@article {Kabuche2024165, title = {Pooling functional disability and mortality in long-term care insurance and care annuities: A matrix approach for multi-state pools}, journal = {Insurance: Mathematics and Economics}, volume = {116}, year = {2024}, pages = {165 {\textendash} 188}, type = {Article}, abstract = {Mortality risk sharing pools including group self-annuitisation, pooled annuity funds and tontines have been developed as an effective solution for managing longevity risk. Although they have been widely studied in the literature, these mortality risk sharing pools do not consider individual health or functional disability status nor the need for long-term care (LTC) insurance at older ages. We extend these pools to include functional disability and chronic illness and present a matrix-based methodology for pooling mortality risk across heterogeneous individuals classified by functional disability states and chronic illness statuses. We demonstrate how individuals with different health risks can more equitably share mortality risk in a pooled annuity design. A multi-state pool is formed by pooling annuitants considering both longevity and LTC risks and determining the actuarially fair benefits based on individuals{\textquoteright} health states. Our methodology provides a general structure for a pooled annuity product that can be applied for general multi-state models. We present an extensive analysis with numerical examples using the US Health and Retirement Study (HRS) data. Our results compare expected annuity benefits for individuals in poor health to those in good health, show the effects of incorporating systematic trends and uncertainty, assess how the valuation of the expected annuity payments interacts with the assumptions used for the multi-state model and assess the impact of pool size.}, keywords = {functional disability, Health Status, Long-term care insurance, Multi-state models, Pooled annuity}, doi = {10.1016/j.insmatheco.2024.02.006}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85187374382\&doi=10.1016\%2fj.insmatheco.2024.02.006\&partnerID=40\&md5=6fd9f9cf977292857e4e0da00e19e251}, author = {Kabuche, Doreen and Sherris, Michael and Villegas, Andr{\'e}s M. and Ziveyi, Jonathan} } @article {13841, title = {Do changes in personality predict life outcomes?}, journal = {Journal of Personality and Social Psychology}, volume = {125}, year = {2023}, pages = {1495-1518}, abstract = {

The Big Five personality traits predict many important life outcomes. These traits, although relatively stable, are also open to change across time. However, whether these changes likewise predict a wide range of life outcomes has yet to be rigorously tested. This has implications for the types of processes linking trait levels and changes with future outcomes: distal, cumulative processes versus more immediate, proximal processes, respectively. The present study used seven longitudinal data sets ( = 81,980) to comprehensively examine the unique relationship that changes in the Big Five traits have with static levels and changes in numerous outcomes in the domains of health, education, career, finance, relationships, and civic engagement. Meta-analytic estimates were calculated and study-level variables were examined as potential moderators of these pooled effects. Results indicated that changes in personality traits are sometimes prospectively related to static outcomes-such as health status, degree attainment, unemployment, and volunteering-above and beyond associations due to static trait levels. Moreover, changes in personality more frequently predicted changes in these outcomes, with associations for new outcomes emerging as well (e.g., marriage, divorce). Across all meta-analytic models, the magnitude of effects for changes in traits was never larger than that of static levels and there were fewer change associations. Study-level moderators (e.g., average age, number of Big Five waves, internal consistency estimates) were rarely associated with effects. Our study suggests personality change can play a valuable role in one{\textquoteright}s development and highlights that both cumulative and proximal processes matter for some trait-outcome associations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

}, keywords = {Divorce, Health Status, Humans, Longitudinal Studies, Occupations, Personality, Personality Disorders}, issn = {1939-1315}, doi = {10.1037/pspp0000472}, author = {Wright, Amanda J and Jackson, Joshua J} } @article {13205, title = {Short-term effect of retirement on health: Evidence from nonparametric fuzzy regression discontinuity design.}, journal = {Health Econ}, volume = {32}, year = {2023}, pages = {1323-1343}, abstract = {

We estimate the short-term effect of retirement on health in the US using the Health and Retirement Study survey. We use the nonparametric fuzzy regression discontinuity design to avoid assuming any functional form on the age-health profile and minimize potential bias in identifying the causal effect of retirement on health status in the short term. Estimates indicate an 8\% decline in the cognitive functioning score of retirees and a 28\% increase in the CESD depression scale. The likelihood of being in good health status declined by 16\%. The transition from working to retirement has more significant negative impacts on males than females. In addition, retirement has more considerable adverse effects on less-educated individuals compared to high-educated individuals. The short-term effects of retirement on health are consistent and robust across different bandwidths, weighting kernel functions, and age-profile specifications. Moreover, the Treatment Effect Derivative test results highly support the external validity of the nonparametric estimates of the retirement effect on health.

}, keywords = {Female, Health Status, Humans, Male, Retirement, Surveys and Questionnaires}, issn = {1099-1050}, doi = {10.1002/hec.4669}, author = {Ebeid, Mohamed and Oguzoglu, Umut} } @article {12866, title = {Socioeconomic and race/ethnic differences in immunosenescence: Evidence from the Health and Retirement Study.}, journal = {Brain, Behavior, and Immunity}, volume = {107}, year = {2023}, pages = {361-368}, abstract = {

BACKGROUND: The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence have not well described.

METHODS: We characterized measures of immunosenescence from the 2016 Venous Blood Study from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 50~years and older.

RESULTS: Median values of the CD8+:CD4+, EMRA:Na{\"\i}ve CD4+ and EMRA:Na{\"\i}ve CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95~\% CI: 0.35, 0.39) compared to 0.30 in non-Hispanic Whites (95~\% CI: 0.29, 0.31). Non-Hispanic Blacks had the highest median value of the EMRA:Na{\"\i}ve CD4+ ratio (0.08; 95~\% CI: 0.07, 0.09) compared to non-Hispanic Whites (0.03; 95~\% CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex.

CONCLUSIONS: Lower educational attainment and minoritized racial ethnic status were associated with higher levels of immunosenescence. This population variation may have important implications for both risk of age-related disease and vulnerability to emerging pathogens (e.g., SARS-CoV-2).

}, keywords = {Academic Success, COVID-19, Health Status, Pandemics, SARS-CoV-2}, issn = {1090-2139}, doi = {10.1016/j.bbi.2022.10.019}, author = {Noppert, Grace A and Stebbins, Rebecca C and Dowd, Jennifer Beam and Aiello, Allison E} } @article {12595, title = {The Association Between Handgrip Strength Asymmetry Severity and Future Morbidity Accumulation: Results from the Health and Retirement Study}, journal = {International Journal of Exercise Science}, volume = {15}, year = {2022}, pages = {1133-1141}, abstract = {Analyzing the severity of handgrip strength (HGS) asymmetry in aging populations may help to screen for morbidities and add utility to handgrip dynamometer testing. Our study sought to determine the relationships between HGS asymmetry severity and future accumulating morbidities in older Americans. Secondary analyses from the 2006-2016 waves of the Health and Retirement Study included 18,506 adults >= 50 years old. The highest recorded HGS values from each hand were used to calculate HGS asymmetry ratio (non-dominant HGS/dominant HGS). If the HGS asymmetry ratio < 1.0, it was inversed to make all asymmetry ratios >= 1.0. Participants were categorized into groups based on the severity of their HGS asymmetry ratio: 1) 0.0\% - 10.0\%, 2) 10.1\% - 20.0\%, 3) 20.1\% - 30.0\%, and 4) > 30.0\%. Healthcare provider-diagnosed morbidities (hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems) were self-reported. Covariate-adjusted ordinal generalized estimating equations evaluated the relationships between HGS asymmetry severity on future accumulating morbidities. Results showed 8,936 (48.3\%) participants had HGS asymmetry 0.0\%-10.0\%, 6,105 (33.0\%) participants had HGS asymmetry 10.1\%-20.0\%, 2,411 (13.0\%) participants had HGS asymmetry 20.1\%-30.0\%, and 1,054 (5.7\%) participants had HGS asymmetry > 30.0\%. Overall, every 10\% increase in HGS asymmetry was associated with a 1.17 (CI: 1.05, 1.32) greater odds of future morbidity accumulation. Additionally, asymmetry between 10.1\% - 20.0\%, 20.1\% - 30.0\%, and > 30.0\% was associated with a 1.10 (CI: 1.05, 1.15), 1.11 (CI: 1.04, 1.18), and 1.20 (CI: 1.09, 1.33) greater odds for morbidity accumulation during aging. These findings suggest that severe functional asymmetries may elevate the odds for accumulating morbidities.}, keywords = {environment, Health Status, multimorbidity, muscular atrophy, Public Health}, url = {https://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=3327\&context=ijes}, author = {Klawitter, Lukus and Collins, Kyle S. and Ringhofer, Dawson and Christensen, Bryan K. and McGrath, Ryan} } @article {12276, title = {Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {85}, year = {2022}, pages = {1621-1637}, abstract = {

BACKGROUND: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS: We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

}, keywords = {Activities of Daily Living, Age Factors, Cognitive Dysfunction, ethnicity, Female, Health Status, Humans, Male, Middle Aged, Mobility Limitation, Neuropsychological tests, Psychomotor Performance, Retirement, Risk Factors, Self Report, Surveys and Questionnaires}, issn = {1875-8908}, doi = {10.3233/JAD-215192}, author = {Wu, Benson and Toseef, Mohammad Usama and Stickel, Ariana M and Gonz{\'a}lez, Hector M and Tarraf, Wassim} } @article {12631, title = {Can adherence to moral standards and ethical behaviors help maintain a sense of purpose in life? Evidence from a longitudinal study of middle-aged and older adults.}, journal = {PLoS One}, volume = {17}, year = {2022}, pages = {e0273221}, abstract = {

Personal factors, such as character strengths, have been shown to be favorably associated with concurrent and future well-being. Positive associations have also been reported between purpose in life and concurrent and subsequent health and well-being. Evidence on antecedents of purpose in life is, however, limited. This study examines whether the adherence to moral standards and ethical behaviors (AMSEB) is associated with subsequent purpose in life. Data from the Health and Retirement Study obtained from a sample of 8,788 middle-aged and older adults in the US (mean age = 64.9 years, age range 50-96 years) were used. The prospective associations between AMSEB and purpose in life were examined using generalized linear models. A rich set of covariates and prior outcomes were used as controls to reduce the risk of reverse causation. The robustness analyses included computation of sensitivity measures, E-values, and running a set of secondary analyses conducted on subsamples of respondents and using a limited set of covariates. It was found that middle-aged and older adults who demonstrated higher AMSEB reported a higher sense of purpose in life after the 4-year follow-up period. This association was found to be monotonic, moderately robust to potential unmeasured confounding and independent of demographics, prior socioeconomic status, prior health conditions, and health behaviors as well as prior psychological predispositions such as dispositional optimism and life satisfaction. It was also robust to missing data patterns. Policymakers and health practitioners may consider a predisposition to adherence to moral standards and ethical behaviors as a potential intervention target, as its improvement and/or maintenance has the potential to improve longevity and to help promote healthy and purposeful aging.

}, keywords = {Health Status, Morals, Retirement}, issn = {1932-6203}, doi = {10.1371/journal.pone.0273221}, author = {Weziak-Bialowolska, Dorota and Bialowolski, Piotr} } @article {12695, title = {Sociodemographic and health status differences in delaying medical care during the COVID-19 pandemic among older adults: findings from the Health and Retirement Study.}, journal = {BMC Public Health}, volume = {22}, year = {2022}, pages = {1720}, abstract = {

BACKGROUND: During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care.

METHOD: We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample (N = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits.

RESULTS: About 30\% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care.

CONCLUSIONS: Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future.

}, keywords = {COVID-19, Health Status, Health Status Disparities, Pandemics, Retirement}, issn = {1471-2458}, doi = {10.1186/s12889-022-14118-4}, author = {Farina, Mateo P and Jennifer A Ailshire} } @article {12052, title = {AGE OF MIGRATION AND THE HEALTH STATUS OF OLDER LATINOS: FINDINGS FROM THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {454}, abstract = {Life course research emphasizes the importance of considering how early life experiences set individuals on specific trajectories over time with implications across multiple health domains. Life experiences of older Latinos are shaped by where they were born and, for the foreign-born, when they immigrated to the United States. Prior research examining the extent to which age of migration is associated with health has largely been limited to regional studies. To address this gap in knowledge, we use nationally representative data from the Health and Retirement Study to examine associations between age of migration and multiple physical health outcomes among older Latinos residing in the United States. We examine 2010 prevalence and follow-up incidence to 2016 of cardiovascular issues, diabetes, one or more activities of daily living (ADLs), one or more instrumental activities of daily living (IADLs), cognitive issues, and mortality incidence. Preliminary results indicate similar health profiles across Latinos who migrated in early life (<18), during adulthood (18-34), and during later adulthood (35+). Most health profiles were similar among Latino men and women except for prevalence and incidence of experiencing difficulties with at least one ADL. Latino women who migrated in later-adulthood have higher prevalence of ADLs and women who migrated early in life (>18) have higher ADL incidence than Latino men who migrated during the same life course periods. A greater understanding of the how immigrant experiences influence physical health outcomes offers important insights into the development of actionable and culturally appropriate social and health policies.}, keywords = {Health Status, Latino/a, Migration}, url = {https://watermark.silverchair.com/igab046.1753.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAw4wggMKBgkqhkiG9w0BBwagggL7MIIC9wIBADCCAvAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM7s0hSSFNfL04LQwcAgEQgIICweGTh7mwqLLrbUuS19kuV0Fw7WbdU6hksn5EGvEahR}, author = {Blakelee R Kemp and Marc Garcia} } @article {12565, title = {Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium.}, journal = {International Journal of Epidemiology}, volume = {50}, year = {2021}, pages = {880-892}, abstract = {

BACKGROUND: Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.

