %D 2011 %T How Did the Recession of 2007-2009 Affect the Wealth and Retirement of the Near Retirement Age Population in the Health and Retirement Study? %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Demographics %K Employment and Labor Force %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %X This paper uses asset and labor market data from the Health and Retirement Study (HRS) to investigate how the recent Great Recession has affected the wealth and retirement of those in the population who were just approaching retirement age at the beginning of the recession, a potentially vulnerable segment of the working age population. The retirement wealth held by those ages 53 to 58 before the onset of the recession in 2006 declined by a relatively modest 2.8 percentage points by 2010. In more normal times, their wealth would have increased over these four years. Members of older cohorts accumulated an additional 5 percent of wealth over the same age span. To be sure, a part of that accumulation was the result of the upside of the housing bubble. The wealth holdings of poorer households were least affected by the recession. Relative losses are greatest for those who initially had the highest wealth when the recession began.The adverse labor market effects of the Great Recession are more modest. Although there is an increase in unemployment, that increase is not mirrored in the rate of flow out of full-time work or partial retirement. All told, the retirement behavior of the Early Boomer cohort looks similar, at least so far, to the behavior observed for members of older cohorts at comparable ages. Very few in the population nearing retirement age have experienced multiple adverse events. Although most of the loss in wealth is due to a fall in the net value of housing, because very few in this cohort have found their housing wealth under water, and housing is the one asset this cohort is not likely to cash in for another decade or two, there is time for their losses in housing wealth to recover. %B Michigan Retirement and Disability Research Center Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/how-did-the-recession-of-2007-2009-affect-the-wealth-and-retirement-of-the-near-retirement-age-population-in-the-health-and-retirement-study-2/ %4 asset accumulation/labor Force Participation/wealth Accumulation/housing wealth/retirement planning/Great Recession/early boomers %$ 62646 %0 Report %D 2011 %T How Do Subjective Mortality Beliefs Affect the Value of Social Security and the Optimal Claiming Age %A Wei Sun %A Anthony Webb %K Expectations %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X Households that delay claiming Social Security are, in effect, making additional purchases of the Social Security annuity. Theoretical calculations show the delayed claiming is optimal, even for high mortality households. Yet most claim well before the theoretically optimal age. This paper investigates whether subjective mortality beliefs contribute to the prevalence of early claiming. The value of delay depends not only on life expectancy, but also on the degree of uncertainty surrounding the age of death. Using data from the Health and Retirement Study, we show that women approaching retirement understate their probabilities of surviving to age 75 by an average of 10 percentage points, whereas men's forecasts are, on average, correct. But both men and women exhibit greater confidence in their ability to forecast their age of death, relative to the predictions of life tables. But these subjective mortality beliefs have little effect on the value of Social Security or the optimal claim age, and cannot explain the prevalence of early claiming. We also find that self-assessed survival probabilities do not predict survival after controlling for health and socio-economic status, indicating a potential for medical underwriting to reduce adverse selection in the annuity market. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/working-papers/how-do-subjective-mortality-beliefs-affect-the-value-of-social-security-and-the-optimal-claiming-age/ %4 Mortality/social security/public policy/subjective mortality beliefs/early claiming %$ 69552 %0 Journal Article %J Journal of Health and Social Behavior %D 2011 %T How Does Health in Childhood Impact Labor Market Earnings Over the Life Course? %A Steven A Haas %A M. Maria Glymour %A Lisa F Berkman %K Demographics %K Health Conditions and Status %K Public Policy %X The authors use data from the Health and Retirement Study's Earnings Benefit File, which links Health and Retirement Study to Social Security Administration records, to estimate the impact of childhood health on earnings curves between the ages of 25 and 50 years. They also investigate the extent to which diminished educational attainment, earlier onset of chronic health conditions, and labor force participation mediate this relationship. Those who experience poor childhood health have substantially diminished labor market earnings over the work career. For men, earnings differentials grow larger over the early to middle career and then slow down and begin to converge as they near 50 years of age. For women, earnings differentials emerge later in the career and show no evidence of convergence. Part of the child health earnings differential is accounted for by selection into diminished educational attainment, the earlier onset of chronic disease in adulthood, and, particularly for men, labor force participation. %B Journal of Health and Social Behavior %I 52 %V 52 %P 297-297 %G eng %N 3 %4 Educational attainment/Chronic illnesses/Inequality %$ 62632 %R 10.1177/0022146511410431 %0 Journal Article %J Inquiry %D 2011 %T How does health insurance affect the retirement behavior of women? %A Kanika Kapur %A Jeannette Rogowski %K Decision making %K Female %K Health Benefit Plans, Employee %K Humans %K Male %K Models, Econometric %K Multivariate Analysis %K Pensions %K Retirement %K Spouses %K United States %K Women, Working %X

The availability of health insurance is a crucial factor in the retirement decision. Women are substantially less likely to have health insurance from their own employment. Using the Health and Retirement Study, we examine the role of employer-provided retiree health insurance in the retirement decisions of single women, and women in single-earner and dual-earner couples. We compare the effect of health insurance on female and male retirement. Our results show that retiree health insurance increases retirement for all groups except single men. We find suggestive evidence that the role of health insurance for women hinges on their husbands' labor force status.

%B Inquiry %I 48 %V 48 %P 51-67 %8 2011 Spring %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21634262?dopt=Abstract %3 21634262 %4 Health insurance/Retirement planning/Employee benefits/Impact analysis/Female employees/Life insurance/health insurance/Investment analysis/personal finance/benefits/compensation/Experiment/theoretical treatment %$ 69420 %R 10.5034/inquiryjrnl_48.01.04 %0 Report %D 2011 %T How Does Occupational Status Impact Bridge Job Prevalence %A Kevin E. Cahill %A Michael D. Giandrea %A Joseph F. Quinn %A Office of Productivity and Technology %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Retirement Planning and Satisfaction %X Is bridge job prevalence reduced significantly if a change in occupation is required in addition to the hours and tenure requirements that typically define bridge job employment. Prior research has shown that the majority of older Americans with career employment do not exit the labor force directly from their careers. Rather, most career individuals take on a 'bridge job' later in life, that is, a job that follows full-time career (FTC) employment and precedes complete labor force withdrawal (i.e., retirement). One criticism of this finding is that bridge job prevalence may be overstated because the definition of a bridge job in the existing literature does not require a change in occupation. This paper investigates the extent to which bridge jobs involve a change in occupation or a switch to part-time status, both of which may signal retirement transitions as opposed to continued career employment, albeit with a different employer. We use the Health and Retirement Study (HRS), a nationally-representative longitudinal dataset of older Americans that began in 1992 as the basis for our analysis. We find that, among HRS respondents who were on a FTC job at the time of the first interview and who changed jobs in subsequent waves, 48 percent of the men and 40 percent of the women also changed occupations, using 2-digit occupation codes. Further, when hours worked are also considered, we find that more than three quarters of FTC respondents who changed jobs later in life had either a change in occupation or a switch from full-time to part-time status. Finally, an examination of those career workers who changed jobs but not occupations and who remained working full time reveals that, as a whole, they resemble those who took bridge jobs rather than those who remained on their FTC job. We conclude that the vast majority of career workers who changed jobs later in life did in fact do so as part of a retirement transition. %B Economic Working Paper %I U.S. Bureau of Labor Statistics %C Washington, D.C. %G eng %U https://www.bls.gov/osmr/research-papers/2011/ec110050.htm %4 labor Force Participation/Multivariate analysis/Prevalence/Employment/Gradual retirement/Bridge Jobs/full-time career (FTC) employment/full-time career (FTC) employment %$ 62848 %0 Report %D 2011 %T How Does the Personal Income Tax Affect the Progressivity of OASI Benefits? %A Norma B Coe %A Karamcheva, Zhenya %A Richard W Kopcke %A Alicia H. Munnell %K Methodology %K Public Policy %K Social Security %X This study calculates the impact of federal income taxes on the progressiveness of the Old Age and Survivors Insurance (OASI) program. It uses the Health and Retirement Study (HRS) data linked with the Social Security Earnings Records to estimate OASI contributions and benefits for individuals and households, before and after income taxes, for three birth cohorts. It uses two measures of progressivity: redistribution by decile (the difference between the share of total benefits received and the share of total taxes paid) and effective progression (the change in the Gini coefficient). Under both measures, the results without the income tax confirm previous findings: Social Security is progressive on an individual basis, but that progressivity is dramatically cut when one calculates it on a household basis. Adding income taxes could make the program either more or less progressive. On the one hand, the tax treatment of contributions makes the system even less progressive than generally reported. On the other hand, the taxation of benefits makes it more progressive. The net result is that adding the personal income tax to the analysis makes Social Security more progressive than without taxes, on both the individual and household bases. Importantly, however, the impact of taxation on redistribution increases significantly among younger cohorts. Under current law, the Social Security system becomes more progressive over time. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/working-papers/how-does-the-personal-income-tax-affect-the-progressivity-of-oasi-benefits/ %4 Public policy/social security/Gini coefficient/taxation/income tax %$ 69554 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2011 %T How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age? %A Ana R Quiñones %A Jersey Liang %A Joan M. Bennett %A Xiao Xu %A Wen Ye %K Aged %K Aged, 80 and over %K Aging %K Black or African American %K Chronic disease %K Female %K Follow-Up Studies %K Health Behavior %K Health Status Disparities %K Hispanic or Latino %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Middle Aged %K United States %K White People %X

OBJECTIVES: This research examines intra- and interpersonal differences in multiple chronic conditions reported by Americans aged 51 and older for a period up to 11 years. It focuses on how changes in multimorbidity vary across White, Black, and Mexican Americans.

METHODS: Data came from 17,517 respondents of the Health and Retirement Study (1995-2006) with up to 5 repeated observations. Hierarchical linear models were employed to analyze ethnic variations in temporal changes of reported comorbidities.

FINDINGS: Middle-aged and older Americans have on average nearly 2 chronic diseases at the baseline, which increased to almost 3 conditions in 11 years. White Americans differ from Black and Mexican Americans in terms of level and rate of change of multimorbidity. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to Whites. In contrast, Blacks showed an elevated level of multimorbidity throughout the 11-year period of observation, although their rate of change slowed relative to Whites.

DISCUSSION: These results suggest that health differences between Black Americans and other ethnic groups including White and Mexican Americans persist in the trajectory of multimorbidity even when population heterogeneity is adjusted. Further research is needed concerning the impact of health disadvantages and differential mortality that may have occurred before middle age as well as exploring the role of nativity, the nature of self-reported diseases, and heterogeneity underlying the average trajectory of multimorbidity for ethnic elders.

%B J Gerontol B Psychol Sci Soc Sci %I 66 %V 66 %P 739-49 %8 2011 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/21968384?dopt=Abstract %2 PMC3198247 %4 African Americans/ statistics/African Americans/ statistics/numerical data/Aged, 80 and over/Aging/Chronic Disease/ ethnology/Chronic Disease/ ethnology/European Continental Ancestry Group/ statistics/European Continental Ancestry Group/ statistics/numerical data/Female/Follow-Up Studies/Follow-Up Studies/Health Behavior/ ethnology/Health Behavior/ ethnology/Health Status Disparities/Hispanic Americans/ statistics/Hispanic Americans/ statistics/numerical data/Humans/Linear Models/Linear Models/Longitudinal Studies/Middle Aged/United States/epidemiology/United States/epidemiology %$ 62698 %R 10.1093/geronb/gbr106 %0 Report %D 2010 %T Happy Together: A Structural Model of Couples' Joint Retirement Choices %A Maria Casanova %K Retirement Planning and Satisfaction %X Evidence from different sources shows that a signicant proportion of spouses retire within less than a year from each other, independently of the age difference between them. The existing reduced- form analyses of couples' retirement suggest that this is partly due to complementarities in spouses' tastes for leisure, which are present when one or both partners enjoy retirement more if the other is retired as well. In order to accurately estimate the role of leisure complementarities, it is essential to appropriately control for incentives to joint retirement acting through the household budget con- straint. This paper presents a structural, dynamic model of older couples' saving and participation decisions which allows for the complementarities in spouses' leisure and where the nancial incentives and uncertainty facing spouses are carefully modeled. Couples are heterogeneous in household wealth and spouses' wages, pension claims, and health status. They face uncertainty in earnings, medical costs, and survival. The model parameters are estimated using a sample of older individuals from the Health and Retirement Study. Estimation results show that leisure complementarities are positive for both husband and wife and account for up to 8 percent of observed joint retirements. The social security spousal benefit is found to account for an extra 13 percent of them. These results imply that incentives for joint retirement play a crucial role in determining individual choices. Since these incentives cannot be captured in a model that takes one spouse's behavior as exogenous, this sug- gests that individual models of retirement are no longer an appropriate approximation of the average household's behavior, given the increasing number of working couples approaching retirement age. %G eng %U http://www.econ.ucla.edu/casanova/Files/Casanova_joint_ret.pdf %4 joint retirement %$ 25340 %0 Report %D 2010 %T Health and Access Effects of New Drugs: Combining Experimental and Non-Experimental Data %A Pierre-Carl Michaud %A Darius Lakdawalla %A Dana P Goldman %A Sood, Neeraj %A Cong, Ze %K Health Conditions and Status %K Healthcare %K Methodology %K Other %X We propose to combine clinical trial and estimates of behavioral responses in the population to quantify the value of new drug innovations when such values cannot be obtained by randomized experiments alone. New drugs are seen as having two distinct effects on patients. First, they can provide better outcomes for patients currently under treatment, due to better clinical efficacy. Second, they can also provide treatment access to more patients, perhaps by reducing side effects or expanding treatment. We compare these clinical and access effects using claims data, data on the arrival rate of new drugs, and the clinical trials literature on the effectiveness of these drugs. We find that the effect of new drug introductions on the number of patients treated accounts for a substantial majority of the value created by new drugs. %G eng %U https://depot.erudit.org/bitstream/003241dd/1/CIRPEE10-38.pdf %4 Pharmaceutical innovation/effectiveness/cost-benefit analysis/cancer %$ 26040 %0 Report %D 2010 %T Health and Wealth in a Life-Cycle Model %A John Karl Scholz %A Ananth Seshadri %K Consumption and Savings %K Event History/Life Cycle %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %X This paper presents a preliminary model of health investments over the life cycle. Health affects both longevity and provides flow utility. We analyze the interplay between consumption choices and investments in health by solving each household s dynamic optimization problem to obtain predictions on health investments and consumption choices over the lifecycle. Our preliminary model does a good job of matching the distribution of medical expenses across households in the sample. We illustrate the scope of future model applications by examining the effects of a stylized Medicare program on patterns of wealth and mortality. %I The University of Michigan, Michigan Retirement Research Center %G eng %U https://mrdrc.isr.umich.edu/pubs/health-and-wealth-in-a-life-cycle-model/ %4 life Cycle/consumption/health investments/Medical Expenditures/wealth/mortality %$ 24380 %0 Journal Article %J J Econom %D 2010 %T Health, Economic Resources and the Work Decisions of Older Men. %A John Bound %A Todd R. Stinebrickner %A Timothy A Waidmann %X

We specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men late in their working lives. We model health as a latent variable, for which self reported disability status is an indicator, and allow self-reported disability to be endogenous to labor market behavior. We use panel data from the Health and Retirement Study. While we find large impacts of health on behavior, they are substantially smaller than in models that treat self-reports as exogenous. We also simulate the impacts of several potential reforms to the Social Security program.

%B J Econom %I 156 %V 156 %P 106-129 %8 2010 May %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27158180?dopt=Abstract %4 Economic models/Labor economics/Health/Older workers/Dynamic programming/Studies %$ 22310 %R 10.1016/j.jeconom.2009.09.010 %0 Journal Article %J Soc Sci Med %D 2010 %T Health outcomes of Experience Corps: a high-commitment volunteer program. %A S I Hong %A Morrow-Howell, Nancy %K Activities of Daily Living %K Aged %K Aged, 80 and over %K depression %K Female %K Health Promotion %K Health Status %K Humans %K Male %K Middle Aged %K Program Evaluation %K Regression Analysis %K Self Concept %K Volunteers %X

Experience Corps (EC) is a high-commitment US volunteer program that brings older adults into public elementary schools to improve academic achievement of students. It is viewed as a health promotion program for the older volunteers. We evaluated the effects of the EC program on older adults' health, using a quasi-experimental design. We included volunteers from 17 EC sites across the US. They were pre-tested before beginning their volunteer work and post-tested after two years of service. We compared changes over time between the EC participants (n = 167) and a matched comparison group of people from the US Health and Retirement Study (2004, 2006). We developed the comparison group by using the nearest available Mahalanobis metric matching within calipers combined with the boosted propensity scores of those participating in the EC. We corrected for clustering effects via survey regression analyses with robust standard errors and calculated adjusted post-test means of health outcomes, controlling for all covariates and the boosted propensity score of EC participants. We found that compared to the comparison group, the EC group reported fewer depressive symptoms and functional limitations after two years of participation in the program, and there was a statistical trend toward the EC group reporting less decline in self-rated health. Results of this study add to the evidence supporting high-intensity volunteering as a social model of health promotion for older adults.

%B Soc Sci Med %I 71 %V 71 %P 414-420 %8 2010 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20510493?dopt=Abstract %3 20510493 %4 EDUCATION/academic achievement/Volunteering/Experience Corps/methodology/generational transfers %$ 23230 %R 10.1016/j.socscimed.2010.04.009 %0 Journal Article %J J Aging Health %D 2010 %T Health trajectories among older movers. %A Janet M Wilmoth %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Multivariate Analysis %K Regression Analysis %K Social Class %K Transients and Migrants %X

OBJECTIVE: To examine health trajectories among older migrants by reason for move.

METHOD: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves.

RESULTS: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups.

DISCUSSION: The results are consistent with the predictions of Litwak and Longino's (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

%B J Aging Health %I 22 %V 22 %P 862-81 %8 2010 Oct %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract %3 20710006 %4 Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment %$ 24090 %R 10.1177/0898264310375985 %0 Journal Article %J Journal of Public Economics %D 2010 %T Home equity commitment and long-term care insurance demand %A Davidoff, Thomas %K Healthcare %K Housing %X This paper shows how home equity may substitute for long-term care insurance (LTCI). The elderly commonly hold substantial wealth in the form of home equity that is rarely spent before death, except for after moves to long-term care facilities. Absent strong bequest motives implies that marginal utility fluctuates less across health states than one would predict based on a standard model without wealth tied up in housing. Numerical examples show that this asset commitment may substantially weaken LTCI demand. %B Journal of Public Economics %I 94 %V 94 %P 44-49 %G eng %U http://www.sciencedirect.com/science/article/B6V76-4XBG17Y-1/2/7454bb1f43081b6bd02fe86de4c3d416 %N 1-2 %4 Health care markets/Housing %$ 25480 %0 Journal Article %J Med Care %D 2010 %T Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. %A Michele M Heisler %A Choi, Hwajung %A Allison B Rosen %A Sandeep Vijan %A Mohammed U Kabeto %A Kenneth M. Langa %A John D Piette %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Female %K Financing, Personal %K Health Care Costs %K Health Services Accessibility %K Health Status Disparities %K Hospitalization %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Medication Adherence %K Middle Aged %K Multivariate Analysis %K Risk Factors %K United States %X

CONTEXT: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths.

OBJECTIVE: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost.

DESIGN AND SETTING: A retrospective biannual cohort study across 4 cross-sectional waves of the Health and Retirement Study, a nationally representative survey of adults older than age 50. Using multivariate logistic regression to adjust for baseline differences in sociodemographic and health characteristics, we assessed subsequent hospitalizations and deaths between 1998 and 2006 for respondents who reported that they had or had not taken less medicine than prescribed because of cost.

RESULTS: Respondents with cardiovascular disease who reported underusing medications due to cost were significantly more likely to be hospitalized in the next 2 years, even after adjusting for other patient characteristics (adjusted predicted probability of 47% compared with 38%, P < 0.001). The more survey waves respondents reported cost-related medication underuse during 1998 to 2004, the higher the probability of being hospitalized in 2006 (adjusted predicted probability of 54% among respondents reporting cost-related medication underuse in all 4 survey waves compared with 42% among respondents reporting no underuse, P < 0.001). There was no independent association of cost-related medication underuse with death.

CONCLUSIONS: In this nationally representative cohort, middle-aged and elderly adults with cardiovascular disease who reported cutting back on medication use because of cost were more likely to report being hospitalized over a subsequent 2-year period after they had reported medication underuse. The more extensively respondents reported cost-related underuse over time, the higher their adjusted predicted probability of subsequent hospitalization.

