@inbook {12305, title = {Disability-free life trends at older ages: Implications for longevity risk management }, booktitle = {New Models for Managing Longevity Risk: Public-Private Partnerships}, year = {2022}, publisher = {Oxford University Press}, organization = {Oxford University Press}, chapter = {3}, keywords = {Activities of Daily Living, Disability}, isbn = {978{\textendash}0{\textendash}19{\textendash}285980{\textendash}8}, doi = {10.1093/oso/9780192859808.001.0001}, author = {Douglas A. Wolf and Olivia S. Mitchell} } @article {11784, title = {End-of-Life Planning Depends on Socio-Economic and Racial Background: Evidence from the US Health and Retirement Study (HRS).}, journal = {Journal of Pain and Symptom Management}, volume = {62}, year = {2021}, pages = {1198-1206}, abstract = {

CONTEXT: Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care.

OBJECTIVE: To examine determinants of end-of-life planning; including, the effect of an individual{\textquoteright}s ageing and dying process, health status and socio-economic and racial/ethnic background.

METHODS: US observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics.

RESULTS: End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient{\textquoteright}s proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging.

CONCLUSIONS: Understanding differences that increase end-of-life planning is important to incentivize patients{\textquoteright} participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.

}, keywords = {Advance care planning, end-of-life, End-of-life planning, Living will}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2021.05.018}, author = {Martina Orlovic and Warraich, Haider and Douglas A. Wolf and Elias Mossialos} } @article {9292, title = {Estimating the Prevalence of Serious Mental Illness and Dementia Diagnoses Among Medicare Beneficiaries in the Health and Retirement Study}, journal = {Research on Aging}, volume = {40}, year = {2018}, pages = {668-686}, abstract = {Methods: This study utilizes HRS-linked Medicare claims data sets and inverse probability weighting to estimate overall and age-specific cumulative prevalence rates of dementia and serious mental illnesses among 18,740 Medicare beneficiaries. Two-way tabulations determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, and binary logistic regressions determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, controlling for covariates. Results: Weighted prevalence estimates for dementia, schizophrenia (SZP), bipolar disorder (BPD), and major depressive disorder (MDD) are similar to previous studies. Odds of dementia diagnosis are significantly greater for beneficiaries diagnosed with SZP, BPD, or MDD. Conclusions: Co-occurring mental disabilities require further investigation, as in the near future increasing numbers of mentally ill older adults will need appropriate and affordable community-based services and supports. }, keywords = {Cognitive Ability, Dementia, Depressive symptoms, Medicare linkage, Mental Health}, issn = {0164-0275}, doi = {10.1177/0164027517728554}, url = {http://journals.sagepub.com/doi/10.1177/0164027517728554}, author = {Maria T. Brown and Douglas A. Wolf} } @article {9860, title = {A role for genes in the {\textquoteleft}caregiver stress process{\textquoteright}?}, journal = {Translational Psychiatry}, volume = {8}, year = {2018}, abstract = {The stress that accompanies caring for one{\textquoteright}s parent, and the contribution of that stress to adverse physical and mental-health outcomes, is extensively studied and widely acknowledged. Yet there has been almost no attempt to incorporate the well-documented role of genetic variation in psychological distress into research on caregiving. We use phenotypic data from a large, population-based sample linked to extensive genotype data to develop a polygenic risk score (PRS) for depression, and test for both direct and interactive effects of the PRS in a multilevel repeat-measures model of caregiver-related stress. We distinguish three groups: potential caregivers (those with a living parent who does not need care), noncaregivers (those who do not provide care to their parent that needs care), and caregivers. We also obtain separate estimates according to the gender of both the parent and child. We found that a parent{\textquoteright}s need for care, and the child{\textquoteright}s provision of care, are associated with depression in some but not all cases; in contrast the PRS was significantly associated with the risk for increased depressive symptoms (with P <= 0.01) in all cases. These findings support an additive genetic contribution to the diathesis-stress model of depression in the context of caregiving.}, keywords = {Caregiving, Genetics, Psychiatry, Translational research}, doi = {10.1038/s41398-018-0275-7}, url = {http://www.nature.com/articles/s41398-018-0275-7http://www.nature.com/articles/s41398-018-0275-7.pdfhttp://www.nature.com/articles/s41398-018-0275-7.pdfhttp://www.nature.com/articles/s41398-018-0275-7}, author = {Douglas A. Wolf and Middleton, Frank A.} } @article {12183, title = {Disability Measurement in the Health and Retirement Study}, year = {2016}, publisher = {National Institute on Aging}, address = {Bethesda, MD}, keywords = {Disability}, author = {Emily M. Agree and Douglas A. Wolf} } @article {8237, title = {Disability Trajectories at the End of Life: A "Countdown" Model.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {745-52}, publisher = {70}, abstract = {

OBJECTIVES: Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies.

METHODS: We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20\% of the sample), TTD is unknown, producing a missing-data problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors.