METHODS: In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.

RESULTS: A common scale was created for 343~915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.

CONCLUSIONS: The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.

}, keywords = {Aging, Cohort Studies, Health Status, healthy aging, Humans, Reproducibility of Results}, issn = {1464-3685}, doi = {10.1093/ije/dyaa236}, author = {Sanchez-Niubo, Albert and Forero, Carlos G and Wu, Yu-Tzu and Gin{\'e}-V{\'a}zquez, Iago and Prina, Matthew and de la Fuente, Javier and Daskalopoulou, Christina and Critselis, Elena and De La Torre-Luque, Alejandro and Panagiotakos, Demosthenes and Arndt, Holger and Ayuso-Mateos, Jos{\'e} Luis and Bayes-Marin, Ivet and Bickenbach, Jerome and Bobak, Martin and Caballero, Francisco F{\'e}lix and Chatterji, Somnath and Egea-Cort{\'e}s, Laia and Garc{\'\i}a-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Mellor-Mars{\'a}, Blanca and Olaya, Beatriz and Paj{\k a}k, Andrzej and Prince, Martin and Raggi, Alberto and Rodr{\'\i}guez-Artalejo, Fernando and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Tobias-Adamczyk, Beata and Tyrovolas, Stefanos and Haro, Josep Maria} } @article {11927, title = {Older Adults{\textquoteright} Life Satisfaction: The Roles of Seeking Financial Advice and Personality Traits}, journal = {Journal of Financial Therapy}, volume = {12}, year = {2021}, abstract = {This paper uses 1,237 respondents from the Health and Retirement Study dataset to examine the relationships among personality, financial advice-seeking, and life satisfaction of U.S. older adults. The results indicate that extraversion is negatively associated with seeking professional financial advice, while conscientiousness and openness were associated positively with seeking professional financial advice. Individuals with a neurotic personality trait were positively associated with seeking financial advice from families and friends. Additionally, seeking professional financial advice, and being extraverted and conscientious, were positively associated with life satisfaction among older adults. The implications for financial therapists and counselors include suggestions for implementation of cross-functional collaborative counseling strategies when working with older clients who may be experiencing physical and mental health-related problems. Implications of the findings for policymakers are also discussed.}, keywords = {Cognitive Ability, Financial help seeking, financial therapy, Health Status, Life Satisfaction, Personality}, issn = {1944-9771}, doi = {https://doi.org/10.4148/1944-9771.1253}, author = {Chatterjee, Swarn and Fan, Lu} } @article {10978, title = {ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study}, journal = {Inquiry : a journal of medical care organization, provision and financing}, volume = {57}, year = {2020}, abstract = {The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100\% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12\% reduction in metabolic syndrome; a 32\% reduction in complications from metabolic syndrome; an 18\% reduction in the likelihood of gross motor skills difficulties; and a 34\% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.}, keywords = {crowd-out, difference-in-differences, Health Status, Insurance Coverage, Medicaid, near-elderly adults, Patient Protection and Affordable Care Act}, isbn = {1945-72430046-9580}, doi = {10.1177/0046958020935229}, author = {Melissa McInerney and Ruth Winecoff and Padmaja Ayyagari and Kosali I. Simon and M Kate Bundorf} } @article {2020-13542-00120200221, title = {Social capital and health status: Longitudinal race and ethnicity differences in older adults from 2006 to 2014.}, journal = {International Journal of Public Health}, volume = {65}, year = {2020}, pages = {291-302}, abstract = {AbstractObjectivesWe examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults.MethodsWe used Health and Retirement Study, a nationally representative sample of US adults aged >= 50 years evaluated every 2 years (2006{\textendash}2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons.ResultsWe observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the corr}, keywords = {Health Status, longitudinal, Multilevel, No terms assigned, Older Adults, Racial differences, Social capital}, issn = {1661-8556}, doi = {10.1007/s00038-020-01341-2}, author = {Villalonga-Olives, Ester and Josue Almansa and Knott, Cheryl L. and Ransome, Yusuf} } @article {delaFuente20191906, title = {Are younger cohorts in the USA and England ageing better?}, journal = {International journal of epidemiology}, volume = {48}, year = {2019}, note = {cited By 0}, pages = {1906-1913}, abstract = {BACKGROUND: Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA. METHODS: The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment. RESULTS: Similar ageing trends were found in ELSA (β = -0.311; p < 0.001) and HRS (β = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (β = -0.082; p < 0.05) and HRS (β = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (β = 0.125; p < 0.001) and HRS (β = 0.170; p < 0.001). CONCLUSIONS: Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society. {\textcopyright} The Author(s) 2019; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.}, keywords = {Aged, Aging, Article, Cohort Analysis, cultural factor, Education, England, Englishman, Female, Health Status, Household, human, human experiment, human tissue, longitudinal study, major clinical study, Male, mental capacity, Retirement, theoretical study}, issn = {14643685}, doi = {10.1093/ije/dyz126}, author = {de la Fuente, J. and Francisco F{\'e}lix Caballero and Verdes, E. and Rodr{\'\i}guez-Artalejo, F. and Cabello, M. and de la Torre-Luque, A. and Albert S{\'a}nchez-Niub{\'o} and Mar{\'\i}a Haro, J. and Ayuso-Mateos, J.L. and Chatterji, S.} } @article {8808, title = {Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 02 15}, pages = {526-535}, abstract = {

OBJECTIVE: Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life.

METHOD: Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women.

RESULTS: Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS.

DISCUSSION: The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

}, keywords = {Adult, Adult Survivors of Child Abuse, African Americans, Aged, European Continental Ancestry Group, Female, Hand Strength, Health Status, Hispanic Americans, Humans, Male, Risk Factors, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbw147}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw147https://academic.oup.com/psychsocgerontology/article/2645640/Childhood-Misfortune-and-Handgrip-Strength-Among}, author = {Natalie R Smith and Kenneth F Ferraro and Blakelee R Kemp and Patricia M Morton and Sarah A Mustillo and Jacqueline L. Angel} } @article {12564, title = {Cohort Profile: The Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project.}, journal = {International Journal of Epidemiology}, volume = {48}, year = {2019}, pages = {1052-1053i}, keywords = {Female, Global Health, Health Behavior, Health Status, Longitudinal Studies, Male, Mental Health, Physical Functional Performance, Social Environment, Socioeconomic factors}, issn = {1464-3685}, doi = {10.1093/ije/dyz077}, author = {Sanchez-Niubo, Albert and Egea-Cort{\'e}s, Laia and Olaya, Beatriz and Caballero, Francisco F{\'e}lix and Ayuso-Mateos, Jose L and Prina, Matthew and Bobak, Martin and Arndt, Holger and Tobiasz-Adamczyk, Beata and Paj{\k a}k, Andrzej and Leonardi, Matilde and Koupil, Ilona and Panagiotakos, Demosthenes and Tamosiunas, Abdonas and Scherbov, Sergei and Sanderson, Warren and Koskinen, Seppo and Chatterji, Somnath and Haro, Josep Maria} } @article {6507, title = {The Effects of Medicare Part D on Health Outcomes of Newly Covered Medicare Beneficiaries.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Jun 14}, pages = {890-900}, abstract = {

OBJECTIVES: To estimate the impact of Medicare Part D on cost-related prescription nonadherence and health outcomes among the newly covered medicare beneficiaries.

METHOD: Difference-in-differences analyses of data from a balanced panel of Medicare beneficiaries observed in each wave of the Health and Retirement Study from 2000 to 2010 were carried out. The differences in the pre- and post-Part D changes in these outcomes are calculated for previously uncovered Part D enrollees and a comparison group of previously covered Medicare beneficiaries.

RESULTS: The results from this analysis indicate that Part D reduced cost-related nonadherence rates among the newly covered by 7 percentage points and that this decline was sustained through 2010. Part D was also associated with a 5 percentage points increase in the likelihood that a newly covered enrollee reported to be in good or better health and a 4-percentage point decline in the likelihood of being diagnosed with high blood pressure. These improvements were also sustained through 2010 but were only evident among those newly covered beneficiaries who remained enrolled in a Part D plan through 2010. However, there is insufficient evidence to conclude that Part D improved the blood pressure of newly covered, hypertensive beneficiaries.

DISCUSSION: Part D has had a sustained impact on cost-related nonadherence rates and the health status of newly covered beneficiaries. However, the change in health status is conditional on remaining enrolled in a Part D plan over time.

}, keywords = {Aged, Female, Health Status, Humans, Hypertension, Male, Medicare Part D, Medication Adherence, Models, Statistical, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw030}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/05/05/geronb.gbw030.abstract}, author = {Diebold, Jeffrey} } @article {8472, title = {Health Shocks and Initiation of Use of Preventive Services Among Older Adults.}, journal = {J Appl Gerontol}, volume = {37}, year = {2018}, month = {2018 07}, pages = {856-880}, abstract = {

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.

}, keywords = {Aged, Cholesterol, Early Detection of Cancer, Female, Health Status, Health Surveys, Humans, Influenza, Human, Male, Mammography, Middle Aged, Papanicolaou Test, Prostatic Neoplasms, Vaccination, Vaginal Smears}, issn = {1552-4523}, doi = {10.1177/0733464816657474}, url = {http://jag.sagepub.com/cgi/doi/10.1177/0733464816657474}, author = {Ng, Boon Peng and Gail A Jensen} } @article {8493, title = {Linked Lives: Dyadic Associations of Mastery Beliefs With Health (Behavior) and Health (Behavior) Change Among Older Partners.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {787-798}, abstract = {

Objectives: Mastery beliefs are known to contribute to healthy aging. However, it is an open question whether individual mastery-health associations impact the health of close long-term partners.

Method: We applied actor-partner interdependence models to 4-wave, 6-year longitudinal dyadic data from married and cohabitating partners in the Health and Retirement Study (N = 1,981 partners; age at baseline: M = 67 years, SD = 8.93, range 50-94 years).

Results: Higher individual mastery beliefs were associated with better individual physical health and health behaviors. Higher mastery beliefs were associated with subsequent increases in light physical activity. Having a partner with higher levels of mastery was uniquely associated with fewer functional limitations, better self-rated health, and more physical activity. Actor {\texttimes} Partner interaction effects for functional limitations indicated multiplicative associations of actor and partner mastery with health. Of note, mastery-health associations for individuals and their partners were invariant across age, gender, education, employment status, perceived stress over one{\textquoteright}s own and partner{\textquoteright}s health, and cognition.

Discussion: Findings suggest that partner mastery beliefs matter for the health (behaviors) of older adults. We discuss possible mechanisms underlying partner interrelations in mastery and health, their age invariance, and consider implications arising from our results.

}, keywords = {Aged, Aged, 80 and over, Dominance-Subordination, Female, Health Behavior, Health Status, Humans, Male, Marriage, Middle Aged, Models, Theoretical, Psychological Tests, Risk Reduction Behavior, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw058}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27229003}, author = {Drewelies, Johanna and William J. Chopik and Christiane A Hoppmann and Jacqui Smith and Denis Gerstorf} } @article {6509, title = {Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Feb}, pages = {3-24}, abstract = {

OBJECTIVE: To investigate disparities in life satisfaction among older Hispanic immigrants in the United States relative to their native-born Hispanic and non-Hispanic White counterparts, and to identify factors associated with such disparities.

METHOD: Cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) were used to estimate ordinary least squares (OLS) regression models.

RESULTS: Hispanic immigrants reported the highest levels of life satisfaction of all groups. Wealthier older adults, who were socially engaged, had social support, and experienced fewer functional limitations and lower exposure to discrimination, were more satisfied with their lives in the overall sample. Interaction effects revealed that although education was associated with greater life satisfaction only among non-Hispanic Whites, co-residing with children was associated with greater life satisfaction only among Hispanics.

DISCUSSION: Although older Hispanic immigrants had the least amount of socioeconomic resources of all groups in our study, they were the most satisfied with their lives. Possible explanations and directions for future research are discussed.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Emigrants and Immigrants, Female, Health Status, Humans, Male, Middle Aged, Models, Theoretical, Personal Satisfaction, Surveys and Questionnaires}, issn = {1552-6887}, doi = {10.1177/0898264315624901}, url = {http://jah.sagepub.com/content/early/2016/01/14/0898264315624901.abstract}, author = {Roc{\'\i}o Calvo and Dawn C Carr and Matz-Costa, Christina} } @article {6462, title = {Associations Among Individuals{\textquoteright} Perceptions of Future Time, Individual Resources, and Subjective Well-Being in Old Age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 May 01}, pages = {388-399}, abstract = {

OBJECTIVES: Perceptions of future time are of key interest to aging research because of their implications for subjective well-being. Interestingly, perceptions about future time are only moderately associated with age when looking at the second half of life, pointing to a vast heterogeneity in future time perceptions among older adults. We examine associations between future time perceptions, age, and subjective well-being across two studies, including moderations by individual resources.