%B Med Care %I 48 %V 48 %P 87-94 %8 2010 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20068489?dopt=Abstract %2 PMC3034735 %4 Cardiovascular Diseases: drug therapy/Cardiovascular Diseases: economics/mortality/Health Care Costs/Services Accessibility: economics/Health Status Disparities/Hospitalization: economics/Hospitalization: statistics and numerical data/Logistic Models/Longitudinal Studies/Medication Adherence/Multivariate Analysis/Risk Factors %$ 22180 %R 10.1097/MLR.0b013e3181c12e53 %0 Journal Article %J Journal of Housing for the Elderly %D 2010 %T Housing Dissatisfaction and Cognitive Decline in Older Adults %A Russell N. James III %A Sweaney, Anne L. %K Consumption and Savings %K Health Conditions and Status %K Housing %X Analysis of a nationally representative, longitudinal survey of community-dwelling Americans over age 50 indicated that rating the physical condition of one s dwelling unit as poor predicted significantly more rapid cognitive decline in subsequent years. This relationship persisted after controlling for a variety of factors such as wealth, income, education, health, family status, neighborhood safety, depression, and initial cognitive ability. Dissatisfaction with the physical conditions of one s housing may have a direct effect on the rate of cognitive decline in older adults. Addressing housing inadequacy for older adults may thus produce a wider range of societal benefits than previously realized. %B Journal of Housing for the Elderly %I 24 %V 24 %P 93-106 %G eng %N 1 %L newpubs20091202_HousingDissatisfaction %4 Housing/Cognitive Function/Cognitive decline/Neighborhood Characteristics %$ 21370 %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Housing Price Volatility and Downsizing in Later Life %A James Banks %A Richard Blundell %A Oldfield, Zoë %A James P Smith %E David A Wise %K Consumption and Savings %K Cross-National %K Demographics %K Housing %K Retirement Planning and Satisfaction %X In this paper, we modeled several types of housing transitions of the elderly in two countries -- Britain and the United States. One important form of these transitions involves downsizing of housing consumption, the importance of which among older households is still debated. This downsizing takes multiple forms, including reductions in the number of rooms per dwelling and the value of the home. There is also evidence that this downsizing is greater when house price volatility is greater and that American households try to escape housing price volatility by moving to places that are experience significantly less housing price volatility. Our comparative evidence in suggests that there is less evidence of downsizing in Britain. Our results indicate that housing consumption appears to decline with age in the US, even after controlling for the other demographic and work transitions associated with age that would normally produce such a decline. No such fall in housing consumption is found in Britain, largely because British households are much more likely to stay in their original residence. %B Research Findings in the Economics of Aging %I University of Chicago Press %C Chicago %P 337-379 %G eng %4 Housing/consumption/cross-national comparison/downsizing/Mobility %$ 24150 %! Housing Price Volatility and Downsizing in Later Life %& 12 %0 Report %D 2010 %T How Much Is Enough? The Distribution of Lifetime Health Care Costs %A Anthony Webb %A Natalia A. Zhivan %K Healthcare %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X Estimates of the expected present value of lifetime out-of-pocket medical costs from age 65 onward are of limited value to households managing wealth decumulation in retirement. Their risk characteristics may differ from the average. They will also care about the whole probability distribution of health cost outcomes, and will want to update that probability distribution during the course of retirement. Using Health and Retirement Study data, we simulate health, mortality, and health cost histories of retired households. We show that the life expectancy and average health costs of our simulated households closely match published life tables and the findings of previous research. Using our simulated data, assuming a 3-percent real interest rate and including Medicare and private insurance premiums, we estimate that a typical household age 65 has a 5-percent risk of the present value of its lifetime health care costs exceeding 311,000, or 570,000 including the cost of long-term care. We find that relatively little resolution of uncertainty occurs with age, even for those who remain free of chronic disease. %G eng %U http://crr.bc.edu/images/stories/Working_Papers/wp_2010-1.pdf %L newpubs20100407_Webb.pdf %4 health insurance/health care costs/Medicare/retirement planning %$ 21840 %0 Book Section %B Evaluating the Financial Performance of Pension Funds %D 2010 %T Human Capital Risk and Pension Outcomes %A Olivia S. Mitchell %A John A. Turner %K Older Adults %K Pensions %K Retirement Planning and Satisfaction %K Risk Factors %B Evaluating the Financial Performance of Pension Funds %I World Bank %C Washington, DC %P 119-151 %G eng %0 Conference Paper %B Population Association of America 2009 Annual Meeting %D 2009 %T Health and Concentrated Disadvantage in Later Life: Evidence from the Health and Retirement Study %A Carr, Stacie %K Disadvantage %K health %X Not only are adults who live in racially segregated areas exposed to disadvantage on myriad levels over the lifetime, but, in aging, they also may become even more reliant upon the resources embedded in their neighborhoods. This paper uses multi-level analysis to study residential segregation, concentrated disadvantage, and the health of adults in mid- to late-life. Using data from the 2004 Health and Retirement Survey, I analyze the extent to which health disparities between black and white adults over age 50 are associated with neighborhood-level concentrated disadvantage. Random intercept models show that neighborhood-level factors are associated with both fair or poor health and chronic illness. Concentrated disadvantage is significant and in the expected direction, although the magnitude is small. Findings are consistent with previously identified connections between education and health, suggesting that improving educational outcomes for students in highly disadvantaged areas may yield enduring health benefits. %B Population Association of America 2009 Annual Meeting %I Princeton University %G eng %U https://paa2009.princeton.edu/abstracts/91231 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Health and well-being in older married female cancer survivors. %A Aloen L. Townsend %A Karen J Ishler %A Karen F Bowman %A Rose, Julia Hannum %A Peak, Nicole Juszczak %K Age Factors %K Case-Control Studies %K Depressive Disorder %K Female %K Health Status %K Health Status Indicators %K Health Surveys %K Humans %K Marriage %K Middle Aged %K Neoplasms %K Predictive Value of Tests %K Risk Factors %K Survivors %K United States %X

OBJECTIVES: To investigate differences between older married female cancer survivors and a matched comparison sample on physical health and on effects of health on depressive symptomatology.

DESIGN AND SETTING: National survey data from the 1992 Health and Retirement Study.

PARTICIPANTS: Married women who reported having been diagnosed with cancer (N=245) and married women who did not report a cancer diagnosis but who matched the survivors on age, race, and ethnicity (N=245).

MEASUREMENTS: Outcome measure was depressive symptomatology (modified CES-D). Predictors were multiple indicators of health and demographic characteristics.

RESULTS: Cancer survivors reported significantly worse health on all indicators but not higher depressive symptomatology after health and demographics were controlled. Predictors of higher depression were fatigue, pain, and lower education. These effects did not differ between groups.

CONCLUSION: Health impairment in cancer survivors highlights the need for ongoing follow-up care. Survivorship was associated indirectly with higher depressive symptomatology through its relationship with health impairment.

%B J Am Geriatr Soc %I 57 %V 57 Suppl 2 %P S286-8 %8 2009 Nov %G eng %N Suppl 2 %L newpubs20100129_Townsend.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20122019?dopt=Abstract %2 PMC3372320 %4 CANCER/Women/Depressive Symptoms/Marriage %$ 21570 %R 10.1111/j.1532-5415.2009.02514.x %0 Journal Article %J Am J Public Health %D 2009 %T Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. %A Mauricio Avendano %A M. Maria Glymour %A James Banks %A Johan P Mackenbach %K Age Factors %K Aged %K Chronic disease %K Confidence Intervals %K Disabled Persons %K Europe %K Female %K Health Status Disparities %K Heart Diseases %K Humans %K Male %K Middle Aged %K Odds Ratio %K Poverty %K Prevalence %K Risk Factors %K Socioeconomic factors %K United States %X

OBJECTIVES: We compared the health of older US, English, and other European adults, stratified by wealth.

METHODS: Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17,481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.

RESULTS: American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

CONCLUSIONS: American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

%B Am J Public Health %I 99 %V 99 %P 540-8 %8 2009 Mar %G eng %N 3 %L newpubs20101112_Avendano.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19150903?dopt=Abstract %2 PMC2661456 %4 Chronic Disease/cross-national comparison/socioeconomic Factors/Heart disease/health status disparities/risk factors/SHARE/ELSA_ %$ 23710 %R 10.2105/AJPH.2008.139469 %0 Journal Article %J Health Serv Res %D 2009 %T The health effects of Medicare for the near-elderly uninsured. %A Daniel Polsky %A Jalpa A Doshi %A José J Escarce %A Manning, Willard %A Susan M Paddock %A Cen, Liyi %A Jeannette Rogowski %K Aged %K Attitude to Health %K Female %K Follow-Up Studies %K Health Services Accessibility %K Health Services Research %K Health Status %K Health Surveys %K Humans %K Insurance Coverage %K Logistic Models %K Male %K Medically Uninsured %K Medicare %K Mortality %K Multivariate Analysis %K Program Evaluation %K Retirement %K Socioeconomic factors %K Statistics, Nonparametric %K United States %X

OBJECTIVE: To determine whether Medicare enrollment at age 65 has an effect on the health trajectory of the near-elderly uninsured.

DATA SOURCES: Eight biennial waves (1992-2006) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61 year olds and their spouses.

STUDY DESIGN: We use a quasi-experimental approach to compare the health effects of insurance for the near-elderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead).

RESULTS: The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: -4.8, 3.3), 0.3 more in good health (95 percent CI: -3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: -7.4, 2.3), and 2.8 more dead (-4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant.

CONCLUSIONS: Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status.

%B Health Serv Res %I 44 %V 44 %P 926-45 %8 2009 Jun %G eng %N 3 %L newpubs20090908_Polsky_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19674430?dopt=Abstract %2 PMC2699915 %4 Medicare/health status/Health Insurance/Health Benefits %$ 16770 %R 10.1111/j.1475-6773.2009.00964.x %0 Thesis %D 2009 %T Health Events, Household Wealth and Debt Holdings: Evidence from the health and retirement study %A Patryk D. Babiarz %K Adult children %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %X The dissertation is composed of three independent studies that examine the effects of health events on household wealth, debt holdings and health investment behavior. The first study investigates the role of the unsecured credit market as a potential mechanism for intertemporal transfers of income in times of financial hardship caused by health adversities. The ability to borrow through unsecured markets is especially important to households with low financial assets. Unfortunately, households with low financial assets have been previously characterized as particularly likely to face borrowing constraints. However, recent improvements in accessibility and generosity of credit markets can mitigate the borrowing constraints of these households. Results show that the onset of an adverse health condition is associated with an average of 9 percent increase of unsecured debt. This effect is not uniform across households. Families in the bottom quartile of financial assets borrow considerably more than households with above median financial assets. The second study builds on the theory of precautionary saving which predicts that uncertainty of future depresses consumption and increases the accumulation of wealth. This emergency wealth creates a safety net against income shocks or unexpected expenditures, such as catastrophic healthcare charges. The ownership of health insurance reduces the risk of unexpected healthcare costs. Therefore, the ownership of health insurance should reduce the strength of the precautionary saving motive. The goal of the second study is to investigate whether Medicare enrollment and household asset accumulation patterns are consistent with the theory of precautionary saving. Medicare eligibility is exogenously determined using age of the insured. Thus, Medicare enrollment does not correlate with other household characteristics that determine precautionary wealth accumulation and ownership of other types of health insurance. Findings show that non-retirement financial assets of households enrolled in Medicare are over 10 percent lower compared to households without Medicare. The third study examines returns to preventive healthcare expenditures and preventive behaviors. It is widely believed that by engaging in preventive behaviors and purchasing preventive medical services individuals reduce the probability of the future outbreak of an adverse health condition and in consequence lower future healthcare costs. Building on the assumption that the share of preventive expenditures in total out-of-pocket expenditures is higher for individuals who are in good health, the study concludes that past preventive healthcare expenditures reduce the rate of growth of future healthcare expenditures and produce favorable health outcomes. %I Purdue University %C United States, Indiana %8 2009 %G eng %U https://www.researchgate.net/publication/40735984_Health_events_household_wealth_and_debt_holdings_Evidence_from_the_health_and_retirement_study %4 Precautionary Saving %$ 21640 %! Health Events, Household Wealth and Debt Holdings: Evidence from the health and retirement study %0 Journal Article %J BMC Public Health %D 2009 %T The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey. %A Noda, Tatsuya %A Ojima, Toshiyuki %A Hayasaka, Shinya %A Hagihara, Okihito %A Takayanagi, Ryoichi %A Nobutomo, Koichi %K Aged %K Bereavement %K Educational Status %K Female %K Follow-Up Studies %K Health Status %K Health Surveys %K Humans %K Lung Diseases, Obstructive %K Male %K Marriage %K Middle Aged %K Outcome Assessment, Health Care %K Proportional Hazards Models %K Smoking %K United States %X

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major disease among adults, and its deterioration was reported to be associated with psychological imbalance. Meanwhile, bereavement and divorce have proven harmful to the health status of a surviving spouse. But few studies have been conducted to evaluate the remedial effect on survivors' health outcome by remarriage after bereavement. The present study thus examined the associations between remarriage and the onset of COPD.

METHODS: Our cohort was drawn from Health and Retirement Study participants in the United States, and consisted of 2676 subjects who were divorced or bereaved from 1992 to 2002. We then followed them for up to 11 years and assessed the incidence rate of COPD using a Cox proportional hazard model after adjusting for marital status, age, gender, education and the number of cigarettes smoked.

RESULTS: Among all subjects, 224 who remarried after bereavement or divorce tended to be younger and more male dominated. Remarriage after bereavement/divorce was associated with significantly decreased risk of COPD onset for overall subjects [hazard ratio (HR): 0.51, 95% confidence interval (95% CI): 0.28-0.94], female subjects [HR: 0.36, 95% CI: 0.13-0.98], and for those under 70 years old [HR: 0.36, 95% CI: 0.17-0.79].

CONCLUSION: This study investigates the impact of remarriage on health outcome based on a large-scale population survey and indicates that remarriage significantly correlates with reduced risk of COPD incidence, even after adjusting smoking habit.

%B BMC Public Health %I 9 %V 9 %P 412 %8 2009 Nov 14 %G eng %L newpubs20091202_Remarriage.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19912659?dopt=Abstract %2 PMC2781819 %4 Marital Status/risk factors %$ 21390 %R 10.1186/1471-2458-9-412 %0 Journal Article %J Nonprofit and Voluntary Sector Quarterly %D 2009 %T Health, Wealth, and Charitable Estate Planning: A longitudinal examination of testamentary charitable giving plans %A Russell N. James III %K Adult children %X Anticipated generational wealth transfers hold much potential for nonprofits. However, a weighted cross-sectional analysis of 18,469 respondents in the 2006 Health and Retirement Study (HRS) and data from respondents dying between the 2004 and 2006 HRS waves indicated that 88 to 90.5 of donors ( 500/year) more than the age of 50 will die without a charitable bequest. Cross-sectional probit analysis of the 2006 HRS and longitudinal conditional fixed-effects logistic analysis of the 1995-2006 HRS indicated that charitable estate planning was positively associated with age, wealth, education, religious attendance, volunteering, charitable giving, and the absence of children or grandchildren. In all specifications, the absence of children was a dominant predictor of charitable estate planning. %B Nonprofit and Voluntary Sector Quarterly %I 38 %V 38 %P 1026-1043 %G eng %N 6 %L newpubs20091202_NVSQ-Charitable.pdf %4 Bequests/Estate Values %$ 21330 %R https://doi.org/10.1177/0899764008323860 %0 Report %D 2009 %T The Health-Socioeconomic Status Relationship and the Role of Public Policies in the US and UK %A Bender, Keith A. %A Theodossiou, Ioannis %K Cross-National %K Public Policy %I 5th International Vilnius Conference %G eng %U https://www.researchgate.net/publication/266370077_The_Health_-Socioeconomic_Status_Relationship_and_the_Role_of_Public_Policies_in_the_US_and_UK %4 public policy/ELSA_ %$ 25550 %0 Journal Article %J Scottish Journal of Political Economy %D 2009 %T Healthy Minds in Healthy Bodies: An International Comparison of Education-Related Inequality in Physical Health among Older Adults %A Jurges, Hendrik %K Cross-National %K Demographics %K Health Conditions and Status %K Methodology %X We study education-related inequality in the physical health of older adults across 11 European countries and the United States. Combining the data from Health and Retirement Study 2002, the English Longitudinal Study of Ageing 2002 and the Survey of Health, Ageing and Retirement in Europe 2004, our results suggest that education is strongly correlated with health both across and within countries. Education-related inequality in health is larger in Mediterranean and Anglo-Saxon countries than in western European countries. We find no evidence of a trade-off between health levels and equity in health. Education-related inequality in health is hardly driven by income or wealth effects (except in the United States), and differences in health behaviours (smoking) by education level contribute little to health differences across education groups. Copyright (c) 2009 The Author. Journal compilation (c) 2009 Scottish Economic Society. %B Scottish Journal of Political Economy %I 56 %V 56 %P 296-320 %G eng %N 3 %L newpubs20090908_Jurges.pdf %4 Cross Cultural Comparison/Education/health status/ELSA_/SHARE/cross-national comparison %$ 20710 %R https://doi.org/10.1111/j.1467-9485.2009.00485.x %0 Journal Article %J Journal of Risk and Insurance %D 2009 %T Housing, Health, and Annuities %A Davidoff, Thomas %K Consumption and Savings %K Demographics %K Healthcare %K Net Worth and Assets %K Other %X Abstract Annuities, long-term care insurance (LTCI), and reverse mortgages appear to offer important consumption smoothing benefits to the elderly, yet private markets for these products are small. A prominent idea is to combine LTCI and annuities to alleviate both supply (selection) and demand (liquidity) problems in these markets. This article shows that if consumers typically liquidate home equity only in the event of illness or very old age, then LTCI and annuities become less attractive and may become substitutes rather than complements. The reason is that the marginal utility of wealth drops when an otherwise illiquid home is sold, an event correlated with the payouts of both annuities and LTCI. Simulations confirm that demand for LTCI and annuities is highly sensitive to the liquidity and magnitude of home equity. %B Journal of Risk and Insurance %I 76 %V 76 %P 31-52 %G eng %N 1 %4 long Term Care/Annuities/Financial planning/Personal finance/Older people/Home equity loans/Reverse mortgages/Leasebacks %$ 25320 %R 10.1111/j.1539-6975.2009.01287.x %0 Journal Article %J Research on Aging %D 2009 %T How Changes in Social Security Affect Retirement Trends %A Alan L Gustman %A Thomas L. Steinmeier %K Employment and Labor Force %K Retirement Planning and Satisfaction %K Social Security %X For married men, we find the conventional view of retirement trends that the long term trend to early retirement has been reversed -- is partially contradicted by recent data. Specifically, descriptive data collected from both the Census and the Health and Retirement Study (HRS) suggest that for those in their fifties, over the periods 1992 to 1998 and 1998 to 2004, the trend to early retirement reasserted itself and labor force participation fell. In contrast, for those in their sixties, there was an increase in work. Similarly, for those 65 and over, the amount of work increased. Simulations with a structural retirement model suggest that the recent acceleration of the trend to early retirement for those in their fifties is not the result of the change in Social Security rules. According to our model, changes in Social Security rules are expected to reduce the number of those in their early sixties who are working. This suggests that forces other than changing Social Security rules account for the observed increase in work by those in their early sixties, and that the effects of these forces are stronger than those suggested by the trends in descriptive data. Lastly, the analysis suggests that changing Social Security rules do help to explain the increase in work by those age 65 and older. The effects of these rule changes encourage workers to remain in their long term jobs for a longer time, encourage some to return from retirement to full time work, and encourage more partial retirement. Nevertheless, the changes in retirement induced by Social Security changes have been modest. Due to Social Security changes, the number of 65 year old married men at work increases by about two percentage points at ages 65 and 66, with slightly smaller changes at 67 to 69. Given the low basic labor force participation at 65 and 66, with 20 to 25 percent at full time work, and another 17 percent at part time work, the percentage increases in work due to Social Security changes are three or four times higher. %B Research on Aging %I 31 %V 31 %P 261 %G eng %N 2 %L newpubs20070125_MRRCwp127 %4 Retirement Behavior/Labor Force Participation/Social Security %$ 17180 %R https://doi.org/10.1177/0164027508328312 %0 Journal Article %J Review of Economics of the Household %D 2009 %T How Do Health Shocks Influence Retirement Decisions? %A McGeary, Kerry Anne %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X The financial viability of the nation s Medicare and Social Security programs has come into question as older adult workers, in particular members of the baby-boomer generation, begin to voluntarily retire. Obviously, any deterioration in the health of older adults will inevitably increase pressure on the Medicare system. However, if older adults respond to changes in their health by reducing their labor supply, than this will also increase demand for the Social Security system. Using data on married and employed couples from the Health and Retirement Study (HRS), this paper determines how the labor supply of each member of a married couple is influenced by changes in the health, assets and medical expenditures of the other member of the couple. Therefore, adding to the extant literature as we determine how the labor supply of an individual responds to health shocks visited on their spouse. We find that the labor supply of both males and females is influenced by their own health shocks and health shocks suffered by their spouses. %B Review of Economics of the Household %I 7 %V 7 %P 307-321 %G eng %N 3 %L newpubs20090908_McGeary.pdf %4 Health Shocks/RETIREMENT/Labor Supply/GENDER-DIFFERENCES %$ 20980 %R https://doi.org/10.1007/s11150-009-9053-x %0 Report %D 2009 %T How Do Pensions Affect Household Wealth Accumulation? %A David M. Blau %K Consumption and Savings %K Methodology %K Pensions %K Public Policy %X Empirical analysis of the effects of pensions on saving behavior is usually based on a highly stylized version of the life cycle model, with a fixed retirement age, a perfect capital market, no uncertainty, and no institutional constraints on pensions. The model predicts one-for-one crowd out of household wealth by pension wealth over the life cycle. Empirical estimates of crowd out are usually much closer to zero, and it is not well understood whether such estimates are accurate indications of the true magnitude of crowd out or whether the strong assumptions imposed in the analysis result in severe misspecification. In this paper, I specify a richer life cycle model in which several of the key restrictions of the simple model are relaxed. The effects of pensions on household wealth are analyzed by solving and simulating the model. The compensating variation associated with pensions is treated as a measure of crowd out. The simulated data are then used to estimate regressions like those typically found in the literature. Preliminary results indicate that regression estimates of the effects of pensions on wealth accumulation estimated under the assumptions of the typical stylized life cycle model are quite misleading when those assumptions do not hold. Specifically, the extent of crowd out is substantially underestimated in the regression approach. This finding may help explain the common although not universal empirical finding of small crowd out. %G eng %U https://www.semanticscholar.org/paper/How-Do-Pensions-Affect-Household-Wealth-Blau/03d49b368eaf5902b759425b6c5554a3afaf36f8 %4 saving behavior/saving/pensions/Methodology/Crowding out %$ 25560 %0 Book Section %B Developments in the economics of aging %D 2009 %T How Do The Better Educated Do It? Socioeconomic Status And The Ability To Cope With Underlying Impairment %A David M Cutler %A Landrum, Mary Beth %A Stewart, Kate A. %E David A Wise %K Demographics %K Disabilities %K Healthcare %X Our analysis considers two primary issues. First, we ask how much of this gradient in health is a result of underlying differences in functioning versus the ability to cope with impairments. We show that while the bulk of the difference is a result of underlying functioning—the better off have much less difficulty with these measures even in the absence of help—coping is important as well. The better educated are less likely to have functional disabilities in the first place, and cope with them better when they occur. %B Developments in the economics of aging %S A National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 203-254 %@ 0-226-90335-4 %G eng %U https://www.nber.org/books-and-chapters/developments-economics-aging/how-do-better-educated-do-it-socioeconomic-status-and-ability-cope-underlying-impairment %4 socioeconomic Status/DISABILITY/DISABILITY/health outcomes/health gradient %$ 24180 %& 6 %0 Journal Article %J Review of Income and Wealth %D 2009 %T How Household Portfolios Evolve after Retirement: The Effect of Aging and Health Shocks %A Courtney Coile %A Kevin Milligan %K Net Worth and Assets %X We study how the portfolios of U.S. households evolve after retirement, using data from the Health and Retirement Study (HRS). In particular, we investigate the influence of aging and health shocks on a household's ownership of various assets and on the share of total assets held in each asset class. We find that households decrease their ownership of principal residences, vehicles, financial assets, businesses, and real estate as they age, while increasing the share of assets held in liquid assets and time deposits. We find that widowhood and other health shocks are associated with the same kinds of portfolio changes, and that the effect of shocks strengthens with time since the shock. Finally, we show that the effect of a shock is greatly magnified when households have physical or mental impairments. This suggests that factors other than standard risk and return considerations weigh heavily in many older households' portfolio decisions. %B Review of Income and Wealth %I 59 %V 59 %P 226-248 %G eng %N 2 %4 Retirement Wealth/Portfolio Choice/Assets/asset choice %$ 20720 %R 10.1111/j.1475-4991.2009.00320.x %0 Report %D 2009 %T How Parents Play Favorites: Evidence from Grandchild Care, Financial Transfers, and Coresidency %A Xiaoyan Li %K Adult children %I Beijing, China, China Center for Economic Research, Peking University %G eng %4 Transfers/Families/Inter Vivos Transfers %$ 25380 %0 Report %D 2009 %T How Seniors Change Their Asset Holdings During Retirement %A Karen E. Smith %A Soto, Mauricio %A Penner, Rudolph %K Demographics %K Net Worth and Assets %K Public Policy %X We use the 1998-2006 waves of the Health and Retirement Study (HRS) to investigate how households change their asset holdings at older ages. We find a notable increase in the net worth of older households between 1998 and 2006, with most of the growth due to housing. Our results indicate that, through 2006, older households did not spend all of their capital gains. This asset accumulation provides older households with a financial cushion for the turbulence experienced after 2007. The wealth distribution is highly skewed, and the age patterns of asset accumulation and decumulation vary considerably by income group. High-income seniors increase assets at older ages. Middle-income seniors reduce their assets in retirement, but at a rate that for most seniors will not deplete assets within their expected life. Many low-income seniors accumulate fewer assets and spend their financial assets at a rate that will mostly deplete them at older ages, leaving low-income seniors with only Social Security and DB pension income at older ages. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/how-seniors-change-their-asset-holdings-during-retirement/ %4 Net Worth/asset accumulation/socioeconomic Status/wealth distribution %$ 22080 %0 Journal Article %J Journal of Financial Transformation %D 2009 %T Hypothetical versus Actual Earnings Profiles: Implications for Social Security Reform %A Olivia S. Mitchell %A John W R Phillips %K Income %K Older Adults %K Social Security %B Journal of Financial Transformation %V 24 %P 102-04 %G eng %0 Book %D 2008 %T Handbook of cognitive aging: interdisciplinary perspectives %A Scott M Hofer %A Duane F. Alwin %K Health Conditions and Status %I Sage Publications %C Thousand Oaks, Calif %G eng %4 Cognition / Age factors./Aging / Psychological aspects. %$ 25930 %R 10.4135/9781412976589 %0 Journal Article %J J Health Econ %D 2008 %T Health and wealth of elderly couples: causality tests using dynamic panel data models. %A Pierre-Carl Michaud %A Arthur H.O. vanSoest %K Aged %K Causality %K Family Characteristics %K Female %K Health Status Indicators %K Humans %K Income %K Longitudinal Studies %K Male %K Middle Aged %K Models, Econometric %K Retirement %K Social Class %K Spouses %K United States %X

A positive relationship between socio-economic status (SES) and health, the "health-wealth gradient", is repeatedly found in many industrialized countries. This study analyzes competing explanations for this gradient: causal effects from health to wealth (health causation) and causal effects from wealth to health (wealth or social causation). Using six biennial waves of couples aged 51-61 in 1992 from the US Health and Retirement Study, we test for causality in panel data models incorporating unobserved heterogeneity and a lag structure supported by specification tests. In contrast to tests relying on models with only first order lags or without unobserved heterogeneity, these tests provide no evidence of causal wealth health effects. On the other hand, we find strong evidence of causal effects from both spouses' health on household wealth. We also find an effect of the husband's health on the wife's mental health, but no other effects from one spouse's health to health of the other spouse.