RESULTS: Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities.

DISCUSSION: The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending.

}, keywords = {Aged, Aged, 80 and over, Aging, Death, Disabled Persons, Female, Humans, Male, Time Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu182}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract}, author = {Douglas A. Wolf and Vicki A Freedman and Jan I Ondrich and Christopher L Seplaki and Brenda C Spillman} } @mastersthesis {6201, title = {Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S}, volume = {3713670}, year = {2015}, note = {Copyright - Copyright ProQuest Dissertations Publishing 2015 Last updated - 2015-09-02 First page - n/a}, month = {2015}, pages = {105}, school = {Syracuse University}, type = {Ph.D.}, address = {Syracuse, NY}, abstract = {Situated in the context of a rapidly aging population, this dissertation examines the implications of supplying long-term care (LTC) services to the elderly in the United States. The first two essays investigate private costs of LTC assistance borne by adult children of elderly parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC services. The first essay analyzes whether adult children devote less time to exercise as time allocation in parental caregiving increases. The empirical model is a system of four correlated equations, where the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, nor in hours of work, among either men or women. The second essay goes beyond time resources and examines whether dementia onset in parents leads to a reduction in adult children{\textquoteright}s household wealth. Towards this, I construct a longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile regressions indicate that parental dementia substantially reduces household wealth of an unmarried adult child in the upper quantiles of the wealth change distribution in the first two years after parental diagnosis. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent time period as well. An examination of mechanisms suggests that both, losses in labor income and nursing home expenditures, may play a role in leading to wealth declines. This paper makes two contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous studies, it does not limit the analysis to adult children who are informal caregivers. The final essay examines the cost implications of publicly provided formal care services. Medicaid{\textquoteright}s Personal Care Services (PCS) State Plan benefit is a key mechanism through which states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has been very little empirical work on examining the effect of the PCS State Plan benefit on Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly during the early-growth years in 1980s. Further, findings suggest that states make decisions to adopt the program based on financial experiences of other adopting states. This study provides evidence consistent with the interpretation that when faced with the dilemma of balancing increased access and uncontrolled expenditures, state officials adapt the design of an entitlement benefit in an effort to make it less expensive. In its entirety, the dissertation provides new thinking on two dominant themes in conventional long-term care research: "caregiver burden" and "woodwork effect". In particular, the results of the first and third essay question the presence of "caregiver burden" and "woodwork effect" respectively, while the third essay challenges the pervasiveness of "caregiver burden" among unmarried adult children. These findings, which in some aspect are unexpected in the context of existing literature, have important implications for policy intervention and the direction of future research efforts in this area.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Methodology, Net Worth and Assets, Public Policy}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708672813?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/}, author = {Arora, Kanika} } @article {7985, title = {Is There a Trade-off Between Parent Care and Self-care?}, journal = {Demography}, volume = {51}, year = {2014}, note = {Times Cited: 0}, pages = {1251-70}, publisher = {51}, abstract = {Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women.}, keywords = {Adult children, Healthcare}, doi = {10.1007/s13524-014-0309-6}, author = {Arora, Kanika and Douglas A. Wolf} } @article {7704, title = {Family structure and the reproduction of inequality: Parents{\textquoteright} contribution to children{\textquoteright}s college costs.}, journal = {Soc Sci Res}, volume = {41}, year = {2012}, month = {2012 Jul}, pages = {876-87}, publisher = {41}, abstract = {

This article examines the role of family structure in the financial support parents provide for their children{\textquoteright}s college education. Data are from the Health and Retirement Study. We focus on aspects of family structure that affect parental support and estimate shared family variance in investments as well as within-family variation using a multilevel model. Family membership accounts for about 60\% of the variance in payment of college costs. Small family size, living with both biological parents (compared to one biological parent and a stepparent), higher parental education, and having older parents are associated with greater parental expenditures.

}, issn = {1096-0317}, doi = {10.1016/j.ssresearch.2012.02.008}, author = {John C Henretta and Douglas A. Wolf and Matthew F. Van Voorhis and Beth J Soldo} } @inbook {5222, title = {Family Care and Assisted Living: An Uncertain Future?}, booktitle = {The Assisted Living Residence: A Vision for the Future}, year = {2008}, note = {ProCite field 6 : In ProCite field 8 : eds}, pages = {198-222}, publisher = {Johns Hopkins University Press}, organization = {Johns Hopkins University Press}, address = {Baltimore}, keywords = {Healthcare, Retirement Planning and Satisfaction}, author = {Douglas A. Wolf and Jenkins, Carol}, editor = {Golant, Steven M. and Hyde, Joan} } @article {7067, title = {Parent Care and the Stress Process: Findings from panel data}, journal = {The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, volume = {61}, year = {2006}, pages = {S248-55}, publisher = {61}, abstract = {OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent{\textquoteright}s need for care and an adult child{\textquoteright}s caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: . We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages.}, keywords = {Health Conditions and Status, Healthcare}, url = {http://psychsoc.gerontologyjournals.org/contents-by-date.2006.shtml}, author = {Amirkhanyan, Anna A. and Douglas A. Wolf} } @article {6931, title = {Disability and Home Care Dynamics Among Unmarried Older Americans}, journal = {The Journals of Gerontology: Social Sciences}, volume = {59B}, year = {2004}, pages = {S25-S33}, publisher = {59B}, abstract = {Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.}, keywords = {Disabilities, Healthcare}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Vicki A Freedman and Aykan, Hakan and John E. Marcotte and Douglas A. Wolf} } @article {6878, title = {Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity.}, journal = {Gerontologist}, volume = {43}, year = {2003}, month = {2003 Dec}, pages = {817-27}, publisher = {43}, abstract = {