METHOD: Using data from the Berlin Aging Study (N = 516; Mage = 85 years), we link one operationalization (subjective nearness to death) and age to subjective well-being. Using Health and Retirement Study data (N = 2,596; Mage = 77 years), we examine associations of another future time perception indicator (subjective future life expectancy) and age with subjective well-being.

RESULTS: Consistent across studies, perceptions of limited time left were associated with poorer subjective well-being (lower life satisfaction and positive affect; more negative affect and depressive symptoms). Importantly, individual resources moderated future time perception-subjective well-being associations with those of better health exhibiting reduced future time perception-subjective well-being associations.

DISCUSSION: We discuss our findings in the context of the Model of Strength and Vulnerability Integration.

}, keywords = {Affect, Age Factors, Aged, Aged, 80 and over, Aging, Attitude, depression, Female, Forecasting, Health Status, Humans, Male, Personal Satisfaction}, issn = {1758-5368}, doi = {10.1093/geronb/gbv063}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/05/geronb.gbv063.abstract}, author = {Christiane A Hoppmann and Frank J Infurna and Ram, Nilam and Denis Gerstorf} } @article {6494, title = {Associations Between Arthritis and Change in Physical Function in U.S. Retirees.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 Jan}, pages = {127-133}, abstract = {

BACKGROUND: The aims of this study were to determine among retirees: the associations of arthritis with limitations in physical functions, and whether these associations changed differently with age for those with arthritis versus without arthritis.

METHODS: We identified retirees from the Health and Retirement Study, a nationally representative longitudinal panel study of U.S. adults >=51 years old. We calculated incidence density ratios (IDRs) using Poisson regression modeling with generalized estimating equations to estimate the associations between arthritis and limitations in four physical function measures (large muscle tasks, mobility, activities of daily living, and instrumental activities of daily living) adjusting for age, sex, race/ethnicity, marital status, education, total household income, depression, obesity, smoking, chronic conditions, physical activity, and cohort status. We examined interaction effects between arthritis and age to determine if the rate of change in physical function differed by arthritis status across age.

RESULTS: Over 8 years (2004-2012), significantly more retirees with arthritis had limitations with large muscle tasks (IDR 2.1: 95\% confidence interval 1.6, 2.8), mobility (IDR 1.6: 1.2, 2.2), activities of daily living (IDR 2.2: 1.0, 4.7), and instrumental activities of daily living (IDR 3.7: 1.9, 7.4) than retirees without arthritis. Retirees with arthritis did not develop limitations in mobility, activities of daily living, and instrumental activities of daily living at a different rate as they aged compared to those without arthritis.

CONCLUSIONS: Arthritis was associated with a greater prevalence of physical function limitations. Preventing limitations caused by arthritis is a key strategy to prevent disability in retirees.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Arthritis, Case-Control Studies, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Muscle Strength, Retirement, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw075}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2016/04/26/gerona.glw075.abstract}, author = {Nancy A. Baker and Kamil E Barbour and Charles G Helmick and Matthew M. Zack and Soham Al Snih} } @article {6511, title = {Dog Walking, the Human-Animal Bond and Older Adults{\textquoteright} Physical Health.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 Oct 01}, pages = {930-939}, abstract = {

PURPOSE OF THE STUDY: This study explored the associations between dog ownership and pet bonding with walking behavior and health outcomes in older adults.

DESIGN AND METHODS: We used data from the 12th wave (2012) of the Health and Retirement Study which included an experimental human-animal interaction module. Ordinary least squares regression and binary logistic regression models controlling for demographic variables were used to answer the research questions.

RESULTS: Dog walking was associated with lower body mass index, fewer activities of daily living limitations, fewer doctor visits, and more frequent moderate and vigorous exercise. People with higher degrees of pet bonding were more likely to walk their dog and to spend more time walking their dog each time, but they reported walking a shorter distance with their dog than those with weaker pet bonds. Dog ownership was not associated with better physical health or health behaviors.

IMPLICATIONS: This study provides evidence for the association between dog walking and physical health using a large, nationally representative sample. The relationship with one{\textquoteright}s dog may be a positive influence on physical activity for older adults.

}, keywords = {Aged, Animals, Dogs, Female, Health Status, Human-Animal Bond, Humans, Least-Squares Analysis, Linear Models, Logistic Models, Male, Middle Aged, Ownership, Walking}, issn = {1758-5341}, doi = {10.1093/geront/gnw051}, url = {http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract}, author = {Angela L Curl and Bibbo, Jessica and Rebecca A Johnson} } @article {8831, title = {Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement?}, journal = {J Occup Environ Med}, volume = {59}, year = {2017}, month = {2017 02}, pages = {184-190}, abstract = {

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.

}, keywords = {Age Factors, Aged, Chronic disease, depression, Female, Health Status, Health Surveys, Humans, Male, Mental Health, Middle Aged, Personal Satisfaction, Retirement, Unemployment, United States, Work}, issn = {1536-5948}, doi = {10.1097/JOM.0000000000000933}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00043764-900000000-98945}, author = {Maren W Voss and Wendy Church Birmingham and Lori Wadsworth and Wei Chen and Bounsanga, Jerry and Gu, Yushan and Hung, Man} } @article {8855, title = {Identifying adults aging with disability using existing data: The case of the Health and Retirement Study.}, journal = {Disabil Health J}, volume = {10}, year = {2017}, month = {2017 Oct}, pages = {611-615}, abstract = {

BACKGROUND: The population of persons aging with disabilities is growing. Being able to segment aging with disability sub-populations within national data sets is becoming increasingly important in order to understand the relationship of aging with disability to a range of outcomes in later life including health and wellness, economic security, and health and long-term service and support need and use.

OBJECTIVE: The purpose of this study was to identify viable sub-samples of adults aging with disabilities within the Health and Retirement Study, one of the most used secondary data sets to study aging and older adults.

METHOD: Samples used in this research are drawn from wave 11 (2012) of the HRS. Five operationalizations of disability were used: childhood disability (n~=~719), childhood chronic condition (n~=~3070), adult chronic condition (n~=~13,723), functional limitation in adulthood (n~=~4448) and work disability (n~=~5632).

RESULTS: These subsamples are not mutually exclusive. Among respondents that reported having a childhood disability, 87\% also report having at least one chronic disease in adulthood, 50\% report having functional limitations in adulthood and 38\% report interruption in their ability to work due to a disability. Compared to the childhood disability samples, rates of reporting fair/poor health are nearly double among adults with functional limitations or those with work disruptions because of disability.

CONCLUSION: Work disability and functional limitation appeared to be the most viable sub-sample options to consider when using the HRS to study experiences of adults aging with disability. Overall, age at onset is unclear.

}, keywords = {Activities of Daily Living, Adolescent, Age of Onset, Aged, Aged, 80 and over, Aging, Child, Child Health, Chronic disease, Disabled Persons, Female, health, Health Status, Health Surveys, Humans, Male, Middle Aged, Retirement, Self Report, Work}, issn = {1876-7583}, doi = {10.1016/j.dhjo.2016.12.016}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1}, author = {Caitlin E. Coyle and Putnam, Michelle} } @article {8697, title = {Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 03}, pages = {276-284}, abstract = {

BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.

OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.

DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest.

SUBJECTS: A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States.

MEASURES: Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures.

OUTCOMES: Medicare expenditures in the top quartile and inpatient utilization.

RESULTS: Median annual expenditures were $4354, and 41\% were hospitalized within 2 years. The tree model shows some notable combinations: 64\% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70\%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use.

CONCLUSIONS: The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Health Behavior, Health Expenditures, Health Status, Humans, Machine learning, Male, Medicare, Retrospective Studies, Self Report, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000660}, author = {Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Avi Dor and Charles W Given and Kurt C Stange and Siran M Koroukian} } @article {8507, title = {The Influence of the Transportation Environment on Driving Reduction and Cessation.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 10 01}, pages = {824-832}, abstract = {

Purpose of the Study: Driving is by far the most common mode of transportation in the United States, but driving ability is known to decline as people experience age-related functional declines. Some older adults respond to such declines by self-limiting their driving to situations with a low perceived risk of crashing, and many people eventually stop driving completely. Previous research has largely focused on individual and interpersonal predictors of driving reduction and cessation (DRC). The purpose of this study was to assess the influence of the transportation environment on DRC.

Design and Methods: Data were combined from the Health and Retirement Study, the Urban Mobility Scorecard, and StreetMap North America (GIS data). Longitudinal survival analysis techniques were used to analyze seven waves of data spanning a 12-year period.

Results: As roadway density and congestion increased in the environment, the odds of DRC also increased, even after controlling for individual and interpersonal predictors. Other predictors of DRC included demographics, relationship status, health, and household size.

Implications: The current study identified an association between the transportation environment and DRC. Future research is needed to determine whether a causal link can be established. If so, modifications to the physical environment (e.g., creating livable communities with goods and services in close proximity) could reduce driving distances in order to improve older drivers{\textquoteright} ability to remain engaged in life. In addition, older individuals who wish to age in place should consider how their local transportation environment may affect their quality of life.

}, keywords = {Aged, Aging, Automobile Driving, environment, Family Characteristics, Female, Geographic Information Systems, Health Status, Humans, Longitudinal Studies, Male, Marital Status, Risk, Survival Analysis, Transportation, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnw088}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27342439}, author = {Jonathon M Vivoda and Steven G Heeringa and Amy J Schulz and Grengs, Joe and Cathleen M. Connell} } @article {8828, title = {Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S.}, journal = {Soc Sci Med}, volume = {174}, year = {2017}, month = {2017 02}, pages = {149-158}, abstract = {

Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Health Status, Humans, Interpersonal Relations, Male, Residence Characteristics, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.12.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml}, author = {Esther M Friedman and Regina A Shih and Mary E Slaughter and Margaret M Weden and Kathleen A. Cagney} } @article {8856, title = {Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Mar 01}, pages = {279-289}, abstract = {

Objective: We conceptualize successful aging as a cumulative index of individual resources (the absence of disease and disability, high cognitive and physical functioning, social embeddedness) in the service of successful aging outcomes (global well-being, experienced well-being, and vital status), and conditioned by age, social structure, and environment.

Method: The study used baseline and follow-up data from the 2008-2014 waves of the Health and Retirement Study (N = 17,230; age = 51-101). Linear, multilevel, and logistic models compared individual resources at baseline as independent, cumulative, and binary predictors of outcomes 4 years later.

Results: Individual resources were unequally distributed across age group and social structures (education, wealth, race, gender) and had a cumulative effect on all successful aging outcomes. For experienced well-being, individual resources were most important at midlife and for groups with lower education. Person-environment congruence (social cohesion, city satisfaction) was associated with all successful aging outcomes and conditioned the effect of individual resources on experienced well-being.

Discussion: A cumulative index allows for gradations in resources that can be compensated for by external factors such as person-environment congruence. This index could guide policy and interventions to enhance resources in vulnerable subgroups and diminish inequalities in successful aging outcomes.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, environment, Female, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Personal Satisfaction, Social Support, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw148}, url = {http://psychsocgerontology.oxfordjournals.org/cgi/pmidlookup?view=long\&pmid=28077430}, author = {Shannon T. Mejia and Lindsay H Ryan and Gonzalez, Richard and Jacqui Smith} } @article {6497, title = {Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA.}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Sep}, pages = {917-23}, abstract = {

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.

METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.

RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11\% lower risk of all-cause mortality (95\% CI 8\% to 15\%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95\% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.

CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

}, keywords = {Adult, Aged, Female, Health Status, Humans, Life Expectancy, Life Style, Longitudinal Studies, Male, Middle Aged, Mortality, Premature, Retirement, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2015-207097}, url = {http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract}, author = {Wu, Chenkai and Michelle C Odden and Gwenith G Fisher and Stawski, Robert S} } @article {8596, title = {The Benefits of Social Technology Use Among Older Adults Are Mediated by Reduced Loneliness.}, journal = {Cyberpsychol Behav Soc Netw}, volume = {19}, year = {2016}, month = {2016 Sep}, pages = {551-6}, abstract = {

Technology has the ability to enhance and enrich the lives of older adults by facilitating better interpersonal relationships. However, few studies have directly examined associations between technology use for social reasons and physical and psychological health among older adults. The current study examines the benefits of technology use in 591 older adults from the 2012 wave of the Health and Retirement Study (Mage = 68.18, SD = 10.75; 55.5\% female). Social technology use was assessed through five technology-based behaviors (i.e., using e-mail, social networking sites, online video/phone calls, online chatting/instant messaging, using a smartphone). Attitudes toward the usability and benefits of technology use were also assessed. Older adults had generally positive attitudes toward technology. Higher social technology use was associated with better self-rated health, fewer chronic illnesses, higher subjective well-being, and fewer depressive symptoms. Furthermore, each of the links between social technology use and physical and psychological health was mediated by reduced loneliness. Close relationships are a large determinant of physical health and well-being, and technology has the potential to cultivate successful relationships among older adults.