%B J Health Econ %I 27 %V 27 %P 1312-25 %8 2008 Sep %G eng %N 5 %L newpubs20081014_Michaud-vanSoest.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18513809?dopt=Abstract %2 PMC2867362 %4 Wealth/HEALTH/socioeconomic status %$ 19370 %R 10.1016/j.jhealeco.2008.04.002 %0 Journal Article %J J Aging Soc Policy %D 2008 %T Health insurance coverage as people approach and pass age-eligibility for Medicare. %A Caffrey, Christine %A Christine L Himes %K Aged %K Eligibility Determination %K Female %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medicare %K Middle Aged %K United States %X

This study uses six waves of the Health and Retirement Study (HRS) to measure dynamics of health insurance coverage as people approach and pass age-eligibility for Medicare. Thirteen percent of 59- to 64-year-olds were uninsured and 13% of 65- to 70-year-olds relied solely on Medicare. Those unmarried, in good health, and in poor health had an increased likelihood of being uninsured before age-eligibility for Medicare, while non-whites and those in good health had an increased likelihood of having Medicare-only coverage after age-eligibility for Medicare. Although only a small percentage was continually without coverage or with Medicare-only coverage, a substantial percentage had these coverage types at some point. Limitations and policy implications are included.

%B J Aging Soc Policy %I 20 %V 20 %P 29-44 %8 2008 %G eng %N 1 %L newpubs20080229_ViewEText.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18198158?dopt=Abstract %3 18198158 %4 Health Insurance Coverage/Medicare %$ 18590 %R 10.1300/j031v20n01_02 %0 Journal Article %J Journal of Business & Economic Statistics %D 2008 %T Health Risk and Portfolio Choice %A Ryan D. Edwards %K financial risk %K Retirement %K risky health %X [This article investigates the role of self-perceived risky health in explaining continued reductions in financial risk taking after retirement. If future adverse health shocks threaten to increase the marginal utility of consumption, either by absorbing wealth or by changing the utility function, then health risk should prompt individuals to lower their exposure to financial risk. I examine individual-level data from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), which reveal that risky health prompts safer investment. Elderly singles respond the most to health risk, consistent with a negative cross partial deriving from health shocks that impede home production. Spouses and planned bequests provide some degree of hedging. Risky health may explain 20% of the age-related decline in financial risk taking after retirement.] %B Journal of Business & Economic Statistics %V 26 %P - 485472 %8 2008 %@ 07350015 %G eng %U www.jstor.org/stable/27639006 %N 4 %0 Journal Article %J J Health Econ %D 2008 %T Health status and health dynamics in an empirical model of expected longevity. %A Hugo Benítez-Silva %A Ni, Huan %K Chronic disease %K Delivery of Health Care %K Empirical Research %K Female %K Health Expenditures %K Health Status %K Humans %K Life Expectancy %K Longevity %K Male %K Models, Econometric %X

Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

%B J Health Econ %I 27 %V 27 %P 564-84 %8 2008 May %G eng %N 3 %L newpubs20080822_JnlHealthEcon %1 http://www.ncbi.nlm.nih.gov/pubmed/18187217?dopt=Abstract %2 PMC2862058 %4 Longevity/PREDICTIVE MODEL/HEALTH %$ 19140 %R 10.1016/j.jhealeco.2007.09.008 %0 Thesis %D 2008 %T Health status and the labor force participation decisions of married couples %A Lin, Peng %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %K Women and Minorities %X This thesis examines the labor force participation decisions of married couples, and special attention is paid to a spouse's health conditions affecting their own and the spouse's labor force participation decision. I used the Health and Retirement Study survey data and estimated a seemingly unrelated bivariate probit model. A number of variables besides health condition were added: age, education level, and family unearned income. The results of this research paper support the findings from the relevant literature that the labor supply decisions of the husband and wife are related. The oldest age group is least likely to work. The younger the husband, the more likely it is that the husband will work. At the ages between 40 and 49, wives have the biggest probability to work. The higher the education level, the more likely it is that a spouse is going to work. The more total family unearned income, the less probable the spouse will go to work. Poor health has a negative effect on labor force participation and a positive effect for the spouse's labor force participation. %I University of Texas A&M %C College Station, TX %8 Dec 2008 %G eng %9 MS %4 women %$ 69296 %! Health status and the labor force participation decisions of married couples %0 Journal Article %J Cien Saude Colet %D 2008 %T [The health status of the elderly population: what do we need to know?]. %A Reboucas, Monica %A Siulmara Cristina Galera %A Pereira, Silvia Regina Mendes %A Pereira, Mauricio Gomes %K Aged %K Brazil %K Cross-Sectional Studies %K Geriatric Assessment %K Health Status Indicators %K Humans %K Middle Aged %K United States %X

The objective of this research was to evaluate the data on the health of the elderly population available in the Brazilian information system and their correspondence with the North American statistics using the Internet. The North American publication "Older Americans 2000: Key Indicators of Well-Being" was used as a standard. The databases and instruments used in the North American and Brazilian surveys are presented. The North American data are based on the Supplement on Aging and Second Supplement on Aging; Health and Retirement Study; National Health Interview Survey and National Long Term Care Survey. The Brazilian data were collected from the Mortality Information System; Information System of the National Program of Immunizations; National Household Sample Survey conducted in 1998 and 2003 and from the Household Survey on Risk Behavior and Morbidity from Not Transmissible Diseases of 2002-2003. There is a great number of Brazilian information about the aged population of the Country available in the Internet and with few exceptions the information on aged Brazilians corresponds to the information available about aged North Americans.

%B Cien Saude Colet %I 13 %V 13 %P 1305-12 %8 2008 Jul-Aug %G por %N 4 %L newpubs20090126_Reboucas %1 http://www.ncbi.nlm.nih.gov/pubmed/18813630?dopt=Abstract %3 18813630 %4 Elderly/health status/Cross Cultural Comparison %$ 19700 %R 10.1590/s1413-81232008000400027 %0 Report %D 2008 %T Height, Health and Cognitive Function at Older Ages %A Case, Anne %A Paxson, Christina %K Health Conditions and Status %G eng %U http://www.princeton.edu/rpds/papers/pdfs/Case_Paxson_Height_Health_and_Cognitive_Function.pdf %4 cognition/height %$ 25590 %0 Book %B U.S. Department of Health and Human Services %D 2008 %T Home Modifications: Use, Cost, and Interactions with Functioning Among Near-Elderly and Older Adults %A Vicki A Freedman %K Healthcare %K Housing %X Recent studies suggest a potentially large role for assistive home features in the daily lives of older adults. Yet surprisingly little current and generalizable information has been available to policy makers to allow them to investigate who has assistive home features, who has added these features and at what cost, who actually uses such features, and who potentially needs such features but has not put them into place. The 2005 Pilot Study of Technology and Aging was funded by the Assistant Secretary for Planning and Evaluation in cooperation with the National Center for Health Statistics and the National Institute on Aging to develop measures of the home environment and assistive technology use for national health and aging surveys (Freedman, Agree, and Cornman 2005; Freedman, Agree, and Landsberg 2006; Freedman, Agree, and Cornman 2006b). A subset of these items was included in the 2006 Health and Retirement Study (HRS) as an experimental module. In this report we analyze the 2006 HRS Home Modification Module (N=1,512) to describe the range of assistive home features for near-elderly and older adults (born 1953 or earlier; ages 52 and older in 2006). Research Questions. Four questions are addressed: (1) To what extent do near-elderly and older adults live in homes with assistive features and to what extent have they added and do they use such features (alone and in combination with personal care). (2) What is the distribution of out-of-pocket costs for adding assistive features and to what extent do insurance and government programs contribute. (3) How does the existence, addition, and use of assistive home features vary for demographic groups. Are these differences accounted for by differences in economic or health-related factors. (4) To what extent are near-elderly and older adults at risk for home modification sthat is, what percentage of near-elderly and older adults have low functioning, yet do not have relevant assistive home features and what is the demographic and socioeconomic makeup of this group. Data and Methods. Respondents to the 2006 HRS Home Modifications Module were asked about ten assistive home features: ramps at the entrance, handrails at the entrance (asked if the respondent has to step up or down to get into home), an emergency call system, grab bars in the shower or tub area, a seat for the shower or tub, grab bars around the toilet, a raised or modified toilet seat, a stair glide or chair lift to go up or down stairs (asked if the respondent has living space on more than one floor), handrails in the stairways (if the respondent has living space on more than one floor), and handrails in the hallways. %B U.S. Department of Health and Human Services %I Office of the Assistant Secretary for Planning and Evaluation %C Washington, D.C. %G eng %U https://aspe.hhs.gov/basic-report/home-modifications-use-cost-and-interactions-functioning-among-near-elderly-and-older-adults %4 Assistive home features/Home modifications/Assistive technology %$ 21860 %0 Journal Article %J Fisc Stud %D 2008 %T How did the Elimination of the Earnings Test above the Normal Retirement Age affect Retirement Expectations? %A Pierre-Carl Michaud %X

We look at the effect of the 2000 repeal of the earnings test above the normal retirement age on retirement expectations of workers in the Health and Retirement Study, aged 51 to 61 in 1992. For men, we find that those whose marginal wage rate increased when the earnings test was repealed, had the largest increase in the probability to work full-time past normal retirement age. We do not find significant evidence of effects of the repeal of the earnings test on the probability to work past age 62 or the expected claiming age. On the other hand, for those reaching the normal retirement age, deviations between the age at which Social Security benefits are actually claimed and the previously reported expected age are more negative in 2000 than in 1998. Since our calculations show that the tax introduced by the earnings test was small when accounting for actuarial benefit adjustments and differential mortality, our results suggest that although male workers form expectations in a way consistent with forward-looking behavior, they misperceive the complicated rules of the earnings test. Results for females suggest similar patterns but estimates are imprecise.

%B Fisc Stud %I 29 %V 29 %P 197-231 %8 2008 Jun 01 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21037938?dopt=Abstract %2 PMC2964895 %4 labor Force Participation/social security earnings and benefits %$ 25210 %R 10.1111/j.1475-5890.2008.00073.x %0 Report %D 2008 %T How Does Modeling of Retirement Decisions at the Family Level Affect Estimates of the Impact of Social Security Policies on Retirement? %A Alan L Gustman %A Thomas L. Steinmeier %K modeling %K Policy %K Retirement %K Social Security %X This paper applies structural models of retirement and saving of two earner couples to explore the effects on retirement of two actuarially neutral policies, which we know from previous work can have a substantial effect on retirement if heterogeneity in time preference rates is allowed. The main question being investigated here is whether using a model that explicitly incorporates the retirement interactions of two working spouses yields a different evaluation of policies than when a much simpler model that treats the retirement decisions of the second spouse as exogenous is used. The findings indicate that unless the question of interest is specifically related to joint retirement issues, the effects of the two actuarially neutral policies being investigated are roughly equal whichever model is estimated. A second question explored in the paper is whether two earner and one earner households can be combined in the analysis. The effects of policy changes are clearly different for one earner and two earner households, but there is some evidence that the principal difference is due to the differing budget sets of the two groups. Though the estimated preference parameters are significantly different, the critical parameters governing responses to policy changes are similar. As a result, it seems plausible that unless the question being investigated involves looking at these two groups separately, the overall impact of the policy changes may be adequately assessed by combining the two groups, separately identifying them by a dummy variable. A third question involves the magnitude of the effects for these two specific policy changes. Increasing the Social Security early entitlement age from 62 to 64 would reduce the level of retirement for husbands from two earner households by 4.4-4.6 percentage points at age 62, and by 5.1-5.7 percentage points for wives. In contrast, this policy change would induce husbands from one earner households to reduce the level of retirement by 10.2 percentage points at age 62. In a system of personal accounts, offering Social Security benefits as a lump sum instead of as an annuity would increase the level of retirement for husbands from two earner households by 7.1-8.1 percentage points at age 62 and by 8.9 percentage points for husbands in one earner households, and by 2.8-3.2 percentage points for wives in two earner households. %I Michigan Retirement Research Center %C Ann Arbor, MI %8 10/2008 %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1287302 %0 Report %D 2008 %T How Much Do Older Workers Value Employee Health Insurance? %A Friedberg, Leora %A Wei Sun %A Anthony Webb %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %X This brief seeks to answer the question in the title by analyzing data from the Health and Retirement Study (HRS), a nationally representative survey of older Americans. New questions in the HRS enable researchers to compare the value that workers place on health insurance with their perceptions about the cost of coverage. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %L newpubs20081014_ib_8-9.pdf %4 Health Insurance/Health Expenditures %$ 19460 %0 Report %D 2008 %T How Much Do Respondents in the Health and Retirement Study Know About Their Tax-deferred Contribution Plans? A Crosscohort Comparison %A Irena Dushi %A Honig, Marjorie %K Pensions %K Social Security %X We use information from Social Security earnings records to examine the accuracy of survey responses regarding participation in tax-deferred pension plans. As employer-provided defined benefit pensions are replaced by voluntary contribution plans, employees understanding of the link between their annual contribution decisions and their post-retirement wealth is becoming increasingly important. We examine the extent to which wage-earners in the Health and Retirement Study correctly report their inclusion in tax-deferred contribution plans and, conditional on inclusion, their annual contributions. We use two samples representing different cohorts in two different periods: the original HRS cohort interviewed in 1992 at ages 51-61, and a combination of the War Babies and Early Baby Boomer cohorts at the same ages interviewed twelve years later. Our findings indicate that while respondents interviewed in 2004 were more likely to report correctly whether they were included in DC plans, they were no more accurate in reporting whether they contributed to their plans than respondents interviewed in 1992. Respondents in both cohorts, moreover, overestimated their annual contributions. In both 1992 and in 2004, the mean absolute difference between respondent-reported and Social Security earnings record contributions was 1.5 times larger than the mean earnings record contribution. %B University of Michigan Retirement Research Center Working Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://deepblue.lib.umich.edu/bitstream/handle/2027.42/64473/wp201.pdf?sequence=1&isAllowed=y %4 pension Plans/social security earnings and benefits/Defined contribution pension plans %$ 25630 %0 Report %D 2008 %T How Much Do State Economics and Other Characteristics Affect Retirement Behavior? %A Alicia H. Munnell %A Soto, Mauricio %A Triest, Robert K. %A Natalia A. Zhivan %K Employment and Labor Force %K Retirement Planning and Satisfaction %X The labor force participation of men age 55-64 varies significantly among the various states of the Union. Little is known, however, about the reasons such variations exist. Using the Current Population Survey for the period 1977-2007, this paper demonstrates that the differences in the labor force participation of men age 55-64 are related to the labor market conditions, the nature of employment, and the employee characteristics in each state as well as a state pseudo replacement rate. These variables explain more than one-third of the total variation in labor force participation across states. Even controlling for state specific characteristics only cuts the explanatory power by half. To assess whether these relationships reflect different populations or unique aspects of the state economies, we turn to the Health and Retirement Study (HRS). We estimate equations for the probability of working and for the expected retirement for men in their late fifties and early sixties. We first estimate an equation predicting labor force participation using just the state-level variables taken from the CPS, then estimate an equation using both the CPS state-level variables and demographic and economic information for each individual taken from the HRS. The results show that while the state-level variables explain very little variation in an individual s probability of working or expected retirement age, most state-level variables have a statistically significant effect on such behavior both before and after the inclusion of the HRS information. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/how-much-do-state-economics-and-other-characteristics-affect-retirement-behavior/ %L newpubs20090908_CRR2008-12.pdf %4 Labor Force Participation/Retirement Behavior %$ 20570 %0 Report %D 2008 %T How Well Do Individuals Predict the Selling Prices of Their Homes? %A Hugo Benítez-Silva %A Selçuk Eren %A Frank Heiland %A Jimenez-Martin, Sergi %K Housing %K Net Worth and Assets %X Self-reported home values are widely used as a measure of housing wealth by researchers employing a variety of data sets and studying a number of different individual and household level decisions. The accuracy of this measure is an open empirical question, and requires some type of market assessment of the values reported. In this research, we study the predictive power of self-reported housing wealth when estimating sales prices utilizing the Health and Retirement Study. We find that homeowners, on average, overestimate the value of their properties by between 5 and 10 . We also find a strong correlation between accuracy and the economic conditions (measured by the prevalent interest rate, the growth of household income, and the growth of median housing prices) at the time of the purchase of the property. While most individuals overestimate the value of their properties, those who bought during more difficult economic times tend to be more accurate, and in some cases even underestimate the value of their house. This cyclicality of the overestimation of house prices can provide some clues regarding the reasons for the difficulties currently faced by many homeowners. %B Levy Economics Institute Working Paper %I The Levy Economics Institute %C New York, New York %G eng %L newpubs20080908_fedea2008-10.pdf %4 Housing Equity/Wealth %$ 20990 %R http://dx.doi.org/10.2139/ssrn.1107165 %0 Report %D 2008 %T HRS Design History %A HRS Staff %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 12/2008 %G eng %0 Report %D 2008 %T HRS Sample Evolution: 1992-1998 %A HRS Staff %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 12/2008 %G eng %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T Health Insurance Patterns Nearing Retirement %A Helen G Levy %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %G eng %U https://pensionresearchcouncil.wharton.upenn.edu/publications/books/redefining-retirement-how-will-boomers-fare/ %4 Health Insurance Coverage/RETIREMENT %$ 18150 %0 Journal Article %J JAMA %D 2007 %T Health of previously uninsured adults after acquiring Medicare coverage. %A J. Michael McWilliams %A Meara, Ellen %A Alan M. Zaslavsky %A John Z. Ayanian %K Aged %K Cardiovascular Diseases %K depression %K Diabetes Mellitus %K Female %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Outcome Assessment, Health Care %K United States %X

CONTEXT: Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes than insured adults. However, the health benefits of providing insurance coverage for uninsured adults have not been clearly demonstrated.

OBJECTIVE: To assess the effect of acquiring Medicare coverage on the health of previously uninsured adults.

DESIGN AND SETTING: We conducted quasi-experimental analyses of longitudinal survey data from 1992 through 2004 from the nationally representative Health and Retirement Study. We compared changes in health trends reported by previously uninsured and insured adults after they acquired Medicare coverage at age 65 years.

PARTICIPANTS: Five thousand six adults who were continuously insured and 2227 adults who were persistently or intermittently uninsured from ages 55 to 64 years.

MAIN OUTCOME MEASURES: Differential changes in self-reported trends after age 65 years in general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these 6 domains; and adverse cardiovascular outcomes (all trend changes reported in health scores per year).

RESULTS: Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure (differential change in annual trend, +0.20; P = .002) and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health (differential change in annual trend, +0.26; P = .006), change in general health (+0.02; P = .03), mobility (+0.04; P = .05), agility (+0.08; P = .003), and adverse cardiovascular outcomes (-0.015; P = .02) but not in depressive symptoms (+0.04; P = .32). Previously uninsured adults without these conditions reported differential improvement in depressive symptoms (+0.08; P = .002) but not in summary health (+0.10; P = .17) or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50%.

CONCLUSION: In this study, acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.