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents{\textquoteright} care needs and child{\textquoteright}s care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members.

DESIGN AND METHODS: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings.

RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers.

IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.

}, keywords = {Caregivers, depression, Female, Humans, Male, Middle Aged, Regression Analysis, Risk Factors, Stress, Psychological}, issn = {0016-9013}, doi = {10.1093/geront/43.6.817}, author = {Amirkhanyan, Anna A. and Douglas A. Wolf} } @article {5525, title = {Modeling Income in the Near Term: Revised Projections of Retirement Income Through 2020 for the 1931-1960 Birth Cohorts}, year = {2002}, note = {RDA 1998-006}, institution = {The Urban Institute}, address = {Washington, D.C.}, abstract = {The Division of Policy Evaluation (DPE) of the Social Security Administration (SSA) has entered into two contracts with the Urban Institute to help it develop a new tool for analyzing the distributional consequences of Social Security reform proposals. The first, awarded in 1998, led to the development of Modeling Income in the Near Term (MINT), a tool for simulating the retirement incomes of members of the Baby Boom and neighboring cohorts. The second, awarded in 2000, was to expand and improve on the first version of MINT. In all phases of the project, members of the research staff at SSA/DPE collaborated closely with the contractors. The Brookings Institution served as a subcontractor to the Urban Institute under both contracts and the RAND Corporation participated in the development of the initial version of MINT under a separate contract. This report describes the work of the researchers at Urban and Brookings under the second contract.}, keywords = {Disabilities, Net Worth and Assets, Pensions, Social Security}, url = {http://www.urban.org/UploadedPDF/410609_ModelingIncome.pdf}, author = {Toder, Eric and Thompson, Lawrence H. and Melissa Favreault and Richard W. Johnson and Perese, Kevin and Ratcliffe, Caroline and Karen E. Smith and Cori E. Uccello and Timothy A Waidmann and Berk, Jillian and Woldemariam, Romina and Gary T. Burtless and Claudia R Sahm and Douglas A. Wolf} } @inbook {5125, title = {Intergenerational Transfers: Blood, Marriage, and Gender Effects on Household Decisions}, booktitle = {Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster.}, year = {1999}, note = {ProCite field[3]: Georgetown U; Center for Policy Research, Syracuse U; U FLProCite field[8]: eds.}, pages = {335-55}, publisher = {University of Michigan Press}, organization = {University of Michigan Press}, address = {Ann Arbor, MI}, keywords = {Adult children, Consumption and Savings, Demographics, Event History/Life Cycle, Methodology}, author = {Beth J Soldo and Douglas A. Wolf and John C Henretta}, editor = {James P Smith and Robert J. Willis} } @article {6580, title = {The division of family labor: care for elderly parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {102-9}, publisher = {52B}, abstract = {

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent{\textquoteright}s needs and the child{\textquoteright}s own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child{\textquoteright}s hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child{\textquoteright}s supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

}, keywords = {Aged, Caregivers, Family, Frail Elderly, Humans, Models, Theoretical, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.102}, author = {Douglas A. Wolf and Vicki A Freedman and Beth J Soldo} } @article {6579, title = {Selection of Children to Provide Care: The effect of earlier parental transfers}, journal = {The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, volume = {52B}, year = {1997}, publisher = {52B}, abstract = {We use the first wave of data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the effects of past parent-to-child financial transfers on selection of a child to provide assistance with basic personal care for unmarried parents. We estimate a fixed-effects conditional logit model and find a positive and significant association between past financial transfers and a child{\textquoteright}s current helping behavior. The coefficient of past financial transfers is in the direction hypothesized, and its magnitude is 80 as large as that of gender, a well-documented powerful predictor of parental caregiving. There appears to be substantial evidence that earlier parent-to-child financial gifts play a role in determining which child in the family will provide assistance.}, keywords = {Adult children, Demographics, Health Conditions and Status, Healthcare, Income, Methodology, Other}, author = {John C Henretta and Martha S. Hill and Li, Wei and Beth J Soldo and Douglas A. Wolf} }