}, keywords = {Aged, Aged, 80 and over, Attitude to Computers, depression, Female, Health Status, Humans, Interpersonal Relations, Loneliness, Male, Middle Aged, Personal Satisfaction, Social Networking, Telecommunications}, issn = {2152-2723}, doi = {10.1089/cyber.2016.0151}, url = {http://online.liebertpub.com/doi/10.1089/cyber.2016.0151}, author = {William J. Chopik} } @article {8414, title = {Combat exposure, social relationships, and subjective well-being among middle-aged and older Veterans.}, journal = {Aging Ment Health}, volume = {20}, year = {2016}, month = {2016}, pages = {637-46}, publisher = {20}, abstract = {

OBJECTIVES: This study described the association of subjective well-being with combat exposure and social relationships among middle-aged and older Veteran men in the USA. The stress-buffering hypothesis, which predicts social relationships may moderate the association between combat exposure and subjective well-being, was also examined.

METHOD: Data from the 2008 Health and Retirement Study (N = 2961) were used to estimate logistic regression models, focusing on three measures of subjective well-being: depression, life satisfaction, and self-reported health.

RESULTS: In the fully adjusted models, there were no statistically significant relationships between combat exposure and the three indicators of subjective well-being. However, compared to Veterans who had lower scores on the social relationship index, Veterans who had higher scores were less likely to be depressed and less likely to report poor or fair health. Veterans who had higher scores on the social relationships index reported higher levels of life satisfaction than those Veterans who had lower scores. There was no evidence for a social relationships buffering effect.

CONCLUSION: The results of this study demonstrated that combat exposure did not have a long-term relationship with subjective well-being. Longitudinal research designs with more comprehensive indicators of combat exposure may help researchers better understand some of the underlying complexity of this relationship. Complementary research with samples of women Veterans, as well as samples of Hispanic, and non-Black, non-White Veterans, is also needed.

}, keywords = {Aged, Combat Disorders, depression, Health Status, Humans, Interpersonal Relations, Male, Middle Aged, Personal Satisfaction, United States, Veterans}, issn = {1364-6915}, doi = {10.1080/13607863.2015.1033679}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84928663859andpartnerID=40andmd5=1e37c22429f6fa6e7b41027ddedf9237}, author = {Mai See Yang and Jeffrey A Burr} } @article {6495, title = {Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.}, journal = {J Gen Intern Med}, volume = {31}, year = {2016}, month = {2016 Jun}, pages = {630-7}, chapter = {630}, abstract = {

BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.

OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50~years of age or older (n = 16,640).

MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2~years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.

KEY RESULTS: Twenty-nine percent and 23~\% of respondents reported fair/poor health and self-rated worse health at 2~years, respectively, and 5~\% died in 2~years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80~\%); b) for self-rated worse health at 2~years: 68.5~years of age or older, difficulty walking several blocks and being in fair/poor health (60~\%); and c) for 2-year mortality: 80.5~years of age or older, and presenting with limitations in both ADLs and IADLs (> 40~\%).

CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Geriatric Assessment, Health Status, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Prognosis, Risk Factors, Self Report, Sex Distribution, Socioeconomic factors, Syndrome, United States}, issn = {1525-1497}, doi = {10.1007/s11606-016-3590-9}, url = {http://dx.doi.org/10.1007/s11606-016-3590-9}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Kathleen A Smyth and Kurt C Stange and Charles W Given} } @article {8682, title = {A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 10}, pages = {1256-78}, abstract = {

OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION: Japan{\textquoteright}s compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Cause of Death, Cross-Cultural Comparison, Educational Status, Employment, Family Characteristics, Female, Health Status, Health Surveys, Healthy Lifestyle, Humans, Japan, Life Expectancy, Life Tables, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Retirement, Sex Distribution, United States}, issn = {1552-6887}, doi = {10.1177/0898264316656505}, author = {Chi-Tsun Chiu and Mark D Hayward and Saito, Yasuhiko} } @article {8502, title = {Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis.}, journal = {Lancet Diabetes Endocrinol}, volume = {4}, year = {2016}, month = {2016 08}, pages = {686-694}, abstract = {

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0{\textperiodcentered}8-2{\textperiodcentered}3 year delay in disability across the three metrics (mobility, 63{\textperiodcentered}0 [95\% CI 62{\textperiodcentered}3-63{\textperiodcentered}6] to 64{\textperiodcentered}8 [63{\textperiodcentered}6-65{\textperiodcentered}7], p=0{\textperiodcentered}01; instrumental activities of daily living, 63{\textperiodcentered}5 [63{\textperiodcentered}0-64{\textperiodcentered}0] to 64{\textperiodcentered}3 [63{\textperiodcentered}0-65{\textperiodcentered}3], p=0{\textperiodcentered}24; activities of daily living, 62{\textperiodcentered}7 [62{\textperiodcentered}1-63{\textperiodcentered}3] to 65{\textperiodcentered}0 [63{\textperiodcentered}5-65{\textperiodcentered}9], p<0{\textperiodcentered}0001) and 1{\textperiodcentered}3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2{\textperiodcentered}8 [2{\textperiodcentered}5-3{\textperiodcentered}2] to 1{\textperiodcentered}5 [1{\textperiodcentered}3-1{\textperiodcentered}9]; p<0{\textperiodcentered}0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1{\textperiodcentered}1-2{\textperiodcentered}3 year delay in disability across the three metrics (mobility, 61{\textperiodcentered}3 [95\% CI 60{\textperiodcentered}5-62{\textperiodcentered}1] to 63{\textperiodcentered}2 [61{\textperiodcentered}5-64{\textperiodcentered}5], p=0{\textperiodcentered}0416; instrumental activities of daily living, 63{\textperiodcentered}0 [62{\textperiodcentered}4-63{\textperiodcentered}7] to 64{\textperiodcentered}1 [62{\textperiodcentered}7-65{\textperiodcentered}2], p=0{\textperiodcentered}16; activities of daily living, 62{\textperiodcentered}3 [61{\textperiodcentered}6-63{\textperiodcentered}0] to 64{\textperiodcentered}6 [63{\textperiodcentered}1-65{\textperiodcentered}6], p<0{\textperiodcentered}0001) and 0{\textperiodcentered}8 fewer life-years lost by age 70 years (1{\textperiodcentered}9 [1{\textperiodcentered}7-2{\textperiodcentered}2] to 1{\textperiodcentered}1 [0{\textperiodcentered}9-1{\textperiodcentered}5]; p<0{\textperiodcentered}0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0{\textperiodcentered}0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health \& Human Services and the US Centers for Disease Control and Prevention.

}, keywords = {Activities of Daily Living, Aged, Diabetes Mellitus, Disabled Persons, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, United States}, issn = {2213-8595}, doi = {10.1016/S2213-8587(16)30090-0}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27298181}, author = {Barbara H. Bardenheier and Ji Lin and Zhuo, Xiaohui and Mohammed K. Ali and Theodore J Thompson and Yiling J. Cheng and Edward W Gregg} } @article {8491, title = {Correlated probit analysis of repeatedly measured ordinal and continuous outcomes with application to the Health and Retirement Study.}, journal = {Stat Med}, volume = {35}, year = {2016}, month = {2016 10 15}, pages = {4202-25}, abstract = {

The Health and Retirement Study was designed to evaluate changes in health and labor force participation during and after the transition from working to retirement. Every 2~years, participants provided information about their self-rated health (SRH), body mass index (BMI), smoking status, and other characteristics. Our goal was to assess the effects of smoking and gender on trajectories of change in BMI and SRH over time. Joint longitudinal analysis of outcome measures is preferable to separate analyses because it allows to account for the correlation between the measures, to test the effects of predictors while controlling type I error, and potentially to improve efficiency. However, because SRH is an ordinal measure while BMI is continuous, formulating a joint model and parameter estimation is challenging. A joint correlated probit model allowed us to seamlessly account for the correlations between the measures over time. Established estimating procedures for such models are based on quasi-likelihood or numerical approximations that may be biased or fail to converge. Therefore, we proposed a novel expectation-maximization algorithm for parameter estimation and a Monte Carlo bootstrap approach for standard errors approximation. Expectation-maximization algorithms have been previously considered for combinations of binary and/or continuous repeated measures; however, modifications were needed to handle combinations of ordinal and continuous responses. A simulation study demonstrated that the algorithm converged and provided approximately unbiased estimates with sufficiently large sample sizes. In the Health and Retirement Study, male gender and smoking were independently associated with steeper deterioration in self-rated health and with lower average BMI. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Algorithms, Female, Health Status, Humans, Longitudinal Studies, Male, Monte Carlo Method, Probability, Retirement, Smoking}, issn = {1097-0258}, doi = {10.1002/sim.6982}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27222058}, author = {Dimitris Georgarakos and Ralitza Gueorguieva} } @article {8824, title = {Do working conditions at older ages shape the health gradient?}, journal = {J Health Econ}, volume = {50}, year = {2016}, month = {2016 12}, pages = {183-197}, abstract = {

This study examines whether working conditions at the end of workers{\textquoteright} careers impact health and contribute to health disparities across occupations. A dynamic panel correlated random effects model is used in conjunction with a rich data set that combines information from the Health and Retirement Study (HRS), expert ratings of job demands from the Occupational Information Network (O*NET), and mid-career earnings records from the Social Security Administration{\textquoteright}s (SSA) Master Earnings File (MEF). Results reveal a strong relationship between positive aspects of the psychosocial work environment and improved self-reported health status, blood pressure, and cognitive function. However, there is little evidence to suggest that working conditions shape observed health disparities between occupations in the years leading up to retirement.

}, keywords = {Aged, Female, Health Status, Humans, Income, Male, Middle Aged, Occupations, Retirement, Workplace}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2016.10.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S016762961630337Xhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/plain}, author = {Lauren L Schmitz} } @article {8702, title = {Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {26-34}, chapter = {26-34}, abstract = {

OBJECTIVES: The aims of this study are to examine the pattern of pre- and post-retirement changes in functional health and to examine the degree to which socioeconomic position (SEP) modifies pre- and post-retirement changes in functional health.

METHOD: This longitudinal study was conducted using data from the Health and Retirement Study from 1992 to 2012. Piecewise linear regression analyses with generalised estimating equations were used to calculate trajectories of limitations in mobility and large muscle functions before and after retirement spanning a time period of 16 years. Interaction terms of three indicators of SEP with time before and after retirement were examined to investigate the modifying effect of SEP on changes in functional health before and after retirement.

RESULTS: Average levels of limitations in mobility and large muscle functions increased significantly in the years prior to retirement. This increase slowed down after retirement, most prominently for limitations in large muscle functions. Higher SEP was associated with a slower increase of functional limitations prior to retirement. After retirement, a less clear pattern was found as only wealth modified the increase of limitations in mobility functions.

DISCUSSION: Prevention of functional decline in older working adults may be essential in achieving longer and healthier working lives. Such strategies may have to give special consideration to lower SEP adults, as they tend to experience functional health declines prior to retirement at a greater rate than higher SEP adults.

}, keywords = {Aged, Aging, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Retirement, Social Class, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.10.002}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616305615}, author = {Sander K. R. van Zon and B{\"u}ltmann, Ute and Reijneveld, Sijmen A and Carlos F. Mendes de Leon} } @article {8397, title = {Functional status in older women diagnosed with pelvic organ prolapse.}, journal = {Am J Obstet Gynecol}, volume = {214}, year = {2016}, month = {2016 May}, pages = {613.e1-7}, publisher = {214}, abstract = {

BACKGROUND: Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.

OBJECTIVE: The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).

STUDY DESIGN: This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age >=65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.

RESULTS: The prevalence of functional limitations was 76.2\% in strength, 44.9\% in upper and 65.8\% in lower body mobility, 4.5\% in ADL, and 13.6\% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5\% vs 69.9\% in strength, 72.9\% vs 33.5\% in upper and 88.0\% vs 56.8\% in lower body mobility, 11.6\% vs 0.9\% in ADL, and 30.6\% vs 6.7\% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.

CONCLUSION: Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Sectional Studies, Female, Health Status, Health Surveys, Humans, Medicare, Middle Aged, Mobility Limitation, Muscle Strength, Pelvic Organ Prolapse, United States, Upper Extremity}, issn = {1097-6868}, doi = {10.1016/j.ajog.2015.11.038}, url = {http://www.sciencedirect.com/science/article/pii/S0002937815024783}, author = {Tatiana V D Sanses and Nicholas K Schiltz and Bruna M. Couri and Sangeeta T Mahajan and Holly E Richter and David F Warner and Jack M. Guralnik and Siran M Koroukian} } @article {6437, title = {Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Nov}, pages = {1120-1130}, abstract = {

OBJECTIVE: To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD: Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS: Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION: Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognitive Dysfunction, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Population Dynamics, Residence Characteristics, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv075}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract}, author = {Esther M Friedman and Margaret M Weden and Regina A Shih and Stephanie Kovalchik and Singh, Reema and Jos{\'e} J Escarce} } @article {8817, title = {Health Effects of Short-Term Fluctuations in Macroeconomic Conditions: The Case of Hypertension for Older Americans.}, journal = {Health Econ}, volume = {25 Suppl 2}, year = {2016}, month = {2016 11}, pages = {113-125}, abstract = {

We investigate the health effects of short-term macroeconomic fluctuations as described by changes in unemployment rate, house, and stock market price indexes. The {\textquoteright}Great Recession{\textquoteright} 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 {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Commerce, Economic Recession, Female, Health Status, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Socioeconomic factors, Stress, Psychological, Surveys and Questionnaires, Unemployment, United States}, issn = {1099-1050}, doi = {10.1002/hec.3374}, url = {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}, author = {Marco Angrisani and Jinkook Lee} } @article {8383, title = {Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study.}, journal = {American Journal of Preventive Medicine}, volume = {50}, year = {2016}, pages = {191-198}, publisher = {50}, abstract = {

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.