%B JAMA %I 298 %V 298 %P 2886-94 %8 2007 Dec 26 %G eng %N 24 %L newpubs20080229_joc70139.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18159058?dopt=Abstract %4 Medicare/Insured Status/SELF-RATED HEALTH %$ 18480 %R 10.1001/jama.298.24.2886 %0 Thesis %D 2007 %T Heterogeneity, Risk Sharing and the Welfare Costs of Risk %A Schulhofer-Wohl, Samuel A. %K Employment and Labor Force %K Insurance %K Public Policy %K Risk Taking %X How well do people share risk? Do non-market institutions – charity, progressive taxes, transfer payments – make up for the lack of complete insurance markets? Or is risk sharing far worse than what complete markets could achieve? Standard risk-sharing regressions assume that any variation in households' risk preferences is uncorrelated with variation in income. I combine administrative and survey data with a simple model of imperfect insurance to show that this assumption fails; risktolerant workers sort into jobs where earnings carry more aggregate risk. The correlation makes previous risk-sharing regressions too pessimistic. I derive techniques that eliminate the bias, apply them to U.S. data, and find that the welfare losses from uninsured shocks are practically small and statistically difficult to distinguish from zero. In addition, because more risk-tolerant people bear more aggregate risk, the welfare costs of macroeconomic fluctuations are small even for arbitrarily riskaverse households. There is little room to improve households' welfare by smoothing idiosyncratic or aggregate shocks unless smoothing shocks also allows households to choose more productive occupations. %I The University of Chicago %8 2007 %G eng %U http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.541.8970&rep=rep1&type=pdf %L newpubs20071002_Schulhofer-Wohl.pdf %4 Welfare %$ 18090 %! Heterogeneity, Risk Sharing and the Welfare Costs of Risk %0 Journal Article %J Med Care %D 2007 %T Hospital episodes and physician visits: the concordance between self-reports and medicare claims. %A Frederic D Wolinsky %A Thomas R Miller %A An, Hyonggin %A John F Geweke %A Robert B Wallace %A Kara B Wright %A Elizabeth A Chrischilles %A Li Liu %A Claire E Pavlik %A Elizabeth A Cook %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %K Aged %K Centers for Medicare and Medicaid Services, U.S. %K Episode of Care %K Female %K Hospitalization %K Humans %K Insurance Claim Review %K Interviews as Topic %K Male %K Physicians %K Quality Assurance, Health Care %K Self Disclosure %K United States %X

BACKGROUND: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

OBJECTIVE: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

METHODS: We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).

RESULTS: The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.

CONCLUSIONS: Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

%B Med Care %I 45 %V 45 %P 300-7 %8 2007 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/17496713?dopt=Abstract %2 PMC1904836 %4 health Services/ADMINISTRATIVE DATA/Self-reported health/Medicare/HOSPITALIZATION %$ 25000 %R 10.1097/01.mlr.0000254576.26353.09 %0 Journal Article %J Economic Inquiry %D 2007 %T Hours Flexibility and Retirement %A Kerwin K. Charles %A Decicca, Philip %K Employment and Labor Force %K Retirement Planning and Satisfaction %X Data from the Health and Retirement Study indicate that hours constraints are a common feature of jobs held by workers nearing retirement. We present a simple model that predicts that workers who are not free to lower their usual hours of work should be more likely than their unconstrained counterparts to retire by some future date. Our estimates, which are robust to various specifications, support this prediction. The amount by which being hours constrained is estimated to raise retirement probabilities is nearly as large as the effect of being in relatively poor health, suggesting an economically significant effect. %B Economic Inquiry %I 45 %V 45 %P 251 %G eng %N 2 %L newpubs2071002_HoursFlex.pdf %4 Job Characteristics/Labor--retirement decisions/Working Hours %$ 18080 %R https://doi.org/10.1111/j.1465-7295.2006.00009.x %0 Report %D 2007 %T Housing Wealth and Retirement Timing %A Martin P. Farnham %A Purvi Sevak %K Housing %K Retirement Planning and Satisfaction %X We use data from the Health and Retirement Study (HRS) and the Office of Housing Enterprise Oversight to measure the effect of changes in housing wealth on retirement timing. Using cross-MSA variation in house-price movements to identify wealth effects on retirement timing, we find evidence that such wealth effects are present. According to some specifications the rate of transition into retirement increases in the presence of positive housing wealth shocks. In addition, we use data on expected age of retirement to measure the impact of housing wealth shocks on expectations about retirement timing. Using renters as a control for heterogeneity in local amenities and using individual fixed effects to control for unobserved individual heterogeneity, we find that a 10 increase in housing wealth is associated with a reduction in expected retirement age of between 3.5 and 5 months. %I The University of Michigan, Michigan Retirement Research Center %G eng %U https://deepblue.lib.umich.edu/handle/2027.42/57437 %L newpubs20080229_wp172.pdf %4 Housing Equity/Retirement planning %$ 18350 %0 Journal Article %J Employee Benefit Research Institute Issue Brief 302 %D 2007 %T How Are New Retirees Doing Financially in Retirement? %A Copeland, Craig %K Consumption and Savings %K Net Worth and Assets %X Although there has been extensive analysis of the accumulation of retirement assets in the United States, limited research has been done on how quickly Americans use their assets in retirement. Utilizing data from the Health and Retirement Study (HRS), this Issue Brief examines those currently between ages 65 and 75 to determine their levels of wealth in retirement, how those levels have changed, and to see if this group is on track for a financially secure retirement. %B Employee Benefit Research Institute Issue Brief 302 %I Issue Brief 302 %V Issue Brief 302 %G eng %U https://www.ebri.org/content/how-are-new-retirees-doing-financially-in-retirement--3781 %4 Assets/Consumption/Wealth %$ 17310 %0 Report %D 2007 %T How do Immigrants Fare in Retirement? %A Purvi Sevak %A Lucie Schmidt %K Demographics %K Net Worth and Assets %K Pensions %K Social Security %X Existing literature suggests that immigrants receive lower wages than U.S.-born workers with similar characteristics. This could imply that immigrant households would enter retirement at a significant financial disadvantage. In this paper, we examine the retirement resources available to immigrant families by examining Social Security benefits, pension coverage, and private wealth accumulation. Our results suggest that although immigrant families may be financially better-off in the U.S. than in their native countries, they do enter retirement at a significant financial disadvantage relative to native born households with similar characteristics. %B University of Michigan Retirement Research Center Working Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://deepblue.lib.umich.edu/handle/2027.42/57433 %L newpubs20080229_wp169.pdf %4 Immigrants/Retirement Wealth/Social Security/Pensions %$ 18380 %0 Journal Article %J Journal of Aging and Health %D 2006 %T Health Effects of Managed Care among the Near-Elderly %A Xiao Xu %A Gail A Jensen %K Healthcare %K Medicare/Medicaid/Health Insurance %X OBJECTIVE: The authors evaluate whether enrolling in a health maintenance organization (HMO) or preferred provider organization (PPO) affects the health of adults ages 55 to 64, relative to fee-for-service plans. METHODS: A nationwide random sample of 4,044 adults with employer-sponsored health insurance is drawn from the 1994 to 2000 waves of the Health and Retirement Study. Multinomial logit regressions are estimated for self-reported general health status, first using a sample of all near-elders, then using subsamples of near-elders with and without longstanding chronic health conditions. The possibility of selection bias into managed care plans is considered and explicitly addressed in model estimation. RESULTS: We find no ill effects of HMOs on health status, and older adults with a history of chronic health conditions actually fare better upon enrolling in these plans. DISCUSSION: More research is needed to understand the reasons for the observed beneficial effects of managed care. %B Journal of Aging and Health %I 18 %V 18 %P 507-33 %G eng %N 4 %4 Health Insurance Coverage/health outcomes %$ 16710 %0 Journal Article %J Health Services Research %D 2006 %T Health Insurance and Health at Age 65: Implications for medical care spending on new Medicare beneficiaries %A Hadley, J. %A Timothy A Waidmann %K End of life decisions %K Healthcare %K Insurance %K Medicare/Medicaid/Health Insurance %K Other %X Objectives. To investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage. . Data. The longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998. . Study Design. Instrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period. . Findings. Continuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in their first few years of coverage would be slightly lower because of the improvement in health status. In addition, total Medicare and Medicaid spending for new beneficiaries over their first few years of coverage would be about the same or slightly lower, even though more people survive to age 65. Conclusions. Extending insurance coverage to all Americans between the ages of 55 and 64 would improve health (increase survival and shift people from good-fair-poor health to excellent-very good health) at age 65, and possibly reduce total short-term spending by Medicare and Medicaid for newly eligible Medicare beneficiaries, even though more people would enter the program because of increased survival. %B Health Services Research %I 41 %V 41 %P 429 -451 %G eng %N 2 %L pubs_2006_Hadley.pdf %4 insurance/health outcomes/Medicare and Medicaid spending/IV analysis/INSTRUMENTS/SERVICES/COVERAGE/DECLINE %$ 15870 %0 Journal Article %J Medical Care %D 2006 %T Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992-2002 %A David W. Baker %A Joseph J Sudano %A Durazo-Arvizu, Ramon %A Joseph Feinglass %A Whitney P. Witt %A Jason A. Thompson %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Other %X Background: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. . Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. .Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. . Results: People who were uninsured at baseline had a 35 (95 confidence interval CI 12-62 ) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95 CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95 CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6 ) died; of those who died, only 70 (31.8 ) were still uninsured at the HRS inter-view prior to death. Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance. %B Medical Care %I 44 %V 44 %P 277 -282 %G eng %N 3 %4 health insurance/mortality/health status/outcome studies/SELF-RATED HEALTH/MYOCARDIAL-INFARCTION/REGRESSION-ANALYSIS/LONGITUDINAL DATA/MORTALITY/OUTCOMES/TERMINATION/CANCER/COHORT/SPELLS %$ 15790 %0 Report %D 2006 %T Heterogeneity in Preferences and Productivity: Implications for Retirement %A Gortz, Mette %K Consumption and Savings %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper discusses the determinants of the retirement decision and the implications of retirement on economic well-being. The main contribution of the paper is to formulate the role of individual heterogeneity explicitly. We argue that individual heterogeneity in 1) productivity of market work versus housework, 2) preferences for leisure compared to consumption, and 3) marginal utility of wealth, is correlated with the retirement decision. Based on US consumption and time use data for 2001 and 2003 from the Consumptions and Activities Mail Survey (CAMS), we study the patterns of individual choices of expenditure, household production and leisure for people in and around retirement. The unobserved individual heterogeneity factor is isolated by comparing cross-sectional evidence and panel data estimates of the effects of retirement on consumption and time allocation. Based on cross-section data, we can identify a difference in consumption due to retirement status, but when the panel nature of the data is exploited, the effect of retirement on consumption is small and insignificant. Moreover, the analyses point at a large positive effect of retirement on household production. Our results therefore contribute to the discussion of the so-called retirement-consumption puzzle. Many analyses of the retirement-consumption drop assume that the retirement decision is exogenous. However, the individual decision on when to retire may depend on expected changes in consumption and time allocation. This suggests that the retirement decision is endogenous. To test this, we apply an instrumental variables method in the treatment effects tradition. %I University of Copenhagen, Dept. of Economics %G eng %U http://www/econ.ku.dk/CAM %L wp_2006/CAMwp2006-001.pdf %4 RETIREMENT/Consumption/Household Production %$ 16610 %0 Thesis %D 2006 %T His and Her Marriage Today: The impact of wives' employment on husbands' later mid-life health %A Kristen W Springer %K Adult children %K Demographics %K Health Conditions and Status %K Methodology %K Women and Minorities %X Marriage is a highly gendered institution with expectations, norms, and resources organized through gender relations. The short-lived, though idealized, 1950s' notion of the "male breadwinner" solidified men's power in marriage through economic contributions from paid employment. However, the last several decades have witnessed an explosion of wives entering the labor market, all but demolishing the reality of the male breadwinner. This dissertation situates itself in this historical context to explore how wives' employment affects husbands' health. By combining gender literature on the breadwinner role with health inequalities literature, this dissertation utilizes feminist theories to contextualize men's health while at the same time using health as a heuristic to examine gender inequality and gender relations in marriage. I analyze longitudinal data on married couples from the Health and Retirement Study (HRS) to find strong evidence that a wife's employment impacts a husband's health only when he fails to achieve the normative prescription of the family breadwinner---supporting what I've termed the changing gendered-norms model. I found no support for the predominant sociological explanation that a wife's employment harms a husband's health because it limits her time available for caregiving. The starving hearts model which posits ill health effects of the social and financial burden associated with breadwinning also failed to explain the relationship between wives' employment and husbands' health. Further exploration of mechanisms driving the changing gendered-norms model did not support standard marital relations explanations including the economic resource mechanism and the marital dissatisfaction mechanism. In other words, husbands' health is not harmed because high earning wives exercise power in marital decisions nor is husbands' health harmed because economically dependent husbands are dissatisfied with their marriages. Rather, the results indicate that a husband's economic dependency adversely impacts his health through a masculinity threat resulting from having a primary breadwinning wife. These results underscore that gender inequality and ideological norms that privilege men are the sources of husbands' ill health associated with wives' employment. Social policies designed to dismantle the male breadwinner ideology and support combining home with work could improve women's social status while enhancing men's health. %I The University of Wisconsin - Madison %C United States -- Wisconsin %8 2006 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1225147281&Fmt=7&clientId=17822&RQT=309&VName=PQD %4 Gender %$ 17510 %! His and Her Marriage Today: The impact of wives' employment on husbands' later mid-life health %0 Report %D 2006 %T Home Production by Dual Earner Couples and Consumption During Retirement %A Christopher L House %A John Laitner %A Stolyarov, Dmitriy %K Consumption and Savings %K Event History/Life Cycle %K Net Worth and Assets %X To study the role of home production in life cycle behavior, this paper creates a theoretical model in which both spouses in a couple allocate their time between market and home work. It then derives a pair of regression equations for estimating the parameters of the model, and it carries out the estimation using panel data on household net worth and lifetime earnings from the Health and Retirement Study and pseudo panel data on household consumption expenditures from the Consumer Expenditure Survey. We estimate that the value of forgone home production is roughly 10-15 cents for every dollar that a married man earns, but 30-35 cents per dollar of married women s market earnings. Our findings imply male labor supply elasticities that are very near zero and female elasticities in the range of 0.50. Our model predicts a substantial decline in measured consumption expenditure at a household s retirement, and it shows that Euler equation models of consumption behavior should include terms reflecting home production. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/ %L newpubs20070125_House_etal_wp143 %4 Life Cycle Models and Saving/Household Production/Consumption %$ 17040 %0 Report %D 2006 %T How Accurate are Expected Retirement Savings? %A Steven Haider %A Melvin Stephens Jr. %K Consumption and Savings %K Expectations %X This paper examines the ability of workers nearing retirement to report their expected retirement savings, where retirement savings refers to funds held in savings, checking, and investment-type accounts. Responding to such a question is likely to be difficult, even for those who are near retirement, because it requires respondents to assess when they will retire, their likely income stream between the survey date and retirement, and what portfolio choices will be made at retirement. Based on two nationally representative surveys collected two decades apart, we find that most individuals provide some response to the question, particularly when they are allowed to provide a range. Moreover, the responses that are given have substantial predictive power for actual retirement savings, even when compared to the savings in the initial wave. Despite this predictive power, there is evidence that responses do not satisfy the more stringent requirements of the rational expectations hypothesis. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/publications/papers %L newpubs20070125_MRRCwp128 %4 Retirement Saving/Subjective Expectations %$ 17170 %0 Report %D 2006 %T How Did the Elimination of the Earnings Test Above the Normal Retirement Age Affect Retirement Expectations? %A Pierre-Carl Michaud %A Arthur H.O. vanSoest %K Retirement Planning and Satisfaction %K Social Security %X This study examines the effect of the 2000 repeal of the earnings test above the normal retirement age on retirement expectations of workers aged 51 to 61 their probabilities to work past age 62 and 65 as well as the age at which they expect to start claiming old age social security benefits. We use administrative records linked to the HRS to create variables that accurately reflect the change in financial incentives. For men, we find results in line with theoretical predictions on the probability to work after age 65. For example, men whose marginal wage rate increased when the earnings test was repealed, showed the largest increase in the probability to work full-time past normal retirement age. For women, we do not find significant results, possibly due to omitting spouse benefits and their interaction with the earnings test. We also do not find significant evidence of effects of the repeal of the earnings test on the probability to work past age 62 or the expected claiming age. On the other hand, for those reaching the normal retirement age, deviations between the age at which Social Security benefits are actually claimed and the previously reported expected age are more negative in 2000 than in 1998, suggesting that the repeal has increased claiming immediately after reaching normal retirement age. Since our calculations show that the tax introduced by the earnings test was small when accounting for actuarial benefit adjustments and differential mortality, our results suggest that although workers form expectations in a way consistent with forward-looking behavior, they misperceive the complicated rules of the earnings test. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/ %L newpubs20070125_MRRCwp135 %4 Retirement Behavior/Social Security benefit claiming %$ 17100 %0 Report %D 2006 %T How Secure Are Retirement Nest Eggs? %A Richard W. Johnson %A Mermin, Gordon B.T. %A Cori E. Uccello %K Adult children %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %X Life s uncertainties can upend the best-laid retirement plans. Health can fail as people grow older, or their spouses can become ill. Older people can lose their jobs, and often have trouble finding new ones. Marriages can end in widowhood or divorce. Health, employment, and marital shocks near retirement can have serious financial repercussions, raising out-of-pocket medical spending, reducing earnings, disrupting retirement saving, and forcing people to dip prematurely into their nest eggs. This brief examines different types of negative events that can strike near retirement. It reports the incidence of widowhood, divorce, job layoffs, disability, and various medical conditions over a 10-year period, and estimates their impact on household wealth. Data come from the Health and Retirement Study (HRS), a nationally representative survey of older Americans conducted by the University of Michigan for the National Institute on Aging. The survey interviewed a large sample of non-institutionalized adults ages 51 to 61 in 1992 and re-interviewed them every other year. The analysis uses data through 2002, the most recent year available. The results show that many people in their 50s and 60s experience negative shocks that threaten retirement security. Job layoffs, divorce, and the onset of work disabilities near retirement substantially erode retirement savings. The findings highlight the limitations of the safety net when things go wrong in late midlife. %I Boston College, Center for Retirement Research %G eng %U http://www.bc.edu/centers/crr/ib_45.shtml %L wp_2006/CRRib_45a.pdf %4 Retirement Saving/Health Shocks/Divorce/Widowhood %$ 16370 %0 Journal Article %J J Aging Health %D 2005 %T Health and living arrangements among older Americans: does marriage matter? %A Jersey Liang %A Brown, Joseph W. %A Krause, Neal M. %A Mary Beth Ofstedal %A Joan M. Bennett %K Adult children %K Aged %K Demography %K Health Status %K Humans %K Institutionalization %K Marital Status %K Marriage %K Mental Health %K Parents %K Residence Characteristics %K Social Support %K Socioeconomic factors %K Spouses %K United States %X

OBJECTIVE: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons.

METHODS: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags.

RESULTS: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others.

DISCUSSION: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

%B J Aging Health %I 17 %V 17 %P 305-35 %8 2005 Jun %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15857961?dopt=Abstract %4 Health/Living Conditions/Marriage/Health Physical %$ 14370 %R 10.1177/0898264305276300 %0 Journal Article %J J Behav Med %D 2005 %T Health events and the smoking cessation of middle aged Americans. %A Tracy Falba %K Diabetes Mellitus %K Female %K Health Behavior %K Health Status %K Heart Failure %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Smoking %K Smoking cessation %K Social Environment %K Socioeconomic factors %K United States %X

This study investigates the effect of serious health events including new diagnoses of heart attacks, strokes, cancers, chronic lung disease, chronic heart failure, diabetes, and heart disease on future smoking status up to 6 years postevent. Data come from the Health and Retirement Study, a nationally representative longitudinal survey of Americans aged 51-61 in 1991, followed every 2 years from 1992 to 1998. Smoking status is evaluated at each of three follow-ups, (1994, 1996, and 1998) as a function of health events between each of the four waves. Acute and chronic health events are associated with much lower likelihood of smoking both in the wave immediately following the event and up to 6 years later. However, future events do not retrospectively predict past cessation. In sum, serious health events have substantial impacts on cessation rates of older smokers. Notably, these effects persist for as much as 6 years after a health event.

%B J Behav Med %I 28 %V 28 %P 21-33 %8 2005 Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/15887873?dopt=Abstract %4 Health Behavior/Smoking/Smoking Cessation/Health Shocks %$ 14326 %R 10.1007/s10865-005-2560-1 %0 Journal Article %J Contemporary Economic Policy %D 2005 %T Health Insurance Coverage and Reemployment Outcomes Among Older Displaced Workers %A Lin, Emily Y. %K Employment and Labor Force %K Medicare/Medicaid/Health Insurance %X This paper investigates the relationship between health insurance coverage and employment behavior among older workers with an involuntary job loss. It finds that various sources of health insurance are available to mitigate the circumstances where employer-sponsored health insurance is terminated when older workers lose jobs involuntarily. However, older displaced workers remain less likely to be insured than comparable non-displaced workers by 7.6 percentage points one year after the job loss. The analysis also reveals that having secure health coverage before job displacement is associated with lower probabilities of reemployment and longer post-displacement non-employment spells. %B Contemporary Economic Policy %I 23 %V 23 %P 529-544 %G eng %N 4 %L pubs_2005_LinCEP.pdf %4 Health Insurance/Job Loss/Older Workers %$ 14322 %R https://doi.org/10.1093/cep/byi039 %0 Journal Article %J Arch Intern Med %D 2005 %T Health insurance coverage during the years preceding medicare eligibility. %A David W. Baker %A Joseph J Sudano %K Age Factors %K Black or African American %K Cohort Studies %K Female %K Health Status %K Hispanic or Latino %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medically Uninsured %K Middle Aged %K Sex Factors %K Socioeconomic factors %K United States %K White People %X

BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear.

METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period.

RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3%, 10.8%, 9.7%, 8.8%, and 8.2%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3% by 2000; few participants (2.6%) were continuously uninsured. Only 60.1% of participants were continuously enrolled in private insurance across all 5 interviews.

CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.

%B Arch Intern Med %I 165 %V 165 %P 770-6 %8 2005 Apr 11 %G eng %N 7 %L pubs_2005_baker-sudano.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15824296?dopt=Abstract %4 Age Factors/Cohort Studies/Female/Health Status/African-Americans/Health Insurance/Health Insurance Coverage/Sex Factors/Socioeconomic Factors/United States %$ 14334 %R 10.1001/archinte.165.7.770 %0 Report %D 2005 %T Health Status, Insurance, and Expenditures in the Transition from Work to Retirement %A Hugo Benítez-Silva %A Boz, Emine %A Buchinsky, Moshe %A Nichols, Joseph B. %A Roy, Sharbani %A Rust, John %A Tristao, Ignez %K Health Conditions and Status %K Insurance %X This paper analyzes the dynamics of health insurance coverage, health expenditures, and health status in the decade expanding from 1992 to 2002, for a cohort of older Americans. We follow 13,594 individuals interviewed in Waves 1 to 6 of the Health and Retirement Study, most of whom were born between 1930 and 1940, as they transition from work into retirement. Although this depression cohort is by and large fairly well prepared for retirement in terms of pension coverage and savings, we identify significant gaps in their health insurance coverage, especially among the most disadvantaged members of this cohort. We find that government health insurance programs particularly Medicare and Medicaid significantly reduce the number of individuals who are uninsured and the risks of large out of pocket health care costs. However, prior to retirement large numbers of these respondents were uninsured, nearly 18 at the first survey in 1992. Moreover, a much larger share, about 55 of this cohort, are transitorily uninsured, that is, they experience one or more spells, lasting from several months to several years, without health insurance coverage. We also identify a much smaller group of persistently uninsured individuals, and show that this group has significantly less wealth, and higher rates of poverty, unemployment, and health problems, disability, and higher mortality rates than the rest of the members of the cohort under study. We provide evidence that lack of health insurance coverage is correlated with reduced utilization of health care services; for example, respondents with no health insurance visit the doctor one fourth as often as those with private insurance and are also more likely to report declines in health status. We also analyze the components of out of pocket health care costs, and show that prescription drug costs constituted a rapidly rising share of the overall cost of health care during the period of analysis. %B ERIU Working Paper %I Economic Research Initiative on the Uninsured, University of Michigan %C Ann Arbor, MI %G eng %U http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.478.8454&rep=rep1&type=pdf %L wp_2005/ERIU_Benitez-Silva.pdf %4 Health Status/Insurance/Health Expenditures %$ 15120 %0 Journal Article %J Psychol Sci %D 2005 %T Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability. %A Dylan M Smith %A Kenneth M. Langa %A Mohammed U Kabeto %A Peter A. Ubel %K Activities of Daily Living %K Cross-Sectional Studies %K Disability Evaluation %K Female %K Follow-Up Studies %K Happiness %K Health Status %K Humans %K Male %K Middle Aged %K Quality of Life %K Socioeconomic factors %X

We examined the hypothesis that the relationship between financial status and subjective well-being, typically found to be very small in cross-sectional studies, is moderated by health status. Specifically, we predicted that wealth would buffer well-being after the onset of a disability. Using data from the Health and Retirement Study, a longitudinal study of people at and approaching retirement age, we employed within-subjects analyses to test whether wealth measured prior to the onset of a disability protected participants' well-being from some of the negative effects of a new disability. We found support for this hypothesis: Participants who were above the median in total net worth reported a much smaller decline in well-being after a new disability than did participants who were below the median. We also found some evidence that the buffering effect of wealth faded with time, as below-median participants recovered some of their well-being.

%B Psychol Sci %I 16 %V 16 %P 663-6 %8 2005 Sep %G eng %N 9 %L pubs_2005_HealthWealth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16137249?dopt=Abstract %4 Health Status/Subjective/Wealth/Disability/Disability %$ 15230 %R 10.1111/j.1467-9280.2005.01592.x %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Healthy, Wealthy, and Knowing Where to Live: Trajectories of Health, Wealth, and Living Arrangements among the Oldest Old %A Florian Heiss %A Michael D Hurd %A Axel Borsch-Supan %E David A Wise %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %X There are many mechanisms that suggest that living arrangements and well-being derived from health and economic status are closely related. This paper investigates the joint evolution of the three conditions, using a microeconometric approach similar to what is known as vector autoregressions (VAR) in the macroeconomics literature. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %P 241-275 %G eng %L wp_2003/Heiss-Hurd-Supan_NBER9897.pdf %4 Health Status/Wealth/Living Standards %$ 11622 %+ NBER Working Paper 9897. Copies available from: National Bureau of Economic Research, 1050 Massachusetts Avenue,Cambridge, MA 02138. %! Healthy, Wealthy, and Knowing Where to Live: Trajectories of Health, Wealth, and Living Arrangements among the Oldest Old %R 10.3386/w9897 %0 Journal Article %J Soc Sci Med %D 2005 %T Heavy alcohol use and marital dissolution in the USA. %A Ostermann, Jan %A Frank A Sloan %A Donald H. Taylor Jr. %K Alcohol Drinking %K Alcohol-Related Disorders %K Divorce %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Social Class %K United States %X

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.

%B Soc Sci Med %I 61 %V 61 %P 2304-16 %8 2005 Dec %G eng %N 11 %L pubs_2005_Ostermann.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16139939?dopt=Abstract %4 Alcohol Abuse/Marital Dissolution/Marriage/Divorce/Drinking Behavior %$ 15660 %R 10.1016/j.socscimed.2005.07.021 %0 Report %D 2005 %T How Much Pre-Retirement Income Does Social Security Replace? %A Alicia H. Munnell %A Soto, Mauricio %K Income %K Social Security %X Do today's retirees have sufficient income to meet their needs? One common way to address this question is to determine a household's replacement rate. The replacement rate gauges the extent to which retirement income allows workers to maintain their pre-retirement standard of living. In the U.S. retirement income system, Social Security is the single most important source for most people. It provides a basic level of replacement, upon which individuals can build through additional saving. This brief addresses the question of how much pre-retirement income Social Security replaces for current recipients. Subsequent briefs will provide a more comprehensive evaluation of replacement rates by including income from employer-sponsored pensions, other savings, and housing equity, as well as Social Security. The first section of this brief explains the concept of a replacement rate and discusses how much people need for a comfortable retirement. The second section describes how Social Security replacement rates are constructed for this analysis and then reports results for individuals and households. The final section summarizes the key findings. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/how-much-pre-retirement-income-does-social-security-replace/ %L wp_2005/ib_36.pdf %4 Retirement Incomes/Social Security %$ 15500 %0 Report %D 2005 %T HRS 2001 HUMS College Tuition Imputations %A Cao, Honggao %A John C Henretta %A Norgard, T.M. %A Beth J Soldo %A David R Weir %K Consumption and Savings %K Methodology %K Net Worth and Assets %X HRS 2001 Off-Year Mail Survey on Human Capital Investment (HRS 2001 HUMS) collected important information on the education of HRS respondents children. Among other things, the survey asked a selected set of HRS respondents to provide information about whether a child attended a two- or four-year undergraduate college, the total number of years in college(s), his or her age when he or she last attended college, and the name of the college that he or she last attended. One way to use the information is to produce college tuition data associated with each child, which can then be linked in an integrated analysis of family transfer with other family transfer information collected in the HRS core survey. In this document we describe what we have done in imputing HRS 2001 HUMS college tuitions. The general idea is to link the children college attendance information in HRS 2001 HUMS with a college tuition database (CASPAR) created and administered by the National Science Foundation. For 2000 and 2001, college cost data are also taken from the NCES IPEDS online database. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 imputations/methodology/human Capital/college tuition %$ 62890 %0 Journal Article %J Quarterly Journal of Business and Economics %D 2004 %T Health and Family Labor Force Transitions %A Mark C. Berger %A Messer-Pelkowski, Jodi %K Consumption and Savings %K Disabilities %K Employment and Labor Force %K Health Conditions and Status %K Time Use %X We examine the labor force participation responses of older families to changes in the health of family members in the U.S. using the Health and Retirement Study. We estimate transitions among four labor force states for married couples: both working, husband working, wife working and neither working. We find evidence that the onset of health problems increase the probability that the affected individual leaves the labor market. The unaffected spouse is likely to continue working if originally working, but is not likely to enter the labor market if not originally working following the onset of health problems of the spouse. Comparing our results to previous studies suggests that family responses to health changes have remained fairly stable over time in the U.S. In contrast, differences exist in family responses to health changes in the U.S. and Germany, possibly reflecting differences in the institutional environments in the two countries. %B Quarterly Journal of Business and Economics %I 43 %V 43 %P 113-38 %G eng %N 3/4 %4 Time Allocation/Labor Supply/Health/Labor Force/Health Production/Nutrition/Mortality/Morbidity/Substance Abuse and Addiction/Disability/Disability/Economic Behavior %$ 14410 %R 10.2307/40473387 %0 Journal Article %J The Journal of Human Resources %D 2004 %T Health and Retirement: Do Changes in Health Affect Retirement Expectations? %A Kathleen McGarry %K retirement expectations %X The choice of a retirement date is one of the most important decisions facing older workers. It is a decision that will affect their economic well-being for the remainder of their lives. One factor that undoubtedly impacts this choice is the worker's health. However, the many studies examining the relationship between health and retirement have failed to agree on the relative importance of health compared with financial variables. Efforts to do so have been hampered by the difficulty of correctly measuring health status. Much of the concern centers on the fear that subjective reports of health are biased by individuals using poor health as a justification for early retirement. This paper takes advantage of a unique measure of labor force attachment, the subjective probability of continued work, to reexamine the role of health and changes in health status. By focusing exclusively on workers, I eliminate the concern about justification bias among retired individuals and find that subjective reports of health do have important effects on retirement, effects that are arguably stronger than those of the financial variables. The effects of subjective health remain large even when the model includes more objective measures of health, such as disease conditions. I also find that changes in retirement expectations are driven to a much greater degree by changes in health than by changes in income or wealth. %B The Journal of Human Resources %V 39 %P 624-648 %@ 0022166X %G eng %N 3 %R https://doi.org/10.2307/3558990 %0 Report %D 2004 %T Health and Wealth of Elderly Couples %A Pierre-Carl Michaud %A Arthur H.O. vanSoest %K Adult children %K Demographics %K Health Conditions and Status %K Net Worth and Assets %I RAND Labor and Population Series %G eng %L wp_2004/RAND_WR191.pdf %4 Health/Wealth/Elderly/Couples %$ 13632 %0 Journal Article %J Med Care %D 2004 %T The health effects of restricting prescription medication use because of cost. %A Michele M Heisler %A Kenneth M. Langa %A Eby, Elizabeth L. %A A. Mark Fendrick %A Mohammed U Kabeto %A John D Piette %K Aged %K Chronic disease %K Female %K Financing, Personal %K Health Services Accessibility %K Health Status %K Humans %K Male %K Middle Aged %K Multivariate Analysis %K Patient Compliance %K Prospective Studies %K Risk %K United States %X

BACKGROUND: High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known.

METHODS: We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression.

RESULTS: In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort.

CONCLUSIONS: Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.

%B Med Care %I 42 %V 42 %P 626-34 %8 2004 Jul %G eng %N 7 %L pubs_2004_Heisler_04.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15213486?dopt=Abstract %4 Health Insurance/Health Care Costs/Prescription Fees/Female/Multivariate Analysis/Prospective Studies/United States/Health Status/Health Services %$ 12272 %R 10.1097/01.mlr.0000129352.36733.cc %0 Thesis %D 2004 %T The Health Effects of Retirement: A Theoretical and Empirical Investigation %A Neuman, Kevin %Y Teresa Ghilarducci %K Consumption and Savings %K Disabilities %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X This study strives to answer the question of how retirement affects health. Assessing how retirement affects health leads to better estimates of health care costs and a better understanding of the retirement decision. The study develops a model of health investment where individuals maximize lifetime utility derived from consumption goods, leisure and healthy time and produce health using leisure and medical goods. Solving the model generates an equilibrium condition for health investment. Assuming that healthy time is a normal good, the model predicts that retirement will increase health investment and thus health for retirees in the next period relative to workers. The empirical test uses a sample of older adults from the longitudinal Health and Retirement Study. To account for the endogeneity of the retirement decision the study employs an instrumental variable model exploiting exogenous variation in Social Security and private pension benefits. The study also improves on previous work by estimating a model where health change in one period is regressed on previous period retirement status allowing the health stock time to adjust to changes in investment behavior. Using subjective health measures, the study finds that retirement decreases the probability of a good health change for men by over 8%, but increases the probability for women by 15%. The difference between sexes persists using a sample of women who worked a significant number of years in their lifetime, and is not due to the particular set of instruments used. Retirement also preserves health for both sexes, reducing the probability of a health decline by 2.5% for men and 3.5% for women. Comparing the subjective results to objective measures reduces concerns about reporting bias for the negative effects for men although the results cannot rule out role bias in the positive results for women. The results recommend leaving the Social Security early entitlement age untouched, or extending Medicare and disability coverage to those in poor health who are forced to work by entitlement age increases, potentially allowing individuals to enter retirement in better health, reducing health care costs. %I University of Notre Dame %P 163 %8 2004 %G eng %U https://search.proquest.com/openview/3b408231733694e31f1688c33ddeab28/1?cbl=18750&diss=y&pq-origsite=gscholar %9 Dissertation %4 Health Production %$ 14470 %0 Journal Article %J Health Aff (Millwood) %D 2004 %T Health insurance coverage and mortality among the near-elderly. %A J. Michael McWilliams %A Alan M. Zaslavsky %A Meara, Ellen %A John Z. Ayanian %K Cohort Studies %K Female %K health policy %K Humans %K Insurance Coverage %K Insurance, Health %K Longitudinal Studies %K Male %K Medically Uninsured %K Middle Aged %K Mortality %K United States %X

Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.

%B Health Aff (Millwood) %I 23 %V 23 %P 223-33 %8 2004 Jul-Aug %G eng %N 4 %L pubs_2004_McWilliams_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15318584?dopt=Abstract %4 Health Insurance Coverage/Elderly/Mortality %$ 12552 %R 10.1377/hlthaff.23.4.223 %0 Journal Article %J Eur J Cardiovasc Prev Rehabil %D 2004 %T Heart disease, comorbidity, and activity limitation in community-dwelling elderly. %A Oldrige, Neil B. %A Timothy E. Stump %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cross-Sectional Studies %K Female %K Health Status %K Heart Diseases %K Humans %K Male %K Middle Aged %K Motor Activity %K Residence Characteristics %K Self Concept %K Socioeconomic factors %X

PURPOSE: The purpose of this study was to describe the impact of self-report heart disease, other chronic comorbidities, and perceived health status on activity limitation among community dwelling persons older than 50 years of age.

METHODS: Odds ratios for activity limitation in activities of daily living, mobility, and other activities were estimated for respondents with self-report heart disease, eight other chronic comorbid conditions, and perceived health status using data generated in two nationally representative cross-sectional surveys, the Health and Retirement Survey (HRS; respondents aged 51 to 60 years) and the Assets and Health Dynamics of the Oldest Old study (AHEAD; respondents aged 70 years and older).

RESULTS: The prevalence of activity limitation increased significantly across the spectrum from activities of daily living to mobility to other activities in both surveys in respondents with and without heart disease. There was a significantly increased likelihood of mobility and other activity limitation among those with heart disease. Among the HRS respondents with heart disease, five or more of the eight comorbid conditions plus poor or fair perceived health were associated with a significantly increased limitation in each activity category. Among the AHEAD respondents with heart disease, three comorbid conditions plus perceived health were associated with a significantly increased limitation in activities of daily living whereas six comorbid conditions plus perceived health were associated with a significantly increased limitation in mobility and in other activities.

CONCLUSIONS: As a prime objective of cardiac rehabilitation is to reduce activity limitation, the strong associations between comorbidity and activity limitation observed in this study among persons older than 50 years with heart disease suggest that the burden of comorbidity-associated is considerable but should not be an automatic exclusion criterion for referral to cardiac rehabilitation. The lack of rigorous scientific information on how these associations may influence clinicians who refer patients to rehabilitation and those who manage these programs strongly reinforces the need for more research to explore the real-world spectrum of comorbidity among persons with heart disease and the impact on activity limitation.

%B Eur J Cardiovasc Prev Rehabil %I 11 %V 11 %P 427-34 %8 2004 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/15616418?dopt=Abstract %4 quality of life/Elderly/COMORBIDITY/risk factors %$ 16190 %R 10.1097/01.hjr.0000140716.25015.b8 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2004 %T Honeymoons and joint lunches: effects of retirement and spouse's employment on depressive symptoms. %A Maximiliane E Szinovacz %A Adam Davey %K Adaptation, Psychological %K Aged %K Aging %K Data collection %K depression %K Employment %K Female %K Humans %K Life Change Events %K Longitudinal Studies %K Male %K Mental Health %K Middle Aged %K Retirement %K Sex Factors %K Spouses %X

With hypotheses derived from a life course perspective in conjunction with life event stress and role theories, we examine whether a spouse's employment and length of retirement affect a person's postretirement depressive symptoms and whether such effects differ by gender. Analyses use pooled data from Waves 1-4 of the Health and Retirement Survey, using a subsample of married individuals who either remained continuously employed over time or completely retired since the Wave 1 interviews (N = 2,695). Recently retired men seem to be negatively affected by their spouses' continuous employment when compared with men whose wives were continuously not employed. In contrast, spouses' joint retirement has a beneficial influence on both recently retired and longer-retired men. However, for recently retired men, the positive effect of wives' retirement seems to be contingent on spouses' enjoyment of joint activities. Among women, effects of spouses' employment occur only among very recently retired wives (0-6 months). These wives report more depressive symptoms if their spouses were already nonemployed prior to wives' retirement. These results demonstrate the complexity of retirement adaptation processes and suggest that marital context plays an important role in retirement well-being.

%B J Gerontol B Psychol Sci Soc Sci %I 59B %V 59 %P P233-45 %8 2004 Sep %G eng %N 5 %L pubs_2004_szinovacz-Davey_Honeymoons.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15358796?dopt=Abstract %4 Spouses/Retirement Behavior/Depressive Symptoms/Gender Differences %$ 12522 %R 10.1093/geronb/59.5.p233 %0 Journal Article %J Journal of Pension Economics and Finance %D 2004 %T Household Annuitization Decisions: Simulations and empirical analyses %A Irena Dushi %A Anthony Webb %K Net Worth and Assets %X Annuities provide insurance against outliving one s wealth. Previous studies have indicated that, for many households, the value of the longevity insurance should outweigh the actuarial unfairness of prices in the voluntary annuity market. Nonetheless, voluntary annuitization rates are extremely low. Previous research on the value of annuitization has compared an optimal decumulation of unannuitized wealth with the alternative of annuitizing all unannuitized wealth at age 65. We relax these assumptions, allowing households to annuitize any part of their unannuitized wealth at any age and to return to the annuity market as many times as they wish. Using numerical optimization techniques, assuming the levels of actuarial unfairness of annuities calculated in previous research, and retaining the assumption made in previous research that one half of household wealth is pre-annuitized, we conclude that it is optimal for couples to delay annuitization until they are aged 73 82, and in some cases never to annuitize. It is usually optimal for single men and women to annuitize at substantially younger ages, between 65 and 70. Households that annuitize will generally wish to annuitize only part of their unannuitized wealth. Using data from the Asset and Health Dynamics Among the Oldest Old and Health and Retirement Study panels, we show that much of the failure of the average currently retired household to annuitize can be attributed to the exceptionally high proportions of the wealth of these cohorts that is pre-annuitized. We expect younger cohorts to have smaller proportions of pre-annuitized wealth and we project increasing demand for annuitization as successive cohorts age. %B Journal of Pension Economics and Finance %I 3 %V 3 %P 109-143 %G eng %N 2 %4 Annuities/Retirement Wealth %$ 13192 %R https://doi.org/10.1017/S1474747204001696 %0 Thesis %D 2004 %T How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population %A Araiza, Isabel %K Demographics %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %K Women and Minorities %X The conceptualization and operationalization of retirement remains a challenge in retirement research. Those studies which have examined multiple conceptualizations of retirement often limit the investigation to two, three, or four definitions of retirement. These studies also produce contradictory results with respect to the degree of overlap among various definitions of retirement. Moreover, in the investigation of the relationship between predictor variables and the probability of retirement, push and pull factors (such as pension receipt and health) are often the focal point of the inquiry. While most studies include in their analysis a class measure as a control variable for the model, seldom is the relationship between social class and the probability of retirement the focal point of the investigation. This study employs data from the 1998 wave of the Health and Retirement Study to perform an extensive analysis of seven operationalizations of retirement and five operationalizations of social class to evaluate how the use of alternative definitions of retirement and social class shape conclusions drawn about the composition of the retired population. Analyses are performed for the entire sample selected for this study, as well as for Non-Hispanic White, Hispanic, and Non-Hispanic Black subgroups. The results of the analyses indicate that different operationalizations of retirement affect the characterization the retired population; moreover the use of different operationalizations of social class influences the perceptions of the socio-economic condition of the retired population. Despite socio-economic achievements, the findings suggest that initial inequalities associated with ascriptive traits like race and gender continue to constrain women and minorities' life course trajectories. While it is not possible to conduct a comprehensive examination of operationalizations of retirement in gerontological literature, this study includes operationalizations of retirement that acknowledge retirement as an event, an identity, and a process. %I Boston College %C United States -- Massachusetts %8 2004 %G eng %U https://search.proquest.com/openview/5a3ae1f763042c14661718032d4a886e/1?pq-origsite=gscholar&cbl=18750&diss=y %4 Gerontology %$ 17640 %! How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population %0 Report %D 2004 %T How Do Families Allocate Elder Care Responsibilities Between Siblings? %A Richard W. Johnson %A LoSasso, Anthony T. %A Lurie, Ithai Z. %K Adult children %K Healthcare %I The Urban Institute %G eng %L wp_2004/Johnson_etal.pdf %4 Caregiving/Family Characteristics %$ 13942 %0 Report %D 2004 %T How Do Pensions Affect Expected and Actual Retirement Ages %A Alicia H. Munnell %A Triest, Robert K. %A Natalia A. Jivan %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper uses the first six waves of the Health and Retirement Study to investigate the impact of pensions on expected retirement age, on the probability of being retired in each wave given employment in the previous wave, and on the probability of retiring earlier than planned. Pension coverage per se and the type of pension are important in each case. Pension wealth reduces the expected retirement age by 0.6 year, and the incentives in defined benefit plans lower the expected age by another 1.1 years. Pension wealth increases the probability of retiring in a given wave, and pension accruals reduce the probability. Other characteristics of defined benefit plans, as measured by the pension dummy, further raise the probability of being retired. Finally, with regard to the probability of retiring earlier than planned, a change in defined contribution wealth increases the probability, but pension coverage per se reduces it. That is, those with pensions tend to be more accurate planners than those without. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/wp-content/uploads/2004/11/wp_2004-271.pdf %L wp_2004/munnellCRR2004-27 %4 Pension Wealth/Retirement Planning %$ 13752 %0 Journal Article %J Applied Econometrics %D 2004 %T How Large is the Bias in Self-Reported Disability? %A Hugo Benítez-Silva %A Buchinsky, Moshe %A Hiu-Man Chan %A Sheidvasser, Sofia %A Rust, John %K Disabilities %K Methodology %K Social Security %X A pervasive concern with the use of self-reported health and disability measures in behavioral models is that they are biased and endogenous. A commonly suggested explanation is that survey respondents exaggerate the severity of health problems and incidence of disabilities in order to rationalize labor force non-participation, application for disability benefits and/or receipt of those benefits. This paper re-examines this issue using a self-reported indicator of disability status from the Health and Retirement Survey. Using a bivariate probit model we test and are unable to reject the hypothesis that the self-reported disability measure is an exogenous explanatory variable in a model of individual's decision to apply for DI benefits or Social Security Administration's decision to award benefits. We further study a subsample of individuals who applied for Disability Insurance and Supplemental Security Income benefits from the Social Security Administration (SSA) for whom we can also observe SSA's award/deny decision. For this subsample we test and are unable to reject the hypothesis that self-reported disability is health and socio-economic characteristics similar to the information used by the SSA in making its award decisions. The unbiasedness restriction implies that these two variables have the same conditional probability distributions. Thus, our results indicate that disability applicant do not exaggerate their disability status at least in anonymous surveys such as the HRS. Indeed, our results are consistent with the hypothesis that disability applicants are aware of the criteria and decision rules that SSA uses in making awards and act as if they were applying these same criteria and rules when reporting their own disability status. %B Applied Econometrics %I 19 %V 19 %P 649-670 %G eng %N 6 %L pubs_2004_B-Silva_JAE.pdf %4 Social Security/Disability/Disability/Conditional Moment Tests %$ 10362 %R 10.2307/25146315 %0 Journal Article %J Arthritis Rheum %D 2003 %T Health care utilization among older adults with arthritis. %A Dorothy D Dunlop %A Larry M Manheim %A Song, Jing %A Rowland W Chang %K Aged %K Aged, 80 and over %K Ambulatory Surgical Procedures %K Arthritis %K Comorbidity %K Cost of Illness %K Female %K Health Services %K Home Care Services %K Hospitals %K Humans %K Insurance, Health %K Longitudinal Studies %K Male %K Nursing homes %K Physicians' Offices %K Social Class %X