}, keywords = {Age Factors, Aged, Ageism, Attitude of Health Personnel, depression, Female, Health Status, Humans, Hypertension, Male, Mental Health, Middle Aged, Overweight, Physician-Patient Relations, Physicians, Prejudice, Racism, Sex Factors, Socioeconomic factors, Stereotyping}, issn = {1873-2607}, doi = {10.1016/j.amepre.2015.07.034}, author = {Cleopatra M Abdou and Adam W. Fingerhut and James S Jackson and Felicia V Wheaton} } @article {8685, title = {The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning.}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {401-422}, abstract = {

This study investigated sociodemographic and psychosocial factors that enhance or impede the completion of advance care planning, analyzing data from the Health and Retirement Study. The analytic subsample included the panel participants who died between 2006 and 2010 and who had answered the psychosocial and lifestyle questionnaire when they were alive. Multinomial logistic regression was executed to answer the research question (N~=~1,056). The study found that persons who were older, who were women, who identified themselves as White, and who had higher levels of income and education were more likely to be motivated to complete advance care planning. Having greater sense of control was found to weaken the adverse relationship between being African American and the completion of advance directives. Having cancer, suffering from the illnesses for longer periods of time, and having experience of nursing home institutionalization also predicted the completion of advance care planning. Implications include incorporating a culturally tailored approach for racial/ethnic minorities and using advance directives that are clear and easily understood. In addition, future research needs to include a larger minority population and examine the extent to which variations between racial/ethnic groups exist in relation to advance care planning.

}, keywords = {Advance care planning, Advance directives, African Americans, Aged, Aged, 80 and over, Continental Population Groups, European Continental Ancestry Group, Female, Health Status, Hispanic Americans, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Psychology, Social Class}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1229709}, author = {Inoue, Megumi} } @article {8567, title = {Longitudinal Relationships Between Productive Activities and Functional Health in Later Years: A Multivariate Latent Growth Curve Modeling Approach.}, journal = {Int J Aging Hum Dev}, volume = {83}, year = {2016}, month = {2016 10}, pages = {418-40}, abstract = {

This study examined the longitudinal relationships between functional health in later years and three types of productive activities: volunteering, full-time, and part-time work. Using the data from five waves (2000-2008) of the Health and Retirement Study, we applied multivariate latent growth curve modeling to examine the longitudinal relationships among individuals 50 or over. Functional health was measured by limitations in activities of daily living. Individuals who volunteered, worked either full time or part time exhibited a slower decline in functional health than nonparticipants. Significant associations were also found between initial functional health and longitudinal changes in productive activity participation. This study provides additional support for the benefits of productive activities later in life; engagement in volunteering and employment are indeed associated with better functional health in middle and old age.

}, keywords = {Activities of Daily Living, Aged, Aging, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Volunteers}, issn = {1541-3535}, doi = {10.1177/0091415016657557}, url = {http://ahd.sagepub.com/content/early/2016/07/21/0091415016657557.long}, author = {Choi, Eunhee and Tang, Fengyan and Turk, Phillip} } @article {8688, title = {Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories.}, journal = {J Pers Soc Psychol}, volume = {111}, year = {2016}, month = {2016 09}, pages = {411-29}, abstract = {

Empirical evidence over the past 20 years has documented that key aspects of personality traits change during adulthood. However, it is essentially an open question whether and how traits change at the very end of life and what role health, cognitive performance, perceived control, and social factors play in those changes. To examine these questions, we applied growth models to 13-year longitudinal data obtained from now-deceased participants in the Berlin Aging Study (N = 463; age at baseline M = 85.9 years, SD = 8.4; 51\% men). Results revealed that neuroticism, on average, increases (about 0.3 SD in the last 10 years) and that this increase becomes even steeper at the end of life. In contrast, extraversion and openness decline rather steadily at the end of life (about -0.5 SD in the last 10 years). Additionally, poor health manifested as a risk factor for declines in extraversion and openness late in life but not neuroticism. Similar to earlier phases of life, better cognitive performance related to more openness. More loneliness was associated with higher neuroticism, whereas more social activity was associated with higher levels of extraversion and openness. Intriguing additional insights indicated that more personal control was associated with higher levels of extraversion and openness, whereas the feeling that one{\textquoteright}s life is controlled by others was associated with higher neuroticism but also with higher openness closer to death. We discuss potential pathways by which health, cognitive performance, control, and social inclusion resources and risk factors affect personality development late in life. (PsycINFO Database Record

}, keywords = {Aged, Aged, 80 and over, Aging, Anxiety Disorders, Berlin, Extraversion, Psychological, Female, Health Status, Human Development, Humans, Internal-External Control, Longitudinal Studies, Male, Neuroticism, Personality, Social Support}, issn = {1939-1315}, doi = {10.1037/pspp0000071}, author = {Wagner, Jenny and Ram, Nilam and Jacqui Smith and Denis Gerstorf} } @article {6440, title = {Physical, Cognitive, Social, and Emotional Mediators of Activity Involvement and Health in Later Life.}, journal = {Res Aging}, volume = {38}, year = {2016}, month = {2016 Oct}, pages = {791-815}, abstract = {

The current study tests the indirect effect of activity-related physical activity, cognitive activity, social interaction, and emotional exchange on the relationship between activity involvement and health (physical and emotional) in later life. Longitudinal data from the Health and Retirement Study (N = 5,442) were used to estimate a series of linear regression models. We found significant indirect effects for social interaction and benefit to others (emotional exchange) on emotional health (depressive symptoms) and indirect effects for use of body and benefit to others (physical) on physical health (frailty). The most potent indirect effect associated with emotional and physical health was experienced by those engaged in all four domains (use of body, use of mind, social interaction, and benefit to others). While effect sizes are small and results should be interpreted with caution, findings shed light on ways in which public health interventions aimed toward increasing role engagement in later life could be improved.

}, keywords = {Aged, depression, Efficiency, Employment, Exercise, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Quality of Life, Volunteers}, issn = {1552-7573}, doi = {10.1177/0164027515606182}, url = {http://roa.sagepub.com/content/early/2015/09/30/0164027515606182.abstract}, author = {Matz-Costa, Christina and Dawn C Carr and Tay K. McNamara and Jacquelyn Boone James} } @article {8677, title = {A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf.}, journal = {BMC Health Serv Res}, volume = {16}, year = {2016}, month = {2016 09 09}, pages = {485}, abstract = {

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses{\textquoteright} Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Epidemiologic Methods, Female, Health Status, Hospitalization, Humans, Iowa, Male, Medicare, Middle Aged, Patient Acceptance of Health Care, Physicians, Proxy, Spouses, United States}, issn = {1472-6963}, doi = {10.1186/s12913-016-1734-6}, author = {Frederic D Wolinsky and Ayres, Lioness and Michael P Jones and Yiyue Lou and George L Wehby and Fred A Ullrich} } @article {8819, title = {Sex-Specific and Time-Varying Associations Between Cigarette Smoking and Telomere Length Among Older Adults.}, journal = {Am J Epidemiol}, volume = {184}, year = {2016}, month = {2016 12 15}, pages = {922-932}, abstract = {

Inconsistent associations between smoking and telomere length (TL) have been reported in epidemiologic studies, perhaps because of the time-varying nature of smoking behaviors. We estimated the associations of TL, which was measured by quantitative polymerase chain reaction using saliva DNA, with concurrent and past smoking status reported biennially for up to 16 years before TL measurement in~5,624 participants in the Health and Retirement Study (1992-2008). Smoking was associated with reduced TL when we used prospective data on smoking statuses among men and women, but the association was strongly attenuated among men in cross-sectional analyses. This attenuation was largely due to a higher rate of smoking cessation during the study period among men with shorter TL than among men with longer TL. Short TL was also associated with poorer overall health in men, which suggests that male smokers with short TL were more likely to quit smoking because of poor health. Analyses of years since cessation, smoking duration, and pack-years of smoking all support the hypothesis that increased cigarette use shortens TL. Our results provide a potential explanation for the inconsistent associations between smoking and TL reported in previous cross-sectional studies. Time-varying associations should be considered in future studies of smoking behavior, TL, aging, and disease risk.

}, keywords = {Aged, Aged, 80 and over, Aging, Biomarkers, DNA, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Oxidative stress, Polymerase Chain Reaction, Prospective Studies, Saliva, Sex Distribution, Smoking, Smoking cessation, Telomere Shortening}, issn = {1476-6256}, doi = {10.1093/aje/kww102}, url = {http://aje.oxfordjournals.org/lookup/doi/10.1093/aje/kww102}, author = {Zhang, Chenan and Diane S. Lauderdale and Brandon L Pierce} } @article {8510, title = {Trajectories of body mass indices and development of frailty: Evidence from the health and retirement study.}, journal = {Obesity (Silver Spring)}, volume = {24}, year = {2016}, month = {2016 08}, pages = {1643-7}, abstract = {

OBJECTIVE: To estimate trajectories of body mass index (BMI) and determine their association with incident frailty in later life.

METHODS: Data come from the 2004 to 2012 waves of the Health and Retirement Study, a longitudinal survey of older adults. Analysis was restricted to respondents who were not frail at baseline (n = 10,827). BMI (kg/m(2) ) was calculated from self-reported weight and height. Incident frailty was assessed using the Frailty Index. Longitudinal growth mixture modeling was used to estimate the relationship between BMI trajectories and incident frailty over a 10-year period.

RESULTS: Four trajectory classes were identified: weight gain (n = 162 [1.4\%], mean final BMI = 42 kg/m(2) ), weight loss (n = 171 [1.7\%], mean final BMI = 25.0 kg/m(2) ), consistent obesity (n = 640 [6.8\%], mean final BMI = 34.7 kg/m(2) ), and consistent overweight (n = 9,864 [90.1\%] mean final BMI = 26.0 kg/m(2) ). Cumulative incidence of frailty was 19.9\%. Relative to the consistent overweight class, the weight gain class had the highest likelihood of incident frailty (odds ratio, OR: 3.61, 95\% confidence interval, CI: 2.39-5.46). The consistent obesity (OR: 2.72, 95\% CI: 2.06-3.58) and weight loss (OR: 2.81, 95\% CI: 1.84-4.30) classes had similarly elevated risk of frailty.

CONCLUSIONS: Weight change and obesity are associated with risk of frailty.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Body Weight, Female, Frail Elderly, Geriatric Assessment, Health Status, Humans, Incidence, Longitudinal Studies, Male, Obesity, Retirement, Risk Factors, Weight Gain}, issn = {1930-739X}, doi = {10.1002/oby.21572}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27355440}, author = {Briana Mezuk and Matthew C. Lohman and Rock, Andrew K and Payne, Martha E} } @article {8294, title = {Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Feb}, pages = {193-201}, publisher = {70}, abstract = {

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23\% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18\%). Over half (55\%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

}, keywords = {Activities of Daily Living, Aged, 80 and over, Aging, Chronic disease, Cognition, Disability Evaluation, Educational Status, Female, Geriatric Assessment, Health Status, Health Surveys, Humans, Longevity, Longitudinal Studies, Male, Marital Status, Prospective Studies, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu124}, url = {http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract}, author = {Jennifer A Ailshire and Hiram Beltr{\'a}n-S{\'a}nchez and Eileen M. Crimmins} } @article {8314, title = {Childhood and later life stressors and increased inflammatory gene expression at older ages.}, journal = {Soc Sci Med}, volume = {130}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {16-22}, publisher = {130}, abstract = {

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

}, keywords = {Adolescent, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Cyclooxygenase 2, Female, Health Status, Health Surveys, Humans, Interleukin-1beta, Interleukin-8, Life Change Events, Male, Middle Aged, Obesity, RNA, Sex Factors, Smoking, Socioeconomic factors, Stress, Psychological}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.01.030}, author = {Morgan E. Levine and Steven W. Cole and David R Weir and Eileen M. Crimmins} } @article {8241, title = {Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Mar}, pages = {332-8}, publisher = {70}, abstract = {

BACKGROUND: The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.

METHODS: Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline with biennial surveys from 1992 to 2010. Average length of follow-up was 10.3 years ranging from 0 to 18 years. Disease status and physical functioning was asked about at all study phases and 10 items were summed to obtain a physical functioning score (0-10).

RESULTS: Age modified the relationship between number of chronic diseases and physical functioning with older participants having more physical functioning difficulties with increasing number of diseases. An average 70-year-old participant with no diseases had 0.89 (95\% CI: 0.85-0.93) physical functioning difficulties, with one disease 1.72 (95\% CI: 1.69-1.76) difficulties, with two diseases 2.57 (95\% CI: 2.52-2.62) difficulties, and with three or more diseases 3.82 (95\% CI: 3.76-3.88) difficulties. Of the individual diseases memory-related diseases, stroke, pulmonary diseases, and arthritis were associated with significantly higher physical functioning difficulties compared with other diseases.