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

%B Arthritis Rheum %I 49 %V 49 %P 164-71 %8 2003 Apr 15 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/12687506?dopt=Abstract %4 Arthritis/Health Care Utilization %$ 13002 %R 10.1002/art.11003 %0 Journal Article %J Industrial and Labor Relations Review %D 2003 %T Health Insurance Costs and Early Retirement Decisions %A Richard W. Johnson %A Davidoff, Amy J. %A Perese, Kevin %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X The loss of health insurance may be an important component of the cost of retirement, especially for workers without retiree health insurance coverage. The authors find that insurance costs significantly reduce retirement rates for full-time wage and salary workers ages 51 to 61. Simulations suggest that a 1,000 increase in the net present value of health insurance premium costs reduces the probability of early retirement by 1.17 percentage points for men and by 0.24 percentage points for women, corresponding to elasticities of -0.22 and -0.24, respectively. The authors' models predict that expanding the Medicare program to cover those aged 62-64 would increase retirement rates for workers with employer-sponsored coverage who lack retiree benefits, if the government subsidizes their coverage. However, the impact would be small, increasing overall retirement rates by only 7 . %B Industrial and Labor Relations Review %I 56 %V 56 %P 716-729 %G eng %N 4 %4 Health Insurance/Retirement %$ 6592 %R 10.2307/3590965 %0 Report %D 2003 %T Health Insurance Coverage and the Disability Insurance Application Decision %A Gruber, Jonathan %A Kubik, Jeffrey D. %K Disabilities %K Insurance %X We investigate the effect of health insurance coverage on the decision of individuals to apply for Disability Insurance (DI). Those who qualify for DI receive public insurance under Medicare, but only after a two-year waiting period. This raises concerns that many disabled are going uninsured while they wait for their Medicare coverage. Moreover, the combination of this waiting period and the uncertainty about application acceptance may deter those with health insurance on their jobs, but no alternative source of coverage, from leaving work to apply for DI. Data from the Health and Retirement Survey show that, in fact, uninsurance does not rise during the waiting period for DI benefits; reductions in own employer coverage are small, and are offset by increases in other sources of insurance. Correspondingly, we find that imperfect insurance coverage does deter DI application. Those who have an alternative source of insurance coverage (coverage from a spouse's employer or retiree coverage), are 26 to 74 more likely to apply for DI than those without such an alternative. Thus, limiting this waiting period would not increase the insurance coverage of the disabled in the U.S., but it would significantly increase applications to the DI program. %I Employee Benefits, Compensation and Pension Law %G eng %U http://papers.ssrn.com/paper.taf?abstract_id=337222 %L wp_2003/Gruber_JEmployee.pdf %4 Insurance Coverage/Disability/Disability %$ 10072 %0 Report %D 2003 %T Health Shocks and Couples' Labor Supply Decisions %A Courtney Coile %K Adult children %K Employment and Labor Force %K Health Conditions and Status %X This paper explores the effect of negative health shocks, such as heart attacks or new diagnoses of chronic illnesses, on the labor supply of both the affected spouse and his or her partner. In so doing, the paper links two important strands of the retirement literature, the large literature on health and retirement and the small but growing literature modeling retirement in a family context. This paper may also be viewed as an extension of the literature on spousal labor supply as insurance against negative events, which measures whether there is an added worker effect when one spouse becomes sick and whether it is crowded out by public insurance programs. This work uses the first five waves of the Health and Retirement Study (HRS), a recent, nationally representative survey of the young elderly with extensive information on health, labor force status, and demographics. %I Center for Retirement Research at Boston College, WP 2003-08 %G eng %U http://www.bc.edu/centers/crr/wp_2003-08.shtml %L wp_2003/CRRwp_2003-08.pdf %4 Health Shocks/Marital Status/Labor Supply %$ 6634 %0 Journal Article %J Journal of Human Resources %D 2003 %T Health, Wealth, and the Role of Institutions %A Michael D Hurd %A Arie Kapteyn %K Demographics %K Health Conditions and Status %X A positive relationship between socioeconomic status and health has been observed over many populations and many time periods. One of the factors mediating this relation is the institutional environment in which people function. We consider longitudinal data from two countries with very different institutional environments. the United States and The Netherlands. To structure the empirical analysis. we develop a theoretical model relating changes in health status to income and changes in income to health status. We show that income or wealth inequality is closely connected with health inequality. We empirically estimate counterparts to the theoretical relationships with generally corroborative results. %B Journal of Human Resources %I 38 %V 38 %P 386-415 %G eng %U http://www.nber.org/ confer/2001/si2001/hurd.pdf %N 2 %L pubs_2003_Hurd-Kapteyn.pdf %4 Socioeconomic Status/Health %$ 10262 %0 Journal Article %J Journal of Econometrics %D 2003 %T Healthy, wealthy, and wise? Tests for direct casual paths between health and socioeconomic status %A Adams, Peter %A Michael D Hurd %A Daniel McFadden %A Merrill, Angela %A Ribeiro, Tiago %K Demographics %K Health Conditions and Status %K Socioeconomic factors %X This paper provides statistical methods that permit the association of socioeconomic status and health to be partially unraveled in panel data by excluding some postulated causal paths, or delimiting their range of action. These methods are applied to the Asset and Health Dynamics of the Oldest Old (AHEAD) Panel to test for the absence of causal links from socioeconomic status (SES) to health innovations and mortality, and from health conditions to innovations in wealth. We conclude that in this elderly American population, where Medicare covers most acute care and pension income is not affected by ability to work, the evidence supports the hypothesis of no direct causal link from SES to mortality and to incidence of most sudden onset health conditions (accidents and some acute conditions), once initial health conditions are controlled, but there is an association of SES with incidence of gradual onset health conditions (mental conditions, and some degenerative and chronic conditions), due either to causal links or to persistent unobserved behavioral or genetic factors that have a common influence on both SES and innovations in health. There is little evidence to support a broad association of health conditions and wealth changes. The death of a spouse appears to have a negative effect on the wealth of the survivor; this is plausibly a direct causal effect. There is evidence for some association of health conditions with increased dissaving from liquid wealth for intact couples and singles. From these findings, we conclude that there is no evidence that SES-linked therapies for acute diseases induce mortality differentials. The question of whether SES linked preventative care influences onset of chronic and mental diseases remains open. %B Journal of Econometrics %I 112 %V 112 %P 3-56 %G eng %U http://emlab.berkeley.edu/users/mjansson/Courses/ECON242_SPRING02/McFadden.pdf %N 1 %L pubs_2003_Adams_PJEcmetrics.pdf %0 Journal Article %J Health Aff (Millwood) %D 2003 %T High out-of-pocket health care spending by the elderly. %A Dana P Goldman %A Julie M Zissimopoulos %K Aged %K Drug Costs %K Drug Prescriptions %K Financing, Personal %K Health Care Surveys %K Health Expenditures %K Health Maintenance Organizations %K Health Services for the Aged %K Humans %K Insurance, Health %K Medicare %K Poverty %K United States %X

We use data from the Health and Retirement Study to examine the elderly's out-of-pocket health care spending. We find that Medicare HMOs, employer supplements, and Medicaid effectively insulate against the risk of high expenditures. At the ninetieth percentile, Medicare beneficiaries with employer supplements or enrolled in Medicare HMOs spend 1,600 dollars less out of pocket than beneficiaries with traditional Medicare spend. For the poor elderly, Medicaid offers similar protection. Among the near-poor elderly, there is little employer coverage, so Medicare HMOs provide most of the protection against financial risk. There is evidence that Medicare HMO benefits have eroded since 1998, raising the question of whether the near-poor have lost financial protection since then.

%B Health Aff (Millwood) %I 22 %V 22 %P 194-202 %8 2003 May-Jun %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/12757285?dopt=Abstract %4 Health Expenditures/Medicaid/Medicare %$ 11542 %R 10.1377/hlthaff.22.3.194 %0 Journal Article %J Financial Services Review %D 2003 %T Household Income, Asset Allocation, and the Retirement Decision %A Karen E. Lahey %A Kim, Doseong %A Newman, Melinada L. %K Income %K Net Worth and Assets %K Retirement Planning and Satisfaction %B Financial Services Review %I 12 %V 12 %P 219-238 %G eng %4 Income/Assets/Retirement Planning %$ 13412 %0 Report %D 2003 %T How Do Cash Balance Plans Affect the Pension Landscape? %A Kevin E. Cahill %A Soto, Mauricio %K Pensions %K Retirement Planning and Satisfaction %I Boston College, Center for Retirement Research %G eng %U http://www.bc.edu/centers/crr/issues/ib_14.pdf %4 Retirement Behavior/defined contribution pension plans %$ 11992 %0 Thesis %D 2003 %T How Do Negative Events Shape the Subsequent Work-Family Life Course? The case of involuntary versus voluntary retirement %A Dentinger, Emma %K Adult children %K Health Conditions and Status %K Retirement Planning and Satisfaction %X This dissertation examines whether it matters that someone retires voluntarily or involuntarily. Specifically, I investigate three possibilities for life after retirement: subsequent reemployment, divorce, ad major health problems (heart attacks and death). The question I address is: does knowing whether or not one retires voluntarily or involuntarily (due to health problems or downsizing, for example) aid in predicting any of those outcomes after retirement? Do these processes operate differently for various subgroups, such as by race and gender? To do this, I employ Cox event history techniques using the University of Michigan's 1992 - 1998 Health and Retirement Study (HRS). I find that men and women in their 50s, 60s and 70s who are forced to retire for job-related reasons between 1992 and 1998 are more likely to engage in post-retirement employment compared to those who voluntarily retire, adapting to this unexpected transition by re-engaging in the work role. In contrast, men and women who retire for health reasons during this time are less likely to engage in post-retirement employment (for women this is dependent on having a pension) and more likely to experience cumulative health disadvantage. However, men who retire involuntarily for health-related reasons (for their own health or a family member's) are also less likely to divorce post-retirement than are men who are voluntary retirees. Spousal influences, measured by marital status in the combined models and spousal characteristics among the married sample, appear to be significant factors in various ways. For example, women who are divorced, separated or widowed prior to retirement are more likely to re-engage in the work role, reflecting their generally weaker economic positions. Married and partnered men are more likely than single men to re-engage in paid work. I find no confirmation for the prediction that women's family circumstances, such as having a child living at home, are more consequential for their post-retirement experiences than men's family circumstances on their own experiences. Life post-retirement for both men, and women is affected by family influences about equally, albeit in different ways. %I Cornell University %8 2003 %G eng %U Database ID: DAI-A 64/09, p. 3496, Mar 2004 %4 Divorce %$ 12692 %! How Do Negative Events Shape the Subsequent Work-Family Life Course? The case of involuntary versus voluntary retirement %0 Report %D 2003 %T How Has the Shift to 401(k)s Affected the Retirement Age? %A Alicia H. Munnell %A Kevin E. Cahill %A Natalia A. Jivan %K Pensions %K Retirement Planning and Satisfaction %I Boston College, Center for Retirement Research %G eng %U http://www.bc.edu/centers/crr/ %L wp_2003/Munnell_etal_CRR_IB13.pdf %4 Retirement Behavior/defined contribution pension plans %$ 11862 %0 Report %D 2003 %T How Large Are the Classification Errors in the Social Security Disability Award Process? %A Hugo Benítez-Silva %A Buchinsky, Moshe %A Rust, John %K Disabilities %K Methodology %K Social Security %X This paper presents an audit of the multistage application and appeal process that the U.S. Social Security Administration (SSA) uses to determine eligibility for disability benefits of the Disability Insurance (DI) and Supplemental Security Income (SSI) programs. We study a subset of individuals from the Health and Retirement Survey (HRS) who applied for DI or SSI benefits between 1992 and 1996. We compare the SSA s ultimate award decision a (i.e., after allowing for all possible appeals) to the applicant s self-reported disability status d (recorded at the first HRS survey after their initial application for benefits). We use these data to estimate classification error rates under the hypothesis that applicants self-reported disability status d is the relevant measure of true disability and the SSA s ultimate award decision a is a noisy but unbiased indicator of d This truthful, accurate reporting hypothesis allows us to estimate the magnitude of classification errors in the SSA award process and obtain insights into the patterns of self-selection induced by varying delays and award probabilities at various levels of the application and appeal process. Overall we find that 22 of SSI/DI applicants who are ultimately awarded benefits are not disabled, and that 59 of applicants who were denied benefits are disabled. We construct a computerized disability screening rule using a subset of objective health indicators that the SSA uses in making award decisions that results in significantly lower classification error rates than does SSA s current award process. This suggests that there may be cheaper, faster, and more accurate ways to make disability determinations than the SSA s current disability award process. We also estimate classification errors under the assumption that both a and d are noisy but unbiased indicators of an (unobserved) underlying indicator of true disability, t . However, the estimated classification error rates remain virtually unchanged under this alternative hypothesis. %I SUNY-Stony Brook %G eng %U http://ms.cc.sunysb.edu/ hbenitezsilv/dice.pdf %L wp_2003/B-Silva_etal.pdf %4 Social Security/Disability/Disability/Classification errors %$ 10382 %0 Report %D 2003 %T HRS Review: Psychosocial Variables %A Carol D Ryff %K Family Roles/Relationships %K Health Behavior %K Job loss %K Psychosocial %X Psychosocial factors were not prominent in the original conceptualization of the Health and Retirement Study (Juster & Suzman, 1995). Nonetheless, with the limited measures available, many HRS investigators have included psychological and social factors in their analyses. To anchor evaluation of this realm in substantive scientific agendas, I review a wide array of HRS publications that have, or could, profitably incorporate psychosocial factors. In all of these, it is fair to say there is need for improved assessment. The topical areas covered are organized as follows: (a) health behaviors, (b) socioeconomic factors, race/ethnicity, and health, (c) family roles/relationships and health, (d) planning for retirement and subjective probabilities, and (e) voluntary/involuntary job loss and their consequences. Within each, I describe how psychosocial variables were brought into the scientific agendas, or address how they might be utilized to advance substantive areas. My review also notes linkages with findings from MIDUS, another national survey of aging having notable depth in behavioral and psychosocial assessment (although limited coverage of economic factors). %I University of Wisconsin-Madison %C Madison %G eng %0 Generic %D 2002 %T Health and Retirement Study External Review %A Kuller, Lewis %K review %B DMC Commissioned Papers %I National Institute on Aging %C Bethesda, MD %G eng %0 Journal Article %J Soc Sci Med %D 2002 %T The health capital of families: an investigation of the inter-spousal correlation in health status. %A Sven E. Wilson %K Activities of Daily Living %K Chronic disease %K Decision making %K Female %K Health Behavior %K Health Status Indicators %K Humans %K Interviews as Topic %K Life Style %K Male %K Marital Status %K Middle Aged %K Regression Analysis %K Risk Factors %K Risk-Taking %K Self Efficacy %K Sociology, Medical %K Spouses %K United States %X

This study documents and analyzes the inter-spousal correlation in health status (ISCIHS) among married couples in later life. A simple economic theory is developed that integrates standard theories of marriage markets and health capital formation. This theory implies that several causal factors will lead to a positive correlation in the health status of spouses. These include assortative matching in the marriage market along dimensions related to health (such as education); a tendency to share common life-style behaviors such as diet, smoking and exercise; shared environmental risk factors for disease; and a potential for direct effects of the health of one spouse on the health of the other. Empirical estimates using the 1992 Health and Retirement study in the USA demonstrate that ISCIHS is large in magnitude, highly statistically significant, and robust to alternative measures of health status. ISCIHS exists even after controlling for age, education, income, and other socioeconomic and demographic determinants of health status, including behavioral risk factors. These covariates reduce the overall correlation coefficient by 33% to 57%, depending on the health measure, which suggests both that marriage formation and decision making processes systematically affect health in later life and that heretofore unidentified risk factors for disease and disability exist at the household level.

%B Soc Sci Med %I 55 %V 55 %P 1157-72 %8 2002 Oct %G eng %N 7 %L pubs_2002_Wilson_SSocSciMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12365528?dopt=Abstract %4 Health production/Economics of the family/Marriage markets/Shared risks %$ 11782 %R 10.1016/s0277-9536(01)00253-2 %0 Journal Article %J J Health Soc Behav %D 2002 %T Health in household context: living arrangements and health in late middle age. %A Mary Elizabeth Hughes %A Linda J. Waite %K Activities of Daily Living %K Depressive Disorder %K Family Characteristics %K Family Health %K Female %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Self Efficacy %K United States %X

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.

%B J Health Soc Behav %I 43 %V 43 %P 1-21 %8 2002 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/11949193?dopt=Abstract %4 Family Structure/Health/Living Conditions/Middle Aged Adults/Sex Differences/Households %$ 1234 %R 10.2307/3090242 %0 Report %D 2002 %T Health Insurance and Labor Supply: Evidence from Hypothetical Shocks to Wealth %A Matthew D. Shapiro %A Miles S Kimball %K Employment and Labor Force %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %I Ann Arbor, MI, University of Michigan %G eng %4 Health Insurance/Health Shocks/Labor Supply/Wealth %$ 6658 %0 Journal Article %J Health Services Research %D 2002 %T Health Insurance and Mammography: Would a Medicare buy-in take us to universal screening? %A Donald H. Taylor Jr. %A Lynn Van Scoyoc %A Hawley, Sarah T. %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Women and Minorities %X Objective. To determine whether health insurance expansioins via a Medicare buy-in might Plausibly increase mammography screening rates among women aged 50-64.Data Sources. Two waves of the Health and Retirement Study (HRS) (1994, 1996).Study Design. A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996).Data Extraction. Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n=4,583).Principal Findings. From 1994 to 199,6, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in,this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammo graphy, physician visits remained a strong predictor of mammography but BSE did not.Conclusion. Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for, newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates. %B Health Services Research %I 37 %V 37 %P 1469-1486 %G eng %N 6 %4 Health Insurance/Mammography/Medicare/Women %$ 11902 %0 Newspaper Article %B The Christian Science Monitor %D 2002 %T Hold off retiring to that sunny ocean villa %A Cook, David T. %K Expectations %B The Christian Science Monitor %I The Christian Science Monitor %C Washington, DC %P 2 %8 Oct. 27, 2002 %G eng %4 Retirement Expectations %$ 9972 %! Hold off retiring to that sunny ocean villa %0 Report %D 2002 %T Household Retirement Saving and Informal Insurance: Getting by with a little help from friends %A Jennifer M Mellor %A Jensen, Eric R. %K Adult children %K Consumption and Savings %X The literature on wealth accumulation suggests that social insurance programs serve to weaken the precautionary saving motive. Elsewhere, it has been suggested that family members can establish informal insurance arrangements that serve to reduce earnings variation in the same manner as social insurance. Together, these findings imply that another potential explanation for the inadequate retirement saving of many U.S. households is the presence of informal insurance, in the form of intervivos transfers to retired family members. We perform an empirical test of the hypothesis that potential transfers from family members and friends crowd out retirement saving, using data from various waves of the Health and Retirement Study. We estimate two-stage least squares models of welath accumulation, treating the probability of transfer receipt as endogenous and using characteristics of likely donors to identify the model. We find that an increase in the subjective proabability of receiving and intervivos financial transfer reduces wealth accumulation, especially financial wealth in the forms of checking, savings, money market accounts, CDs, and IRAs. A one percentage point (or roughly 8 ) increase in the probability of transfer receipt leads to a 3020 reduction in financial assets. %I College of William and Mary %G eng %4 Transfers/Retirement Saving/Social Support %$ 10012 %0 Report %D 2002 %T How Does Job Loss Affect the Timing of Retirement? %A Sewin Chan %A Ann H. Stevens %K Employment and Labor Force %K Retirement Planning and Satisfaction %X We use the Health and Retirement Study to examine the effects of job loss on factors affecting retirement incentives, including earnings, assets and pensions. We then estimate models of the retirement decision, which take into account the incentive to retire and any additional effects of displacement that are not captured by retirement incentives. There are substantial effects of displacement on retirement incentives as the result of changes to both earnings and pensions. Displacement significantly increases the probability of retirement, but only a small fraction of the displacement-induced changes in retirement behavior and labor force participation are the result of workers responding to these altered retirement incentives. %I National Bureau of Economic Research %G eng %U http://papers.nber.org/papers/w8780.pdf %L wp_2002/Chan_NBER8780.pdf %4 Job Loss/Retirement Incentives %$ 10572 %0 Report %D 2002 %T How Important Are Private Pensions? %A Alicia H. Munnell %A Sundén, Annika %A Lidstone, Elizabeth %K Employment and Labor Force %K Income %K Net Worth and Assets %K Pensions %X Employer-provided pensions play an important role in assuring a comfortable retirement. In 1992, they accounted for about 20 percent of the total wealth of middle-income households aged 51-61, second only to Social Security. However, many workers still lack pension coverage. After increasing sharply in the post-World War II period, the percentage of the private sector workforce covered by an employer-sponsored pension plan at any given point in time has remained around 50 percent since the 1970s. This constancy obscures two major changes, however. First, pension coverage has increased for women and declined for men, primarily reflecting the increased earnings and labor force participation of women and a decline for men in union membership and employment in large manufacturing firms. Second, a major shift has occurred in the types of plans from defined benefit to defined contribution. Defined benefit plans generally provide retired workers with a set amount based on their salary history, while benefits under defined contribution plans depend on the accumulated amount in a worker’s account. The shift to defined contribution plans reflects employment trends as well as conversion of plans… %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/how-important-are-private-pensions/ %L wp_2002/munnell.pdf %4 Private Pensions/Retirement Incomes/Economic Status/Labor %$ 8554 %0 Journal Article %J Social Security Bulletin %D 2002 %T How Policy Variables Influence the Timing of Social Security Disability Insurance Applications %A R.V. Burkhauser %A Butler, J.S. %A Robert R. Weathers II %K Disabilities %K Social Security %X This article analyzes the impact of policy variables—employer accommodations, state Social Security Disability Insurance (DI) allowance rates, and DI benefits— on the timing of an application for DI benefits by workers with a work-limiting health condition starting when their health condition first begins to bother them. The analysis uses a rich mixture of personal and employer characteristics from the Health and Retirement Study linked to Social Security administrative records. %B Social Security Bulletin %I 64 %V 64 %P 52-83 %G eng %U https://www.ssa.gov/policy/docs/ssb/v64n1/v64n1p52.pdf %N 1 %4 Social Security/Disability/Disability %$ 10232 %0 Generic %D 2002 %T HRS external review: Longitudinal aspects of health %A Bandeen-Roche, Karen %K health %K longitudinal analyses %B DMC Commissioned Papers %I National Institute on Aging %C Bethesda, MD %0 Generic %D 2002 %T HRS/AHEAD: Family-related research %A Bumpass, Larry %K AHEAD %K Family %I National Institute on Aging %C Bethesda, MD %0 Report %D 2001 %T Have 401(k)s Raised Household Saving? Evidence from the Health and Retirement Study %A Gary V. Engelhardt %K Consumption and Savings %K Pensions %X The 401(k) pension plan has become the most widespread retirement saving plan since its creation in 1978. At the same time there has been a great deal of debate over the amount that this plan actually effects the financial savings of a household. In this article it is believed that there are fundamental biases in estimating saving effects because of the many ways of saving. After going over numerous studies dealing with 401(k) plans effects on savings, the author thoroughly discusses evidence from the first wave (1992) of the Health and Retirement Study. By way of in-depth analysis it is concluded that 401(k) plans have little effect on a households saving. Only in lower-to-middle income households is saving likely to be widely effected by 401(k) plans. %B Aging Study Program Paper %I Syracuse University %C Syracuse, NY %G eng %U https://www.maxwell.syr.edu/uploadedFiles/cpr/publications/aging_studies/age24.pdf %4 401(k) participation and balances/Saving %$ 6648 %0 Report %D 2001 %T The Health Consequences of Labor Market Segregation %A Oh, Hyun Joo %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Women and Minorities %X Despite the increased participation of people of color and women throughout all levels of work organization, racial and gender segregation of the labor market persists. These divisions can be considered a generating and perpetuating source of societal inequality, because work is a primary determinant of social and economic status. By implication, the segregation of the labor market may contribute to socioeconomic disparities in health status that have persisted over time. To investigate this hypothesis, I analyze data from the 1992 and 1994 waves of the Health and Retirement Study, which provides information about black and white women and men whose ages range from approximately 51 to 61 years at baseline (1992). The sample is limited to adults who were working in 1992 and who survived until the 1994 interview, during which they reported self-ratings of their health. The empirical results indicate that gender mix is not as important as racial composition. A lower percentage of whites is linked to worse self-reported health for both women and men. In addition, women's health reflects significant race differences in the effects of racial composition. Circumstances involving fewer whites pose health advantages for black women, whereas the health of white women suffers. %I Southern Sociological Society %G eng %4 Health/Labor Supply/Social Inequality/African-Americans/Health Status %$ 1256 %0 Report %D 2001 %T Health Insurance and Retirement of Married Couples %A David M. Blau %A Gilleskie, Donna B. %K Adult children %K Employment and Labor Force %K Medicare/Medicaid/Health Insurance %X In this study we propose a new explanation for the fact that labor force participation of older married couples is strongly positively correlated, and we develop and estimate a model that allows us to determine its importance. Our explanation is based on the observations that (1) most health insurance is provided by employers until eligibility for Medicare begins at age 65, (2) many individuals are covered by health insurance from the spouse s employer, and (3) there is substantial variation across employer health insurance plans in coverage for retirees and the spouses of retirees. Descriptive evidence shows that couples who face employment incentives arising from shared health insurance appear to respond strongly to those incentives. We build a dynamic behavioral model of the employment and medical care decisions of older couples. The model places no restrictions on either the degree of complementarity of leisure hours of spouses in utility or the value of health insurance (i.e., risk aversion): these two key aspects of behavior are determined by parameters identified by variation in health risk and health insurance constraints and the behavior of couples in response to these constraints. Estimates of the model therefore allow us to determine the empirical importance of the explanation we propose. Estimates of the model using data from the Health and Retirement Survey indicate that couples have a strong preference for shared leisure and a relatively low degree of risk-aversion. The riskreducing feature of health insurance does not contribute much to the observed correlation in labor force decisions of spouses. %I University of North Carolina at Chapel Hill %C Chapel Hill, NC %G eng %U https://economics.sas.upenn.edu/sites/default/files/filevault/event_papers/Empirical1017023.pdf %4 Marital Status/Medical Expenditures/Employment %$ 10622 %0 Thesis %D 2001 %T Health Insurance, Habits and Health Outcomes: A dynamic stochastic model of investment in health %A Ahmed Khwaja %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Other %X I develop a dynamic stochastic model of individual choices about, health insurance, exercise, smoking, alcohol consumption and medical treatment. The objective is to estimate the parameters of the model to conduct counter-factual health policy experiments. The model is estimated using data on 3671 males from the Health and Retirement Study. The estimated model matches well the means, frequencies and transitions for all the choices and health states. The income and out of pocket medical expenditure trajectories also fit well. The estimates are used for two radically different counter-factual health policy experiments. The first experiment simulates the provision of comprehensive health insurance coverage wherein every individual is mandated to purchase an insurance plan that charges a premium of $1000.0 Per annum but covers all out of pocket costs. The simulations suggest that the proportion of individuals consuming alcohol falls slightly in the younger years (up to 0.05%) And rises (up to 0.4%) In the later years compared to the baseline simulations. Smoking rates show a small rise of up to 0.5%. The proportion of individuals seeking medical treatment increases by up to 49%. The second experiment simulates the withdrawal of subsidized medical care wherein all individuals are denied health insurance. Simulations reveal that the proportion of individuals consuming alcohol rises by up to 0.3% In the younger ages and decreases by a similar amount in the older ages. Smoking rates increase by up to 0.17% At the younger ages and fall by up to 0.6% At the older ages. The proportion of individuals seeking medical care falls by up to 95%. The two experiments together suggest that subsidized medical treatment increases the demand for medical care but does not significantly increase unhealthy behaviors. On the contrary withdrawal of subsidized medical treatment reduces demand for medical services but increases unhealthy behaviors at the younger ages. In particular, the model provides no evidence of the existence of a moral hazard problem associated with the provision of subsidized medical care on habits like smoking and alcohol consumption. %I University of Minnesota %8 2001 %G eng %U https://www.researchgate.net/publication/24127531_Health_Insurance_Habits_and_Health_Outcomes_A_Dynamic_Stochastic_Model_of_Investment_in_Health %4 Medical Expenditures %$ 5014 %+ ISBN 0-493-32071-7 %! Health Insurance, Habits and Health Outcomes: A dynamic stochastic model of investment in health %0 Report %D 2001 %T Health Insurance on the Way to Medicare: Is Special Government assistance warranted? %A Pamela F. Short %A Dennis G. Shea %A M. Paige Powell %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X The survey analyses described in this report are intended to help policymakers understand better the health insurance problems that confront Americans who are approaching age 65 and Medicare eligibility. A clear understanding of these problems is crucial to deciding whether or not to proceed with incremental coverage reforms for older, pre-Medicare adults. We had four specific research objectives: 1. To learn about the transitions in health insurance coverage experienced by older adults prior to age 65, especially as they relate to changes in employment and health; 2. To look at how well a policy allowing people to buy in to the Medicare program at age 62 (as proposed by former President Clinton and others) would compensate for the loss of employer-based insurance; 3. To see if there are compelling arguments, in addition to early retirement and the loss of employer coverage, to target older Americans in particular for coverage expansions; 4. To explore the empirical justification for targeting people age 62 and older, rather than setting eligibility for a buy-in at some other age. More generally, we wanted to produce a compendium of relevant statistics that would be useful to policy analysts and others who are considering coverage reforms for older Americans. %I The Commonwealth Fund, Publication 457 %G eng %U https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2001_jun_health_insurance_on_the_way_to_medicare__is_special_government_assistance_warranted_short_insurance_to_medicare_457_pdf.pdf %4 Health Insurance Coverage/Medicare/Retirement behavior %$ 11092 %0 Report %D 2001 %T Health Risk and Portfolio Choice %A Ryan D. Edwards %K Consumption and Savings %K Health Conditions and Status %I University of California-Berkeley %G eng %L wp_2001/Edwards2001.pdf %4 Health Risk/Saving %$ 6619 %0 Report %D 2001 %T Health, Wealth, and Gender: Do Health Shocks of Husbands and Wives Have Different Impacts on Household Wealth? %A Jennifer L. Ward-Batts %K Adult children %K Health Conditions and Status %X The extent to which men s versus women s health affects household wealth and the mechanisms through which these effects occur have important implications for the welfare of older individuals living with a spouse, and in particular for women who are likely to outlive their husbands by several years. Intermediate mechanisms through which individual health shocks may affect household wealth are discussed. Four waves of HRS data on married couples are used to estimate the direct effect of onset of various health conditions on household wealth, with these effects allowed to differ for husbands and wives. Estimates using only wave 2 health shocks (controlling for baseline health) indicate that the impact of a health shock to the wife has a larger negative impact than a health shock to the husband, which is consistent with prior work. Estimates in which health shocks from waves 2-4 are allowed for produce conflicting results. Further research is required to ascertain the reason for this apparent conflict. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/ %L wp_2001/Ward-Battswp016.pdf %4 Health Shocks/Households/Spouse %$ 11162 %0 Book Section %B Private Versicherung und Soziale Sicherung: Festschrift zum 60. Geburtstag von Roland Eisen %D 2001 %T How Costly are Smokers to Medicare? %A Frank A Sloan %A Gabriel A. Picone %E Mager, Hans-Christian %E Schafer, Henry %E Schrufer, Klaus %K Consumption and Savings %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %B Private Versicherung und Soziale Sicherung: Festschrift zum 60. Geburtstag von Roland Eisen %I Metropolis Verlag %C Marburg %P 103-33 %G eng %4 Smoking/Medicare/Costs %$ 13812 %! How Costly are Smokers to Medicare? %0 Book Section %B Frontiers in Health Policy Research %D 2001 %T How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly %A Gabriel A. Picone %A Frank A Sloan %E Garber, Alan M. %K Demographics %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X This study looks at the impact that smoking has on people over the course of time. Data and studies on the costs of smoking, not just for the smoker but for people around them, are very important for many issues. People aged 51-67 are used since that is the time frame where health problems caused by smoking tend to be most prominent. The researchers calculate the costs from healthcare based on the type of insurer. In the end it is concluded that government payers and then Medicare and Medicaid take the largest amount of the financial problem for smoking. Private insurance companies did not seem to take on a great deal of the costs from this behavior. %B Frontiers in Health Policy Research %I MIT Press %C Cambridge, MA %P 1-29 %G eng %4 Middle Aged Adults/Smoking/Health Care Costs/Medicaid/Medicare %$ 6646 %! How Costly Are Smokers to Other People? Longitudinal Evidence on the Near Elderly %0 Report %D 2001 %T How Do Couples Decide to Retire? %A Courtney Coile %K Adult children %K Retirement Planning and Satisfaction %I NBER %G eng %4 Marital Status/Retirement Planning %$ 6642 %0 Report %D 2001 %T How Does Dipping into Your Pension Affect Your Retirement Wealth? %A Gary V. Engelhardt %K Net Worth and Assets %K Pensions %I Syracuse University %G eng %4 Pensions/Wealth %$ 6606 %0 Journal Article %J Journal of Public Economics %D 2001 %T How Effective is Redistribution Under the Social Security Benefit Formula? %A Alan L Gustman %A Thomas L. Steinmeier %K Consumption and Savings %K Income %K Retirement Planning and Satisfaction %K Social Security %X In this study, data from the Health and Retirement Study linked to the Social Security Administration is used in order to analyze wealth redistribution by way of Social Security. This redistribution seems to go from the upper earners to the lower earners. More specifically, the wealth is being redistributed from men to women and, when looking at the household context, from primary earners to secondary earners. The study also illustrates wealth redistribution when specific factors are taken into account and show how much of an effect different variables have on the redistribution of wealth. From their analysis the authors conclude that privatizing the Social Security system would have no effect on redistribution of wealth. %B Journal of Public Economics %I 82 %V 82 %P 1-28 %G eng %N 1 %L pubs_2000_Gustman_AJPuEc.pdf %4 Personal Income and Wealth Distribution/Social Security and Public Pensions/Economics of the Elderly/Retirement/Retirement Policies/Social Security/Income Redistribution/Retirement %$ 8412 %0 Report %D 2001 %T HRS 1996 Imputations: Documentation %A Cao, Honggao %K Imputation %K Methodology %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %0 Journal Article %J Journal of Aging and Health %D 2000 %T A Health and Demographic Profile of Noninstitutionalized Older Americans Residing in Environments with Home Modifications. %A Tabbarah, M. %A Merril Silverstein %A Teresa Seeman %K Demographics %K Disabilities %K Health Conditions and Status %K Healthcare %K Housing %K Methodology %X OBJECTIVES. In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications. METHODS. Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications. RESULTS. Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications. Low income, Hispanic, and African American elderly appear underrepresented among those with modifications. DISCUSSION. The authors conclude that specialized housing alternatives will be an increasingly important issue in the future as individuals aim to achieve and maintain the delicate balance between their functional ability and their living environment. %B Journal of Aging and Health %I 12 %V 12 %P 204-28 %G eng %N 2 %4 Home Modifications/Health Status/Disability/Disability/Architectural Accessibility/Disabled Persons/Ethnicity/Interior Design and Furnishings/Self Help Devices/Socioeconomic Factors/Support, U.S. Government--PHS %$ 4315 %0 Journal Article %J Social Security Bulletin %D 2000 %T The Health and Retirement Study Data Set %A Unattributed %K Methodology %X This article provides a brief overview of the HRS. It comments on the valuable features and variables unique to the study and mentions the many publications that have been based on HRS data. The Health and Retirement Study (HRS) is a longitudinal study intended to provide data for researchers, policy analysts, and program planners who are making major policy decisions that affect retirement, health insurance, saving, and economic well-being. (taken from article abstract) %B Social Security Bulletin %I 63 %V 63 %P 54 %G eng %N 3 %4 HRS content and design/HRS Data %$ 8594 %0 Journal Article %J Journal of Family Issues %D 2000 %T Health Consequences of Marriage for the Retirement Years %A Pienta, Amy M. %A Mark D Hayward %A Kristi Rahrig Jenkins %K Adult children %K Demographics %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Over the last few decades there has been an increasing trend toward divorce, postponed marriage, never marrying, and cohabitation. It is also known that marriage increases ones health, mainly because of the ability to gain from the help of a spouse or other relatives that transfer finances and time to the married person. How will changes in marriage trends effect the health of people as they reach retirement ages? What aspects of health are linked to marriage? Married persons from this data were the least likely to be afflicted by any of the diseases or limitations studied. Widowed and divorced persons were found to have the worst overall health of any two groups. However, cohabiting people were not much better off then the widowed or divorced persons. The authors also break down the data further and compare genders and races. Exiting marriage, surprisingly, was worse then never having been married. %B Journal of Family Issues %I 21 %V 21 %P 559-586 %G eng %N 5 %L pubs_2001_Pienta-etal_JOFI2000.pdf %4 Marital Status/Retirement Planning/Health Status/Gender %$ 8452 %R 10.1177/019251300021005003 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2000 %T Health effects of involuntary job loss among older workers: findings from the health and retirement survey. %A William T Gallo %A Elizabeth H Bradley %A Michele J. Siegel %A Stanislav V Kasl %K Activities of Daily Living %K Adaptation, Psychological %K Aging %K Female %K Geriatric Assessment %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Unemployment %K United States %X

OBJECTIVES: To estimate the health consequences of involuntary job loss among older workers in the United States.

METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, multivariate regression models were estimated to assess the impact of involuntary job loss on both physical functioning and mental health. Our analysis sample included 209 workers who experienced involuntary job loss between survey dates and a comparison group of 2,907 continuously employed workers.

RESULTS: The effects of late-life involuntary job loss on both follow-up physical functioning and mental health were negative and statistically significant (p < .05), even after baseline health status and sociodemographic factors were controlled for. Among displaced workers, reemployment was positively associated with both follow-up physical functioning and mental health, whereas the duration of joblessness was not significantly associated with either outcome.

DISCUSSION: The findings provide evidence of a causal relationship between job loss and morbidity among older workers. This relationship is reflected in both poorer physical functioning and mental health for workers who experience involuntary job loss. In addition to the economic consequences of worker displacement, there may be important health consequences of job loss, especially among older workers.

%B J Gerontol B Psychol Sci Soc Sci %I 55B %V 55 %P S131-40 %8 2000 May %G eng %N 3 %L pubs_2000_Gallo_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11833981?dopt=Abstract %4 Labor Force/Personnel Downsizing/Health Status/Economic Status %$ 8356 %R 10.1093/geronb/55.3.s131 %0 Journal Article %J J Health Econ %D 2000 %T Health insurance and retirement behavior: evidence from the health and retirement survey. %A Jeannette Rogowski %A Lynn A Karoly %K Aged %K Career Mobility %K Data collection %K Decision making %K Employment %K Health Services Accessibility %K Humans %K Insurance, Health %K Male %K Retirement %K Social Class %K United States %X

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

%B J Health Econ %I 19 %V 19 %P 529-39 %8 2000 Jul %G eng %N 4 %L pubs_2000_Rogowski_JJHE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11010239?dopt=Abstract %4 Retirement/Retirement Policies/Analysis of Health Care Markets/Insurance/Insurance Companies/Elderly/Health Insurance/Health/Insurance/Older Workers/Retirement %$ 1022 %R 10.1016/s0167-6296(00)00038-2 %0 Journal Article %J Prev Med %D 2000 %T Health-promoting behaviors among adults with type 2 diabetes: findings from the Health and Retirement Study. %A Nothwehr, F. %A Timothy E. Stump %K Adult %K Behavior Therapy %K Black or African American %K Data collection %K Diabetes Mellitus, Type 2 %K Diet, Diabetic %K Exercise %K Female %K Health Behavior %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K White People %X

BACKGROUND: Type 2 diabetes has an enormous impact on the health care system and individuals. Dietary habits, exercise, weight management, and smoking status are critical to management and prevention of complications. This study describes the prevalence of these behaviors and their change over time in a national sample of adults with type 2 diabetes. The relationships between behavior change and sociodemographic and health status measures are explored.

METHODS: Data are from the first and third longitudinal waves of the Health and Retirement Study. Surveys were conducted face-to-face or via telephone in 1992 and 1996.

RESULTS: The sample consisted of 733 persons with type 2 diabetes, ages 50-62. The most common behaviors were being on a special diet (79.6%), and not smoking (76.6%). Sixty-six percent were engaged in some physical activity, and 58.4% were trying to lose weight. Reports of being on a special diet, trying to lose weight, and exercising all diminished over time.

CONCLUSIONS: The prevalence of these behaviors is disappointing. Worse, they declined over the 4-year period. A better understanding of factors contributing to a person's decision to begin or discontinue health-promoting behaviors is needed to plan effective supportive or preemptive interventions.

%B Prev Med %I 30 %V 30 %P 407-14 %8 2000 May %G eng %N 5 %L pubs_2000_Nothwehr_FPrevMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10845750?dopt=Abstract %4 Adult/Behavior Therapy/Blacks/Diabetes Mellitus, Non Insulin Dependent/Diabetic Diet/Exercise/Female/Health Behavior/Hispanic Americans/Longitudinal Studies/Middle Age/Whites %$ 4130 %R 10.1006/pmed.2000.0658 %0 Newspaper Article %B Daily Mail %D 2000 %T The Height of Success %A Behar, Darren %A Chapman, James %K Retirement Planning and Satisfaction %B Daily Mail %I Daily Mail %C United Kingdom %P 41 %8 November 24, 2000 %G eng %4 Retirement %$ 9810 %! The Height of Success %0 Thesis %D 2000 %T Heterogeneity in the Retirement Process: Patterns and Determinants of Labor Force Withdrawal Among Individuals with Low-Wage and Short-Duration Jobs %A Kevin E. Cahill %K Employment and Labor Force %K Public Policy %K Retirement Planning and Satisfaction %X While the retirement patterns of full-time career individuals have been closely examined in the retirement literature, much less is known about the retirement behavior of low-wage individuals and those with non- traditional work histories. Knowledge of how these groups retire is crucial in evaluating the impact of pro-work policies on older americans. The first paper of this dissertation presents a two- period theoretical model of retirement with borrowing constraints in which individuals optimize lifetime utility subject to a budget constraint by choosing the intensity of work in and the duration of period one (the working period), and the level of consumption in both periods. The model predicts that individuals with binding borrowing constraints are more likely to exit the labor force early and work full time just before complete labor force withdrawal. The two empirical papers use a nationally representative sample of 12,652 older americans who are participating in the Health and Retirement Study. The first paper focuses on individuals in the bottom 20% of a year-specific, gender-specific wage distribution (low-wage); the second focuses on individuals who have not held a job lasting at least 10 years and consisting of 1600 or more hours per year (non-full-time career). Descriptive statistics show that low-wage individuals and non-full-time career individuals differ from others with respect to health status, race, marital status, wealth, and health insurance and pension coverage. Differences also exist regarding bridge job activity and the consequences of job transitions later in life. An empirical model of retirement yields three notable findings. First, key incentive variables remain significant when examining retirement determinants of both groups. Second, low-wage individuals appear less responsive to many retirement incentives. Third, the marginal impacts of key incentive variables are not significantly altered by the exclusion of non-full-time career individuals. This research suggests that decisions concerning pro-work policies should be made in light of possible heterogeneity in the retirement processes between these two groups and the rest of the population. %I Boston College %8 2000 %G eng %U Database ID: DAI-A 61/07, p. 2853, Jan 2001 0-599-88127-5 %4 Retirement Planning %$ 6617 %+ Dissertation, Dept. of Economics: %! Heterogeneity in the Retirement Process: Patterns and Determinants of Labor Force Withdrawal Among Individuals with Low-Wage and Short-Duration Jobs %0 Report %D 2000 %T How Effective is Redistribution Under the Social Security Benefit Formula? %A Alan L Gustman %A Thomas L. Steinmeier %K Consumption and Savings %K Income %K Retirement Planning and Satisfaction %K Social Security %X This paper uses earnings histories obtained from the Social Security Administration and linked to the survey responses for participants in the Health and Retirement Study to investigate redistribution under the current social security benefit formula. When individuals are arrayed by indexed lifetime earnings, benefits are significantly redistributed from those with high lifetime earnings to those with low lifetime earnings. However, much of this apparent redistribution is from men to women, and when examined at the level of the family, from primary to secondary earners. When families are arrayed according the total lifetime earnings, and spouse and survivor benefits are taken into account, the extent of redistribution from families with high lifetime earnings to families with low lifetime earnings is roughly halved. When families are arrayed by their earnings potential, i.e., earnings during years when both spouses are engaged in substantial work, there is very little redistribution from families with high to low earnings capacity. Accordingly, at least for families on the verge of retirement day, introducing a system that ignored issues of redistribution would have no major effect on the distribution of social security benefits net of taxes among families with different earnings capacities. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %U https://www.nber.org/papers/w7597#:~:text=When%20families%20are%20arrayed%20according,lifetime%20earnings%20is%20roughly%20halved. %4 Personal Income and Wealth Distribution/Social Security and Public Pensions/Economics of the Elderly/Retirement/Retirement Policies/Social Security/Income Redistribution/Retirement %$ 1122 %0 Journal Article %J American Economic Review %D 2000 %T How Much Should Americans Be Saving for Retirement? %A Bernheim, B. Douglas %A Forni, Lorenzo %A Gokhale, Jagadeesh %A Laurence J. Kotlikoff %K Demographics %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Deciding if HRS households are saving too much or too little cannot be determined from the data alone. However, by applying the ESPlanner to the data, the rate at which American households should be saving as they approach retirement can be determined. Households that are currently saving under the assumption that Social Security benefits will be paid in full are saving far too little. For all households besides the poorest ones in the sample, median recommended saving rates are fairly high because of the risk of major cuts in Social Security benefits. %B American Economic Review %I 90 %V 90 %P 288-92 %G eng %N 2 %L pubs_2000_Bernheim_etal.pdf %4 Retirement Planning/Economic Status/Basic Demographics %$ 8398 %R 10.1257/aer.90.2.288 %0 Report %D 2000 %T How Should We Insure Longevity Risk in Pensions and Social Security? %A Brown, Jeffrey R. %K Health Conditions and Status %K Pensions %K Social Security %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/how-should-we-insure-longevity-risk-in-pensions-and-social-security/ %L wp_2000/Brown_ib4.pdf %4 Longevity/Pensions/Social Security %$ 8404 %0 Report %D 2000 %T HRS 1998 Preliminary Imputations %A Cao, Honggao %K Imputation %K Methodology %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %0 Journal Article %J Soc Secur Bull %D 2000 %T HRS data set: Respondent Earnings and Social Security Benefits Files. %A Unattributed %K Humans %K Income %K Social Security %K United States %B Soc Secur Bull %I 63 %V 63 %P 72-3 %8 2000 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/11641990?dopt=Abstract %4 HRS content and design %$ 8648 %0 Journal Article %J J Health Econ %D 1999 %T Health problems as determinants of retirement: are self-rated measures endogenous? %A Debra S. Dwyer %A Olivia S. Mitchell %K Health Services Research %K Health Status Indicators %K Humans %K Male %K Models, Statistical %K Retirement %K Self-Assessment %K United States %X

We explore alternative measures of unobserved health status in order to identify effects of mental and physical capacity for work on older men's retirement. Traditional self-ratings of poor health are tested against more objectively measured instruments. Using the Health and Retirement Study (HRS), we find that health problems influence retirement plans more strongly than do economic variables. Specifically, men in poor overall health expected to retire one to two years earlier, an effect that persists after correcting for potential endogeneity of self-rated health problems. The effects of detailed health problems are also examined in depth.