CONCLUSIONS: Comorbidity is associated with greater burden of physical functioning difficulties. Of the studied diseases, memory-related diseases, stroke, pulmonary diseases, and arthritis alone or in combination limit most physical functioning.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu113}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract}, author = {Stenholm, Sari and Westerlund, Hugo and Head, Jenny and Hyde, Martin and Ichiro Kawachi and Pentti, Jaana and Mika Kivim{\"a}ki and Vahtera, Jussi} } @article {8224, title = {Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Oct}, pages = {1413-20}, publisher = {30}, abstract = {

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 \% female, 83.1 \% white) were included in this study.

MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS: In all, 12.6 \% experienced discrimination infrequently and 5.9 \% frequently. Almost one-third of participants (29 \%) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 \% of those who infrequently and 14.7 \% of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 \% CI 1.16-2.27).

CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

}, keywords = {Activities of Daily Living, Aged, Ageism, Aging, Disabled Persons, Female, Follow-Up Studies, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-015-3233-6}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff}, author = {Stephanie E Rogers and Angela D Thrasher and Yinghui Miao and W John Boscardin} } @article {8175, title = {The effects of constraints and mastery on mental and physical health: Conceptual and methodological considerations.}, journal = {Psychol Aging}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Jun}, pages = {432-448}, publisher = {30}, abstract = {

Perceived control and health are closely interrelated in adulthood and old age. However, less is known regarding the differential implications of 2 facets of perceived control, constraints and mastery, for mental and physical health. Furthermore, a limitation of previous research testing the pathways linking perceived control to mental and physical health is that mediation was tested with cross-sectional designs and not in a longitudinal mediation design that accounts for temporal ordering and prior confounds. Using data from the Health and Retirement Study (HRS; n = 7,612, M age = 68, SD = 10.66; 59\% women) we examined the effect of constraints and mastery on 4-year changes in mental and physical health and whether physical activity mediated such effects in a longitudinal mediation design. Using confirmatory factor analysis, we modeled the 2-factor structure of perceived control that consisted of constraints and mastery. In our longitudinal mediation model, where we accounted for possible confounders (e.g., age, gender, education, neuroticism, conscientiousness, memory, and health conditions), constraints showed a stronger total effect on mental and physical health, than mastery, such that more constraints were associated with 4-year declines in mental and physical health. Physical activity did not mediate the effect of constraints and mastery on mental and physical health (indirect effect). To demonstrate the importance of a longitudinal mediation model that accounts for confounders, we also estimated the mediated effect using 2 models commonly used in the literature: cross-sectional mediation model and longitudinal mediation model without accounting for confounders. These mediation models indicated a spurious indirect effect that cannot be causally interpreted. Our results showcase that constraints and mastery have differential implications for mental and physical health, as well as how a longitudinal mediation design can illustrate (or not) pathways in developmental processes. Our discussion focuses on the conceptual and methodological implications of a 2 facet model of perceived control and the strengths of longitudinal mediation designs for testing conceptual models of human development.

}, keywords = {Aged, Confounding Factors, Epidemiologic, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Motor Activity, Retirement, Self-control}, issn = {1939-1498}, doi = {10.1037/a0039050}, author = {Frank J Infurna and Axel Mayer} } @article {8205, title = {Historical improvements in well-being do not hold in late life: Birth- and death-year cohorts in the United States and Germany.}, journal = {Dev Psychol}, volume = {51}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Jul}, pages = {998-1012}, publisher = {51}, abstract = {

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.

}, keywords = {Aged, Aging, Cohort Effect, depression, Epidemiologic Research Design, Female, Germany, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Propensity Score, United States}, issn = {1939-0599}, doi = {10.1037/a0039349}, author = {H{\"u}l{\"u}r, Gizem and Ram, Nilam and Denis Gerstorf} } @article {8176, title = {The "long arm" of childhood health: linking childhood disability to late midlife mental health.}, journal = {Res Aging}, volume = {37}, year = {2015}, month = {2015 Jan}, pages = {82-102}, publisher = {37}, abstract = {

A growing body of research underscores the early origins of health in later life; however, relatively little is known about the relationship between childhood physical health and adult mental health. This research explores the relationship between childhood disability and depressive symptoms among a nationally representative sample of late midlife adults (N = 3,572). Using data from Waves 8-10 (2006-2010) of the Health and Retirement Study, a series of ordinary least squares regression models were created to assess the number of depressive symptoms. Childhood disability was significantly associated with higher levels of depressive symptoms; however, late midlife social and health factors accounted for differences between those with and without childhood disability. Late midlife physical health appeared to be a particularly salient mediator. Individuals who experience childhood disability may accumulate more physical impairment over the life course, thus experiencing worse mental health such as greater depressive symptoms in late midlife.

}, keywords = {Child, depression, Female, Health Status, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires, Time Factors, United States}, issn = {1552-7573}, doi = {10.1177/0164027514522276}, url = {http://roa.sagepub.com/content/early/2014/02/23/0164027514522276.abstract}, author = {Kenzie Latham} } @article {8257, title = {The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty.}, journal = {Aging Ment Health}, volume = {19}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015}, pages = {892-901}, publisher = {19}, abstract = {

OBJECTIVES: This study evaluates the Paulson-Lichtenberg Frailty Index (PLFI), a self-report measure that is based on Fried{\textquoteright}s well-established frailty phenotype. The PLFI is examined using longitudinal data from the Health and Retirement Study (HRS) database, for which it was developed.

METHODS: The sample was drawn from the HRS and included 8844 community-dwelling older adults. Frailty was measured using the PLFI{\textquoteright}s five-item frailty index (wasting, weakness, slowness, falls, and fatigue).

RESULTS: In comparison to intermediate-frail or non-frail respondents, frail respondents were found to be older, more medically compromised, and less independent for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). On average, frail respondents reported worse self-rated health and had fewer years of education. Women, ethnic minorities, and those who were not partnered were also more likely to be frail. Over subsequent years, frail respondents were more likely to be hospitalized, report more loss of independence, and experience higher mortality rates.

CONCLUSIONS: The PLFI is a valid tool for assessing frailty in the HRS data set.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Fatigue, Female, Frail Elderly, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Self Report, Socioeconomic factors, Walking}, issn = {1364-6915}, doi = {10.1080/13607863.2014.986645}, author = {Daniel Paulson and Peter A Lichtenberg} } @article {8254, title = {Perceived discrimination and physical, cognitive, and emotional health in older~adulthood.}, journal = {Am J Geriatr Psychiatry}, volume = {23}, year = {2015}, month = {2015 Feb}, pages = {171-9}, publisher = {23}, abstract = {

OBJECTIVE: To examine whether perceived discrimination based on multiple personal characteristics is associated with physical, emotional, and cognitive health concurrently, prospectively, and with change in health over time among older adults.

DESIGN: Longitudinal.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Participants (N~= 7,622) who completed the Leave-Behind Questionnaire as part of the 2006 HRS assessment (mean age 67 years); participants (N~= 6,450) completed the same health measures again in~2010.

MEASUREMENTS: Participants rated their everyday experience with discrimination and attributed those experiences to eight personal characteristics: race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation. At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness), and cognitive health (memory, mental status).

RESULTS: Discrimination based on age, weight, physical disability, and appearance was associated with poor subjective health, greater disease burden, lower life satisfaction, and greater loneliness at both assessments and with declines in health across the four years. Discrimination based on race, ancestry, sex, and sexual orientation was associated with greater loneliness at both time points, but not with change over time. Discrimination was mostly unrelated to cognitive health.

CONCLUSIONS: The detrimental effect of discrimination on physical and emotional health is not limited to young adulthood but continues to contribute to health and well-being in old age. These effects were driven primarily by discrimination based on personal characteristics that change over time (e.g., age, weight) rather than discrimination based on more stable characteristics (e.g., race, sex).

}, keywords = {Aged, Cognition, Female, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Prejudice, Social Perception}, issn = {1545-7214}, doi = {10.1016/j.jagp.2014.03.007}, author = {Angelina R Sutin and Yannick Stephan and Carretta, H. and Antonio Terracciano} } @article {8157, title = {Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {793-803}, publisher = {70}, abstract = {

OBJECTIVES: The phenomenon of grandparents caring for grandchildren is disproportionately observed among different racial/ethnic groups in the United States. This study examines the influence of childcare provision on older adults{\textquoteright} health trajectories in the United States with a particular focus on racial/ethnic differentials.

METHOD: Analyzing nationally representative, longitudinal data on grandparents over the age of 50 from the Health and Retirement Study (1998-2010), we conduct growth curve analysis to examine the effect of living arrangements and caregiving intensity on older adults{\textquoteright} health trajectories, measured by changing Frailty Index (FI) in race/ethnic subsamples. We use propensity score weighting to address the issue of potential nonrandom selection of grandparents into grandchild care.

RESULTS: We find that some amount of caring for grandchildren is associated with a reduction of frailty for older adults, whereas coresidence with grandchildren results in health deterioration. For non-Hispanic black grandparents, living in a skipped generation household appears to be particularly detrimental to health. We also find that Hispanic grandparents fare better than non-Hispanic black grandparents despite a similar level of caregiving and rate of coresidence. Finally, financial and social resources assist in buffering some of the negative effects of coresidence on health (though this effect also differs by race/ethnicity).

DISCUSSION: Our findings suggest that the health consequences of grandchild care are mixed across different racial/ethnic groups and are further shaped by individual characteristics as well as perhaps cultural context.

}, keywords = {Aged, Black People, Female, Frail Elderly, Health Status, Health Status Disparities, Hispanic or Latino, Humans, Intergenerational Relations, Longitudinal Studies, Male, Middle Aged, Parenting, Residence Characteristics, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu160}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/12/06/geronb.gbu160.abstract}, author = {Chen, Feinian and Christine A Mair and Bao, Luoman and Yang Claire Yang} } @article {8272, title = {Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {661-71}, publisher = {70}, abstract = {

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3\%, 23.5\%, 24.5\%, and 22.6\% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition Disorders, Disabled Persons, Educational Status, Female, Health Status, Humans, Male, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu095}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract}, author = {Xiao Xu and Jersey Liang and Joan M. Bennett and Anda Botoseneanu and Heather G. Allore} } @article {8239, title = {Substance-use coping and self-rated health among US middle-aged and older adults.}, journal = {Addict Behav}, volume = {42}, year = {2015}, note = {Export Date: 20 January 2015}, month = {2015 Mar}, pages = {96-100}, publisher = {42}, abstract = {

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95\% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95\% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95\% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Alcohol Drinking, depression, Female, Health Status, Humans, Male, Middle Aged, Smoking, Substance-Related Disorders, United States}, issn = {1873-6327}, doi = {10.1016/j.addbeh.2014.10.031}, author = {Pia M Mauro and Sarah L. Canham and Silvia S Martins and Adam P Spira} } @article {8162, title = {What can genes tell us about the relationship between education and health?}, journal = {Soc Sci Med}, volume = {127}, year = {2015}, month = {2015 Feb}, pages = {171-80}, publisher = {127}, abstract = {

We use genome wide data from respondents of the Health and Retirement Study (HRS) to evaluate the possibility that common genetic influences are associated with education and three health outcomes: depression, self-rated health, and body mass index. We use a total of 1.7 million single nucleotide polymorphisms obtained from the Illumina HumanOmni2.5-4v1 chip from 4233 non-Hispanic white respondents to characterize genetic similarities among unrelated persons in the HRS. We then used the Genome Wide Complex Trait Analysis (GCTA) toolkit, to estimate univariate and bivariate heritability. We provide evidence that education (h(2)~=~0.33), BMI (h(2)~=~0.43), depression (h(2)~=~0.19), and self-rated health (h(2)~=~0.18) are all moderately heritable phenotypes. We also provide evidence that some of the correlation between depression and education as well as self-rated health and education is due to common genetic factors associated with one or both traits. We find no evidence that the correlation between education and BMI is influenced by common genetic factors.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Computer Simulation, depression, Educational Status, Female, Gene-Environment Interaction, Genetic Predisposition to Disease, Genome-Wide Association Study, Health Status, Health Status Disparities, Humans, Male, Phenotype, Polymorphism, Single Nucleotide, Social determinants of health, Socioeconomic factors, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.08.001}, url = {http://www.sciencedirect.com/science/article/pii/S0277953614005188}, author = {Jason D Boardman and Benjamin W Domingue and Daw, Jonathan} } @article {8009, title = {Are people healthier if their partners are more optimistic? The dyadic effect of optimism on health among older adults.}, journal = {J Psychosom Res}, volume = {76}, year = {2014}, month = {2014 Jun}, pages = {447-53}, publisher = {76}, abstract = {

OBJECTIVE: Optimism has been linked with an array of positive health outcomes at the individual level. However, researchers have not examined how a spouse{\textquoteright}s optimism might impact an individual{\textquoteright}s health. We hypothesized that being optimistic (and having an optimistic spouse) would both be associated with better health.

METHODS: Participants were 3940 adults (1970 couples) from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Participants were tracked for four years and outcomes included: physical functioning, self-rated health, and number of chronic illnesses. We analyzed the dyadic data using the actor-partner interdependence model.

RESULTS: After controlling for several psychological and demographic factors, a person{\textquoteright}s own optimism and their spouse{\textquoteright}s optimism predicted better self-rated health and physical functioning (bs = .08-.25, ps<.01). More optimistic people also reported better physical functioning (b = -.11, p<.01) and fewer chronic illnesses (b=-.01, p<.05) over time. Further, having an optimistic spouse uniquely predicted better physical functioning (b = -.09, p<.01) and fewer chronic illnesses (b = -.01, p<.05) over time. The strength of the relationship between optimism and health did not diminish over time.

CONCLUSIONS: Being optimistic and having an optimistic spouse were both associated with better health. Examining partner effects is important because such analyses reveal the unique role that spouses play in promoting health. These findings may have important implications for future health interventions.

}, keywords = {Adult, Affect, Aged, Aged, 80 and over, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Personal Satisfaction, Self Report, Spouses}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2014.03.104}, url = {http://www.sciencedirect.com/science/article/pii/S0022399914001731}, author = {Eric S Kim and William J. Chopik and Jacqui Smith} } @article {8095, title = {Cohort differences in the marriage-health relationship for midlife women.}, journal = {Soc Sci Med}, volume = {116}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Sep}, pages = {64-72}, publisher = {116}, abstract = {

The present study aimed to identify potential cohort differences in midlife women{\textquoteright}s self-reported functional limitations and chronic diseases. Additionally, we examined the relationship between marital status and health, comparing the health of divorced, widowed, and never married women with married women, and how this relationship differs by cohort. Using data from the Health and Retirement Study (HRS), we examined potential differences in the level of functional limitations and six chronic diseases in two age-matched cohorts of midlife women in the United States: Pre-Baby Boomers, born 1933-1942, N~=~4574; and Early Baby Boomers, born 1947-1956, N~=~2098. Linear and logistic regressions tested the marital status/health relationship, as well as cohort differences in this relationship, controlling for age, education, race, number of marriages, length of time in marital status, physical activity, and smoking status. We found that Early Baby Boom women had fewer functional limitations but higher risk of chronic disease diagnosis compared to Pre-Baby Boom women. In both cohorts, marriage was associated with lower disease risk and fewer functional limitations; however, never-married Early Baby Boom women had more functional limitations, as well as greater likelihood of lung disease than their Pre-Baby Boom counterparts (OR~=~0.28). Results are discussed in terms of the stress model of marriage, and the association between historical context and cohort health (e.g., the influence of economic hardship vs. economic prosperity). Additionally, we discuss cohort differences in selection into marital status, particularly as they pertain to never-married women, and the relative impact of marital dissolution on physical health for the two cohorts of women.

}, keywords = {Age Factors, Aged, Chronic disease, Cohort Studies, Female, Health Status, Health Surveys, Humans, Marital Status, Marriage, Middle Aged, Mobility Limitation, Risk Factors, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.06.040}, author = {Nicky J Newton and Lindsay H Ryan and Rachel T King and Jacqui Smith} } @article {8046, title = {Cohort Profile: the Health and Retirement Study (HRS).}, journal = {Int J Epidemiol}, volume = {43}, year = {2014}, month = {2014 Apr}, pages = {576-85}, publisher = {43}, abstract = {

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare 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{\textquoteright}s Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for 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).

}, keywords = {Aged, Female, Genetic Predisposition to Disease, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Physical Fitness, Retirement, United States}, issn = {1464-3685}, doi = {10.1093/ije/dyu067}, author = {Amanda Sonnega and Jessica Faul and Mary Beth Ofstedal and Kenneth M. Langa and John W R Phillips and David R Weir} } @article {8033, title = {Heterogeneity in healthy aging.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jun}, pages = {640-9}, publisher = {69}, abstract = {

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.

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Middle Aged, Population Surveillance, Quality of Life, Retrospective Studies, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glt162}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2013/11/13/gerona.glt162.abstract}, author = {David J Lowsky and S Jay Olshansky and Bhattacharya, Jay and Dana P Goldman} } @article {8123, title = {Perceived neighbourhood social cohesion and myocardial infarction.}, journal = {J Epidemiol Community Health}, volume = {68}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov}, pages = {1020-6}, publisher = {68}, abstract = {

BACKGROUND: The main strategy for alleviating heart disease has been to target individuals and encourage them to change their health behaviours. Although important, emphasis on individuals has diverted focus and responsibility away from neighbourhood characteristics, which also strongly influence people{\textquoteright}s behaviours. Although a growing body of research has repeatedly demonstrated strong associations between neighbourhood characteristics and cardiovascular health, it has typically focused on negative neighbourhood characteristics. Only a few studies have examined the potential health enhancing effects of positive neighbourhood characteristics, such as perceived neighbourhood social cohesion.

METHODS: Using multiple logistic regression models, we tested whether higher perceived neighbourhood social cohesion was associated with lower incidence of myocardial infarction. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used to analyse 5276 participants with no history of heart disease. Respondents were tracked for 4 years and analyses adjusted for relevant sociodemographic, behavioural, biological and psychosocial factors.

RESULTS: In a model that adjusted for age, gender, race, marital status, education and total wealth, each SD increase in perceived neighbourhood social cohesion was associated with a 22\% reduced odds of myocardial infarction (OR=0.78, 95\% CI 0.63 to 0.94. The association between perceived neighbourhood social cohesion and myocardial infarction remained even after adjusting for behavioural, biological and psychosocial covariates.

CONCLUSIONS: Higher perceived neighbourhood social cohesion may have a protective effect against myocardial infarction.

}, keywords = {Aged, Aged, 80 and over, Confounding Factors, Epidemiologic, Female, Health Behavior, Health Status, Health Surveys, Humans, Incidence, Interviews as Topic, Male, Mental Health, Middle Aged, Multilevel Analysis, Myocardial Infarction, Perception, Prospective Studies, Protective factors, Residence Characteristics, Self Report, Social Environment, Socioeconomic factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2014-204009}, author = {Eric S Kim and Armani M. Hawes and Jacqui Smith} } @article {8079, title = {Question context and priming meaning of health: effect on differences in self-rated health between Hispanics and non-Hispanic Whites.}, journal = {Am J Public Health}, volume = {104}, year = {2014}, month = {2014 Jan}, pages = {179-85}, publisher = {104}, abstract = {

OBJECTIVES: We examined the implications of the current recommended data collection practice of placing self-rated health (SRH) before specific health-related questions (hence, without a health context) to remove potential context effects, between Hispanics and non-Hispanics.

METHODS: We used 2 methodologically comparable surveys conducted in English and Spanish that asked SRH in different contexts: before and after specific health questions. Focusing on the elderly, we compared the influence of question contexts on SRH between Hispanics and non-Hispanics and between Spanish and English speakers.

RESULTS: The question context influenced SRH reports of Spanish speakers (and Hispanics) significantly but not of English speakers (and non-Hispanics). Specifically, on SRH within a health context, Hispanics reported more positive health, decreasing the gap with non-Hispanic Whites by two thirds, and the measurement utility of SRH was improved through more consistent mortality prediction across ethnic and linguistic groups.

CONCLUSIONS: Contrary to the current recommendation, asking SRH within a health context enhanced measurement utility. Studies using SRH may result in erroneous conclusions when one does not consider its question context.

}, keywords = {Aged, Female, Health Status, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Mortality, Self Report, United States, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301055}, author = {Lee, Sunghee and Schwarz, Norbert} } @article {8026, title = {Self-rated health changes and oldest-old mortality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {612-21}, publisher = {69}, abstract = {

OBJECTIVES: This study explores how 2 measures of self-rated health (SRH) change are related to mortality among oldest-old adults. In doing so, it also considers how associations between SRH and mortality may depend on prior SRH.

METHOD: Data come from the Asset and Health Dynamics survey--the oldest-old portion of the Health and Retirement Study-and follow 6,233 individuals across 13 years. I use parametric hazard models to examine relationships between death and 2 measures of short-term SRH change--a computed measure comparing SRH at time t-1 and t, and a respondent-provided retrospectively reported change.

RESULTS: Respondents who demonstrate or report any SRH change between survey waves died at a greater rate than those with consistent SRH. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death, when compared with those with no change.

DISCUSSION: These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements.

}, keywords = {Aged, Aged, 80 and over, Diagnostic Self Evaluation, Female, Health Status, Humans, Longitudinal Studies, Male, Mortality, Proportional Hazards Models, Randomized Controlled Trials as Topic, Risk, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu013}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/02/geronb.gbu013.abstract}, author = {Eric M Vogelsang} } @article {8118, title = {Self-rated health in the last 12 years of life compared to matched surviving controls: the Health and Retirement Study.}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0 0}, month = {2014}, pages = {e107879}, publisher = {9}, abstract = {

Self-rated health (SRH) is a valid measure of health status and associated with mortality. Based on individual-level biannual repeat data on SRH we sought to characterize the natural history of poor SRH during the 12 years prior to death in men and women in different age groups. We conducted a retrospective analysis of the Health and Retirement Study participants who died between 1998 and 2010 and had at least two SRH measurements in the 12 years prior to death. We used a nested case-control design to compare SRH trajectories of deceased men and women aged 30-64, 65-79 and 80 years versus surviving participants. The cases comprised 3,350 deceased participants who were matched to surviving controls (n = 8,127). SRH was dichotomized into good vs. poor health. Men and women dying at age 65-79 and >= 80 years had 1.5 to 3 times higher prevalence of poor SRH already 11-12 years prior to death compared to surviving controls. The risk estimates remained statistically significant even after adjusting for life-style related risk factors and diagnosed diseases. Prevalence of poor SRH before death was lowest among those aged >= 80 years and highest in 30-64 year-olds. In conclusion, men and women who subsequently die perceive their health worse already 11-12 years prior to death compared to their surviving controls.

}, keywords = {Adult, Aged, Aged, 80 and over, Diagnostic Self Evaluation, Female, health, Health Status, Humans, Life Style, Male, Middle Aged, Mortality, Retirement, Retrospective Studies}, issn = {1932-6203}, doi = {10.1371/journal.pone.0107879}, author = {Stenholm, Sari and Pentti, Jaana and Ichiro Kawachi and Westerlund, Hugo and Mika Kivim{\"a}ki and Vahtera, Jussi} } @article {8096, title = {Social relationships, leisure activity, and health in older adults.}, journal = {Health Psychol}, volume = {33}, year = {2014}, note = {Times Cited: 1 Si}, month = {2014 Jun}, pages = {516-23}, publisher = {33}, abstract = {

OBJECTIVE: Although the link between enhanced social relationships and better health has generally been well established, few studies have examined the role of leisure activity in this link. This study examined how leisure influences the link between social relationships and health in older age.

METHOD: Using data from the 2006 and 2010 waves of the nationally representative U.S. Health and Retirement Study and structural equation modeling analyses, we examined data on 2,965 older participants to determine if leisure activities mediated the link between social relationships and health in 2010, controlling for race, education level, and health in 2006.

RESULTS: The results demonstrated that leisure activities mediate the link between social relationships and health in these age groups. Perceptions of positive social relationships were associated with greater involvement in leisure activities, and greater involvement in leisure activities was associated with better health in older age.

CONCLUSION: The contribution of leisure to health in these age groups is receiving increasing attention, and the results of this study add to the literature on this topic, by identifying the mediating effect of leisure activity on the link between social relationships and health. Future studies aimed at increasing leisure activity may contribute to improved health outcomes in older adults.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, Humans, Interpersonal Relations, Leisure activities, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1930-7810}, doi = {10.1037/hea0000051}, author = {Chang, Po-Ju and Linda A. Wray and Lin, Yeqiang} } @article {8034, title = {Why do older people change their ratings of childhood health?}, journal = {Demography}, volume = {51}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {1999-2023}, publisher = {51}, abstract = {

A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults-those with more socioeconomic resources and better memory-were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one{\textquoteright}s rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources.

}, keywords = {Adaptation, Psychological, Age Factors, Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Memory, Middle Aged, Retrospective Studies, Self Report, Sex Factors, Socioeconomic factors}, issn = {0070-3370}, doi = {10.1007/s13524-014-0344-3}, author = {Vuolo, Mike and Kenneth F Ferraro and Patricia M Morton and Ting-Ying Yang} } @article {7806, title = {Adults with cardiovascular disease who help others: a prospective study of health outcomes.}, journal = {J Behav Med}, volume = {36}, year = {2013}, note = {Copyright - Springer Science Business Media New York 2013 Last updated - 2013-04-30 DOI - 2922261571; 76454332; 69709; BVMD; 22481214; SPVLBVMD108653629414}, month = {2013 Apr}, pages = {199-211}, publisher = {36}, abstract = {

Little is known about the health impact of helping behaviors among individuals with high-risk chronic diseases such as cardiovascular disease (CVD). Using a nationally representative, longitudinal survey, we examined the subsequent health of adults with CVD (n~=~4,491) who spent time providing non-paid assistance to family and friends outside of their households compared with those who had provided no assistance. After both adjusting for baseline characteristics and using propensity score matching methods, spending up to 200~h over the prior 12~months helping others was associated with lower odds of experiencing a new CVD event or dying in the subsequent 2~years. Providing up to 100~h of assistance was associated with reporting fewer depressive symptoms. This threshold effect raises the question of whether assistance beyond a certain number of hours may impose a burden that mitigates health benefits from helping others. Health care providers could play an important role exploring ways that patients with CVD can provide beneficial levels of assistance to others in their own social networks or communities, thereby possibly also improving their own health.