%B J Health Econ %I 18 %V 18 %P 173-93 %8 1999 Apr %G eng %N 2 %L pubs_1999_Dwyer_DJHE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10346352?dopt=Abstract %4 Retirement/Retirement Policies/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Health Status/Retirement Planning %$ 1196 %R 10.1016/s0167-6296(98)00034-4 %0 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T Health, Work, and Economic Well-Being of Older Workers, Aged 51-61: A Cross-National Comparison Using the United States HRS and the Netherlands CERRA Data Sets %A R.V. Burkhauser %A Debra S. Dwyer %A Maarten Lindeboom %A Theeuwes, Jules %A Wottiez, Isolde %E James P Smith %E Robert J. Willis %K Employment and Labor Force %K Health Conditions and Status %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 233-66 %G eng %4 Older Workers/Employment/Health Status %$ 8202 %! Health, Work, and Economic Well-Being of Older Workers, Aged 51-61: A Cross-National Comparison Using the United States HRS and the Netherlands CERRA Data Sets %0 Journal Article %J J Econ Perspect %D 1999 %T Healthy bodies and thick wallets: the dual relation between health and economic status. %A James P Smith %K Financing, Personal %K Health Expenditures %K Health Status %K Humans %K Socioeconomic factors %K United States %X

The first section of this paper documents the size of the association between health and one prominent economic status measure--household wealth. The next section deals with how health influences economic status by sketching out reasons why health may alter household savings (and eventually wealth) and then providing estimates of the empirical magnitude of these effects. The third section shifts attention to the other pathway--the links between economic status and health--and summarizes major controversies and evidence surrounding these issues.

%B J Econ Perspect %I 13 %V 13 %P 144-66 %8 1999 Spring %G eng %U http://www.aeaweb.org/jep/ %N 2 %L pubs_1999_Smith_JJEconPers.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15179962?dopt=Abstract %4 Health Production/Health Behavior/Health Shocks/Economic Status/Income/Savings/Wealth %$ 1100 %0 Report %D 1999 %T Housing America's Elderly Population %A Shafer, Robert %K Housing %K Retirement Planning and Satisfaction %X Abstract: Examined the housing choices of older adults. Data were obtained from the Assets and Health Dynamics Among the Oldest-Old (AHEAD) survey on 8,222 adults aged 70 and older in 1993 and 6,047 housing units. It was found that 74.9 percent of older adults lived in conventional housing, 10 percent lived in shared housing, 6.6 percent in age-segregated housing, 5.5 percent in supported housing, and 2.9 percent in assisted living facilities. While geographic location and income had little effect on housing choices, educational attainment and net worth had significant influences. Older adults with higher educational attainment and higher net worth were more likely to favor conventional housing. While specific medical ailments had little effect on housing choice, the need for assistance with activities of daily living had a meaningful relationship with the decision. %I Cambridge, MA, Harvard University %G eng %L wp_1999/schafer_W99-4.pdf %4 Assisted Living/Housing %$ 16170 %0 Thesis %D 1998 %T The Health and Financial Decisions of the Elderly %A Davis, Morris A. %K Consumption and Savings %K Health Conditions and Status %I University of Pennsylvania %8 1998 %G eng %4 Economics of the Elderly %$ 6539 %+ Thesis %! The Health and Financial Decisions of the Elderly %0 Journal Article %J Journal of Labor Economics %D 1998 %T Health and Labor Market Performance: The Case of Diabetes %A Kahn, Matthew E. %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %X This article documents improvements in diabetic labor market performance. Three cross-sectional data sets, from 1976, 1989, and 1992, are used to study trends in diabetic employment and earnings prospects. Results show that the labor force participation of diabetic women has significantly increased between 1976 and 1992, relative to diabetic men and nondiabetics. Results also indicate that relative to nondiabetic family heads of households, the income of the diabetic family has increased. These findings suggest that medical advance and technological change have helped to reduce the probability and effects of diabetic complications. %B Journal of Labor Economics %I 16 %V 16 %P 878-899 %G eng %N 4 %L pubs_1998_Kahn_MJoLE.pdf %4 Diabetic Status/Health Status/Economic Status/Labor Market %$ 8254 %R 10.1086/209909 %0 Report %D 1998 %T Health and Socioeconomic Mobility: The Economic Consequences of Changes in Health for Pre-Retirement Workers %A Reynolds, John R. %A Quadagno, Jill %K Demographics %K Health Conditions and Status %X The theory of cumulative advantage/disadvantage provides a life-course framework for analyzing stratification systems among the aged. Although income inequality has been the primary focus of this theory, recent studies have examined processes of cumulative disadvantage in terms of health. One consistent finding has been that socioeconomic status has a significant effect on health. Focus here, however, is extended to analyze the opposite - the effect of health on socioeconomic mobility. The first two waves of the Health and Retirement Study are used to estimate the reciprocal effects that exist between health and economic status of the US preretirement working population, specifically, to examine the reciprocal relationships between changes in physical and emotional health, on the one hand, and changes in workforce attachment, earnings, and assets, on the other. Preliminary analyses indicate that, while health and wealth are reciprocally related, among older workers, the association is primarily from health to changes in wealth, and not vice versa. These findings support the cumulative advantage perspective on inequality in old age, and challenge the commonly held view that socioeconomic status is more determinative of health than vice versa. %G eng %4 Health/Socioeconomic Status/Social Mobility %$ 1278 %0 Book Section %B Frontiers in the Economics of Aging %D 1998 %T Health Events, Health Insurance and Labor Supply: Evidence from the Health and Retirement Survey %A Mark McClellan %E David A Wise %K Employment and Labor Force %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %X The economic consequences of health problems are reported to be enormous. For example, many investigators have concluded that the cost to society of common health problems such as heart disease, diabetes, and cancer is many billions of dollars per year in terms of lost work productivity, intensive medical treatments, and additional supportive care. However, these estimates have several important limitations. Few data sets have incorporated detailed information on health problems and economic circumstances such as retirement, medical and personal care expenditures, income, and wealth. Consequently, most existing studies have had to combine data from different sources, possibly missing important correlations between variables such as insurance availability and the occurrence of health problems. Many of these studies have been based on cross-sectional, descriptive comparisons of individuals with and without health problems. As a result, it is difficult to account for other differences besides health problems that might also have affected these outcomes. For example, individuals with health problems may have had chronically worse health status, or have lower-income backgrounds, or have other differences in preferences that might have led to differences in economic outcomes anyway. %B Frontiers in the Economics of Aging %I Univ. of Chicago Press %C Chicago, IL %G eng %U https://www.nber.org/chapters/c7304 %4 Health Status/Labor Supply/Health Insurance %$ 8174 %! Health Events, Health Insurance and Labor Supply: Evidence from the Health and Retirement Survey %0 Report %D 1998 %T Health Insurance and Labor Market Transitions of Older Workers %A Lynn A Karoly %A Jeannette Rogowski %K Employment and Labor Force %K Insurance %X This report describes the labor market transitions associated with the availability and cost of post-retirement health insurance among the population that is not yet eligible for Medicare. The study uses data from the Health and Retirement Survey, a nationally representative survey of Americans who are near elderly, to study transitions from full-time to part-time employment or retirement, and from wage and salary employment to self employment or retirement. The study should be useful to policymakers interested in understanding how public policies aimed at expanding access to health insurance among the near elderly may affect labor market transitions. These include such policy initiatives as continuation and portability mandates, as well as buy-ins to Medicare. In addition, it provides insights on how increases in the age of full Medicare eligibility as well as the trend towards decreased generosity of retiree health insurance among employers might affect the labor force behavior of older workers. %B RAND Unrestricted Draft %I RAND %G eng %U https://www.rand.org/pubs/drafts/DRU1797.html %4 Labor Market/Older Workers %$ 6561 %0 Magazine Article %D 1998 %T His Paycheck is His Pep Pill %A Whitford, David %K Demographics %K Employment and Labor Force %B Fortune Magazine %V 138 %P 138-142 %8 Aug 17, 1998 %G eng %N 4 %4 Labor/Basic Demographics %$ 8596 %! His Paycheck is His Pep Pill %0 Book Section %B Inquiries in the economics of aging %D 1998 %T Household Wealth of the Elderly under Alternative Imputation Procedures %A Hoynes, Hilary %A Michael D Hurd %A Chand, Harish %E David A Wise %K Consumption and Savings %K Demographics %K Income %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Although many reach retirement with few resources except housing equity and a claim to social security and Medicare, financial wealth, nonetheless, makes an important contribution to the economic status of many of the elderly. Most of our up-to-date information about the wealth of the elderly is based on the Survey of Income and Program Participation (SIPP), which sometimes adds an asset module to its core survey. As in many surveys of assets, the rate of missing data on individual asset items is high, about 30 to 40 percent among those with the asset. This raises the issue of the reliability of SIPP wealth measures because respondents who refuse or are unable to give a value to an asset item may not be representative of the population. Indeed, in the Health and Retirement Survey (HRS) it is clear that asset data are not missing at random. Through the use of bracketing methods, which we will discuss below, the HRS was able to reduce the rate of missing asset data substantially, and the data that were added in this way increased mean wealth in the HRS by about 40 percent (Smith 1995). Furthermore, because the additional data increased the mean so much, they undoubtedly increased measures of wealth inequality. %B Inquiries in the economics of aging %I University of Chicago Press %C Chicago and London %P 229 -54 %G eng %U https://www.nber.org/chapters/c7088 %N NBER Project Report series %4 Economics of the Elderly/Retirement/Retirement Policies/Personal Income and Wealth Distribution/Elderly/Wealth %$ 1008 %! Household Wealth of the Elderly under Alternative Imputation Procedures %0 Report %D 1998 %T How America Saves %A Korczyk, Sophie %K Adult children %K Employment and Labor Force %K Expectations %K Health Conditions and Status %K Net Worth and Assets %K Risk Taking %X Certain groups with lower savings througout their work lives reach retirement with significantly fewer assets than their peers. Single people, African American and Hispanic households, those with a high school education or less, people with health problems, and lower income households are all vulnerable to lower savings. Even though people save more as they age, age does not make up for low saving patterns. In nearly all economic and demographic groups, there are some people who do not save at all, some who save a little, and some who save a great deal. Taking into consideration the experiences, attitudes, and personal expectations of people nearing or in the early stages of retirement age is important to understanding their saving capacities, patterns, and decisions. %I Washington, DC, American Association of Retired Persons %G eng %4 Economic Status/Family/Labor/Health Status/Attitudes towards Saving and the Future/Opinions about the Economy %$ 8166 %0 Report %D 1998 %T How Important are Intergenerational Transfers of Time? A Macroeconomic Analysis %A Emanuela Cardia %A Serena Ng %K Adult children %K Employment and Labor Force %K Net Worth and Assets %X In this article the authors consider labor supply and capital accumulation with respect to intergenerational transfers of both time and money. Researchers working on this study created a model that would permit variables for time and monetary transfers, between generations of a family, in order to observe possible effects on the economy. By way of the model and data from the first wave (1992) of the Health and Retirement Study the researchers are able to find that increases in the amount of time transferred between generations will increase the amount of capital accumulation. The authors feel that time transfers have just as large an effect on the economy as monetary transfers. Monetary transfers have a tendency to increase a persons wealth and thus decrease the amount of effort they put into their work. On the other hand, time transfers tend to increase the amount of young people that are in the labor force. The authors examine the effects of different types of tax credits, as well. %I Boston College %G eng %4 Labor Supply/Transfers/Wealth %$ 6551 %0 Report %D 1997 %T Health Insurance and Retirement Behavior: Evidence from the Health and Retirement Study %A Lynn A Karoly %A Jeannette Rogowski %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %I RAND %G eng %4 Retirement Behavior/Health Insurance %$ 6560 %0 Report %D 1997 %T Health Insurance and Retirement in the 1990s: A Dynamic Structural Analysis %A David M. Blau %A Gilleskie, Donna B. %K Medicare/Medicaid/Health Insurance %K Pensions %I University of North Carolina-Chapel Hill %G eng %4 Health insurance/Pensions %$ 6549 %0 Journal Article %J Health Care Financ Rev %D 1997 %T Health insurance coverage at midlife: characteristics, costs, and dynamics. %A Richard W. Johnson %A Crystal, Stephen %K Age Factors %K Costs and Cost Analysis %K Demography %K Female %K Health Benefit Plans, Employee %K Health Care Surveys %K Humans %K Insurance Coverage %K Insurance, Health %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K United States %X

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

%B Health Care Financ Rev %I 18 %V 18 %P 123-48 %8 1997 Spring %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/ %N 3 %9 Journal %L pubs_1997_Johnson_RHCFR.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10170345?dopt=Abstract %4 Age Factors/Costs and Cost Analysis/Demography/Female/Health Benefit Plans, Employee/Health Care Surveys/Human/Insurance Coverage/Insurance, Health/Classification/Statistics and Numerical Data/Logistic Models/Longitudinal Studies/Middle Age/Support, Non U.S. Government/Support, U.S. Government--PHS/United States %$ 4225 %0 Report %D 1997 %T Health Insurance Coverage Transitions of Older Americans %A Loprest, Pamela %A Sheila R Zedlewski %K Medicare/Medicaid/Health Insurance %X Health insurance coverage can be a significant factor in determining older individuals' economic and health security. This report uses data from the first two waves of the Health and Retirement Survey to examine the health insurance transitions of two groups: those who moved into retirement between 1992 and 1994 and those who were already retired in both years. For a quarter of full-time workers in 1992 who moved to retirement, this transition also involved a change in health insurance coverage. The percentage who were uninsured increased from 7 percent to 13 percent. Although the majority of full-time workers with own-employer health insurance kept this coverage when they retired, not all did. Fully a third of workers who became uninsured when they retired between 1992 and 1994 had insurance through an employer while they were working; 43 percent of retirees who became uninsured had no health insurance while they were working. Our results indicate a much lower rate of employer group coverage for those already retired in wave 1 (1992). While insurance coverage for those with employer group insurance (whether through theirown spouse or their employer) remained quite stable, we observe considerable instability amongthose who retired with nongroup coverage or without health insurance. Transitions into government coverage are important for this group, as some completed the two-year waiting period for Medicare eligibility for the disabled and others qualified for Medicaid. Overall, health insurance coverage was a problem for the most vulnerable persons in this age group. The rates of uninsurance were much higher for low-income, disabled, and single persons. Many lacked options for purchasing affordable insurance to tide them over until they were eligible for Medicare at age 65. %I Washington, DC, The Urban Institute %G eng %U https://www.urban.org/sites/default/files/publication/67116/410235-Health-Insurance-Coverage-Transitions-of-Older-Americans.pdf %4 Health Insurance Coverage %$ 6525 %0 Journal Article %J Bulletin of Allied Medical Sciences, Kobe %D 1997 %T Heart Disease Risk Factors and Onset of Heart Problems among the Elderly %A Ueda, Hiroshi %A Shirakawa, Taku %A Goko, Hideki %K Health Conditions and Status %K Risk Taking %X This study looks at the incidence of heart problems among the elderly in order to examine possible risk factors of heart disease. The six heart disease risk factors- - hypertension, diabetes, alcohol consumption, smoking status, body mass index (BMI), and physical performance- - were examined in both bivariate and multivariate logistic regression analyses. In bivariate analyses, hypertension, diabetes, alcohol consumption, and physical performance all related to the incidence of heart problems among the elderly. However, hypertension and alcohol consumption do not show significance in multivariate analyses and therefore their effects as a risk factor on the incidence of heart disease are low. BMI only significantly indicated the risk of the incidence of heart problems in the multiple logistic regression analyses. Both diabetes and physical performance proved to be statistically significant indicators of heart disease in both types of analyses, yet they show different direction of effects when demographic factors are added. %B Bulletin of Allied Medical Sciences, Kobe %I 13 %V 13 %P 21-31 %G eng %4 Health Status/Health Behaviors/Risk Factors/Hypertension/Diabetes Mellitus/Alcohol Drinking/Heart Diseases %$ 8216 %0 Journal Article %J Social Security Bulletin %D 1996 %T The Health and Retirement Study: The New Retirement Survey %A Olson, Janice A. %K Methodology %X This paper provides an introduction to the HRS, describes the support that the Social Security Administration is providing, and comments on some of the features that make it especially valuable to SSA. Early results and references to the growing body of research on the study are also provided. %B Social Security Bulletin %I 59 %V 59 %P 85-88 %G eng %N 1 %L pubs_1996_Olson_JSSB.pdf %4 HRS Sponsorship, Sample, Study Design/SSA Record Linkages/Social Security Research %$ 8234 %0 Journal Article %J Gerontologist %D 1996 %T The health-wealth connection: racial differences. %A Dennis G. Shea %A Toni Miles %A Mark D Hayward %K Black or African American %K Cross-Sectional Studies %K Female %K Health Status %K Humans %K Income %K Male %K Middle Aged %K Models, Theoretical %K Regression Analysis %K United States %K White People %X

This article examines the theoretical connection between health capital and financial capital in an economic life-cycle model, exploring possible explanations for racial differences in capital accumulation behavior. Using data from the Health and Retirement Survey, detailed descriptive analysis and a comparison of regression models for health and financial capital are presented. The results, although preliminary and based on cross-section data, suggest possible racial differences in the connection between health and wealth and deserve further study.

%B Gerontologist %I 36 %V 36 %P 342-9 %8 1996 Jun %G eng %N 3 %L pubs_1996_Shea_DGer.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/8682332?dopt=Abstract %4 Blacks/Comparative Study/Cross Sectional Studies/Female/Health Status/Economic Status/Income/Middle Age/Models, Theoretical/Regression Analysis/Whites %$ 4270 %R 10.1093/geront/36.3.342 %0 Journal Article %J Journal of Economic Literature %D 1996 %T Household Saving: Micro Theories and Micro Facts %A Browning, Martin %A Annamaria Lusardi %K Consumption and Savings %K Methodology %X In this article the main goal is to uncover what causes households to save currency in any form, liquid or not. The authors begin with the eight postulates on saving of John Maynard Keyenes and add a ninth reason to accumulate deposits to buy houses, cars, and other durables. From this they try to link facts about household saving with the microeconomic theories regarding household saving. Their over-arching assumption is that rational forward looking people will not want expenditure or the marginal utility of their expenditure to be greater at one time than at any other time. Various microeconomic saving theories are discussed and the authors make arguments toward what is realistic in the models and where the models deviate from the real world, as well as, how the models differ from one another. Statistical information from the HRS, AHEAD, RHS studies are used as facts that are explained by, or linked to, concepts of the various models. This data thus explains who saves, but not why. The theories described at the beginning of the paper and the statistical information presented are then used in a sort of case study on the declining savings rate over the two decades of the 1970s and 1980s. The conclusion is that the Standard Model of saving is the most flexible and helpful in understanding saving and consumption. The Certainty-Equivalence Model is very strong, but leaves out the important postulate of saving in order to have enough resources in the case of an unforeseen economic downturn or shock. It is the author s belief that the only alternatives to the standard model are behavioral models, but behavioral models may be harder to test. Attempting to link standard model predictions with behavioral models may enable economists to learn more about cross-section variation among ages with regard to savings. %B Journal of Economic Literature %I 34 %V 34 %P 1797-1855 %G eng %U https://www.jstor.org/stable/2729595?seq=1 %N 4 %L pubs_1996_Browning_MJEconLit.pdf %4 Saving/Consumption/Models, Econometric %$ 8394 %0 Report %D 1994 %T How Does Pension Coverage Affect Household Saving. Final Report %A Sabelhaus, J. %K Adult children %K Consumption and Savings %K Employment and Labor Force %K Income %K Methodology %K Pensions %K Retirement Planning and Satisfaction %X This paper analyzes the extent to which substitution between pension coverage and household-level saving occurs at the micro level. Data from the beta release of the Health and Retirement Study (HRS) which covered people age 51 to 61 in 1992 is used. The results are mixed. Although there appears to be some substitution between household saving and pension coverage in the top half of the income distribution, the level differences in accumulated wealth seem to fall short of complete offset. Evidence that household wealth accumulation does not vary significantly by type of pension coverage is also found. The paper explores various explanations for why the pension offset is missing or incomplete. %I Washington, DC, Urban Institute %G eng %4 Trends/Households/Retirement/Savings/Employment/Income/Pensions %$ 1228