}, keywords = {Activities of Daily Living, Aged, Cardiovascular Diseases, depression, Female, Health Status, Helping Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Time Factors}, issn = {1573-3521}, doi = {10.1007/s10865-012-9414-4}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1318045378?accountid=14667}, author = {Michele M Heisler and Choi, Hwajung and John D Piette and Ann Marie Rosland and Kenneth M. Langa and Stephanie Brown} } @article {7929, title = {Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jan}, pages = {96-100}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury.

DESIGN: Longitudinal analysis.

SETTING: Community.

PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008.

MEASUREMENTS: ADL difficulty.

RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95\% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95\% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95\% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates.

CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aging, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Status, Humans, Male, Odds Ratio, Retrospective Studies, Risk Factors, United States, Wounds and Injuries}, issn = {1532-5415}, doi = {10.1111/jgs.12071}, author = {Nishant K. Sekaran and Choi, Hwajung and Rodney A. Hayward and Kenneth M. Langa} } @article {7916, title = {Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Feb}, pages = {136-58}, publisher = {25}, abstract = {

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.

}, keywords = {Aged, Emigrants and Immigrants, Emigration and Immigration, Female, Health Status, Health Surveys, Humans, Male, Mexican Americans, Mexico, Middle Aged, Risk Factors, Risk-Taking, Social Class, United States}, issn = {1552-6887}, doi = {10.1177/0898264312468155}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663916/}, author = {Emma Aguila and Jos{\'e} J Escarce and Leng, Mei and Morales, Leo} } @article {7936, title = {Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Mar}, pages = {290-7}, publisher = {68}, abstract = {

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.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, depression, Female, Health Status, Health Transition, Humans, Longitudinal Studies, Male, Marriage, Memory Disorders, Middle Aged, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbs111}, url = {http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html}, author = {Kandauda Wickrama and Jay A. Mancini and Kwag, Kyunghwa and Kwon, Josephine} } @article {7859, title = {Pain among older Hispanics in the United States: is acculturation associated with pain?}, journal = {Pain Med}, volume = {14}, year = {2013}, note = {Times Cited: 0}, month = {2013 Aug}, pages = {1134-9}, publisher = {14}, abstract = {

BACKGROUND: Previous studies suggest that acculturation may influence the experience of pain.

STUDY DESIGN: We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States.

METHODS SUBJECTS: Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008.

MEASURES: We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain.

ANALYSIS: We applied logistic regression using generalized estimating equations, with NHW as the reference category.

RESULTS: Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95\% confidence interval [CI = 1.1-1.4) and intensity (OR = 1.6; 95\% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95\% CI 0.6-0.9).

CONCLUSION: Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.

}, keywords = {Acculturation, Aged, Confidence Intervals, Cross-Sectional Studies, Female, Health Status, Hispanic or Latino, Humans, Language, Logistic Models, Male, Middle Aged, Odds Ratio, pain, Pain Measurement, Prevalence, Socioeconomic factors, United States}, issn = {1526-4637}, doi = {10.1111/pme.12147}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23718576}, author = {Jimenez, Nathalia and Dansie, Elizabeth and Buchwald, Dedra and Goldberg, Jack} } @article {7788, title = {Pain as a risk factor for disability or death.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, note = {Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain}, month = {2013 Apr}, pages = {583-9}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN: Prospective cohort study.

SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10~yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS: At baseline, 2,283 (18\%) participants had significant pain. Participants with pain were more likely (all P~<~.001) to be female (65\% vs 54\%), have ADL difficulty (e.g., transferring 12\% vs 2\%, toileting 11\% vs 2\%), have difficulty walking several blocks (60\% vs 21\%), and have difficulty climbing one flight of stairs (40\% vs 12\%). Over 10~years, participants with pain were more likely to develop ADL disability or death (58\% vs 43\%, unadjusted hazard ratio (HR)~=~1.67, 95\% confidence interval~(CI)~=~1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR~=~0.98, 95\% CI~=~0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Geriatric Assessment, Health Status, Humans, Life Style, Male, Middle Aged, pain, Prevalence, Prognosis, Prospective Studies, Severity of Illness Index, Sex Distribution, Sex Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12172}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667}, author = {James S Andrews and Irena Cenzer and Yelin, Edward and Kenneth E Covinsky} } @article {7825, title = {Patterns of older Americans{\textquoteright} health care utilization over time.}, journal = {Am J Public Health}, volume = {103}, year = {2013}, month = {2013 Jul}, pages = {1314-24}, publisher = {103}, abstract = {

OBJECTIVES: We analyzed correlates of older Americans{\textquoteright} continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals{\textquoteright} health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7800, title = {Personality profile of the children of long-lived parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {730-8}, abstract = {

OBJECTIVES: Past research has shown that parental longevity is related to offspring physical health and longevity. Preliminary studies suggest that parental longevity may be linked to the offspring{\textquoteright}s personality traits. A comprehensive 5-factor personality model has been related to physical health, but the association with parental longevity has not yet been investigated. We used a 5-factor personality model to investigate the relationship between parental longevity and offspring personality.

METHOD: Data from the longitudinal Health and Retirement Study (HRS) was used in the analyses. Using the Midlife Development Inventory and the Life Orientation test, the relationship between parental attained age and offspring personality was assessed using regression models for both men and women.

RESULTS: Male offspring of long-lived fathers and mothers were more likely to be open to new experiences (p < .01) and be more extroverted (p = .03) compared with male offspring of short-lived fathers or mothers. Maternal or paternal attained age had no effect on the female offspring personality traits.

DISCUSSION: Personality is an important phenotype to consider when investigating genetic and environmental determinants of longevity. Further research is needed to investigate the potential of gender-specific mechanisms.

}, keywords = {Aged, Extraversion, Psychological, Fathers, Female, Health Status, Humans, Interviews as Topic, Longevity, Longitudinal Studies, Male, Mothers, Parents, Personality, Personality Inventory, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt003}, author = {Evangelia E Antoniou and Ambarish Dutta and Kenneth M. Langa and David Melzer and David J Llewellyn} } @article {7921, title = {Self-rated health and morbidity onset among late midlife U.S. adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Jan}, pages = {107-16}, publisher = {68}, abstract = {

OBJECTIVES: Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years).

METHOD: Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770).

RESULTS: SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke.

DISCUSSION: This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

}, keywords = {Chronic disease, Cohort Studies, Female, Health Status, Humans, Male, Middle Aged, Morbidity, Predictive Value of Tests, Self Concept, Self Report, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbs104}, author = {Kenzie Latham and Chuck W Peek} } @article {7941, title = {The socioeconomic origins of physical functioning among older U.S. adults.}, journal = {Adv Life Course Res}, volume = {18}, year = {2013}, month = {2013 Dec}, pages = {244-56}, publisher = {18}, abstract = {

Mounting evidence finds that adult health reflects socioeconomic circumstances (SES) in early life and adulthood. However, it is unclear how the health consequences of SES in early life and adulthood accumulate-for example, additively, synergistically. This study tests four hypotheses about how the health effects of early-life SES (measured by parental education) and adult SES (measured by own education) accumulate to shape functional limitations, whether the accumulation differs between men and women, and the extent to which key mechanisms explain the accumulation. It uses data from the 1994-2010 Health and Retirement Study on U.S. adults 50-100 years of age (N=24,026). The physical functioning benefits of parental and own education accumulated additively among men. While the physical functioning benefits generally accumulated among women, the functioning benefits from one{\textquoteright}s own education were dampened among women with low-educated mothers. The dampening partly reflected a strong tie between mothers{\textquoteright} education level and women{\textquoteright}s obesity risk. Taken together, the findings reveal subtle differences between men and women in the life course origins of physical functioning. They also shed light on a key mechanism-obesity-that may help explain why a growing number of studies find that early-life SES is especially important for women{\textquoteright}s health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Educational Status, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Sex Factors, Socioeconomic factors, United States}, issn = {1879-6974}, doi = {10.1016/j.alcr.2013.08.001}, author = {Jennifer Karas Montez} } @article {7917, title = {Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals.}, journal = {Health Econ}, volume = {22}, year = {2013}, month = {2013 Jan}, pages = {89-105}, publisher = {22}, abstract = {

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

}, keywords = {Adult, Aged, Aged, 80 and over, Alcohol Drinking, Alcoholic Beverages, Behavior, Body Height, Costs and Cost Analysis, Female, Health Status, Humans, Male, Middle Aged, Models, Econometric, Socioeconomic factors, Taxes, United States}, issn = {1099-1050}, doi = {10.1002/hec.1817}, author = {Padmaja Ayyagari and Deb, Partha and Jason M. Fletcher and William T Gallo and Jody L Sindelar} } @article {7741, title = {Vascular depression: an early warning sign of frailty.}, journal = {Aging Ment Health}, volume = {17}, year = {2013}, month = {2013}, pages = {85-93}, abstract = {

OBJECTIVES: Frailty is a common geriatric disorder associated with activities of daily living (ADL) impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004 ), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.

METHODS: We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high cerebrovascular burden (CVB; at least two cerebrovascular risk factors) or probable depression (score >=3 on the 8-item Center for Epidemiological Studies Depression Scale (CES-D)), and the second represented respondents with both high CVB and probable depression.

RESULTS: At baseline, the prevalence of frailty was 31.5\%. Over four years the incidence of frailty was 31.8\%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.

DISCUSSION: These findings suggest that vascular depression is a prodrome for frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, depression, Disabled Persons, Female, Follow-Up Studies, Frail Elderly, Geriatric Assessment, Health Status, Humans, Incidence, Logistic Models, Male, Prevalence, Psychiatric Status Rating Scales, Risk Factors, Socioeconomic factors, United States}, issn = {1364-6915}, doi = {10.1080/13607863.2012.692767}, author = {Daniel Paulson and Peter A Lichtenberg} } @article {7838, title = {Is working later in life good or bad for health? An investigation of multiple health outcomes.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {807-15}, publisher = {68}, abstract = {

OBJECTIVES: To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years.

METHODS: We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics.

RESULTS: We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time.

DISCUSSION: Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, depression, Educational Status, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Memory, Short-Term, Middle Aged, Neuropsychological tests, Psychiatric Status Rating Scales, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt069}, author = {Kandauda Wickrama and Catherine W. O{\textquoteright}Neal and Kyung H. Kwag and Lee, Tae K.} } @article {7683, title = {Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study.}, journal = {Hepatology}, volume = {55}, year = {2012}, month = {2012 Jan}, pages = {184-91}, publisher = {55}, abstract = {

UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients{\textquoteright} health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person.

CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.

}, keywords = {Aged, Black People, Caregivers, Comorbidity, Cost of Illness, Databases, Factual, Disability Evaluation, Female, Health Care Costs, Health Status, Hispanic or Latino, Humans, Incidence, Liver Cirrhosis, Male, Medicaid, Medicare, Prevalence, Prospective Studies, Retirement, United States, White People}, issn = {1527-3350}, doi = {10.1002/hep.24616}, author = {M. O. Rakoski and Ryan J McCammon and John D Piette and Theodore J Iwashyna and J. A. Marrero and Lok, Anna S and Kenneth M. Langa and Volk, Michael L} } @article {7775, title = {Clinical complexity and mortality in middle-aged and older adults with diabetes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Dec}, pages = {1313-20}, publisher = {67}, abstract = {

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8\%; Self-Management Difficulty Group, 79.4\%; and Uncertain Benefit Group, 52.5\%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50\%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Proportional Hazards Models, Self Care}, issn = {1758-535X}, doi = {10.1093/gerona/gls095}, author = {Christine T Cigolle and Mohammed U Kabeto and Pearl G. Lee and Caroline S Blaum} } @article {7691, title = {Cohort differences in the availability of informal caregivers: are the Boomers at risk?}, journal = {Gerontologist}, volume = {52}, year = {2012}, month = {2012 Apr}, pages = {177-88}, publisher = {52}, abstract = {

PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age.

DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles.

RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby.

IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

}, keywords = {Aged, Aged, 80 and over, Aging, Caregivers, Censuses, Family Characteristics, Female, Health Status, Humans, Likelihood Functions, Longitudinal Studies, Male, Middle Aged, Nuclear Family, Population Growth, Residence Characteristics, Retirement, Risk, Socioeconomic factors}, issn = {1758-5341}, doi = {10.1093/geront/gnr142}, author = {Lindsay H Ryan and Jacqui Smith and Toni C Antonucci and James S Jackson} } @article {7743, title = {Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions.}, journal = {J Aging Soc Policy}, volume = {24}, year = {2012}, month = {2012}, pages = {291-308}, publisher = {24}, abstract = {

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

}, keywords = {Activities of Daily Living, Age Factors, Australia, Cross-Cultural Comparison, Florida, Health Benefit Plans, Employee, Health Status, Humans, Job Satisfaction, Middle Aged, Pensions, Public Policy, Retirement, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420.2012.676324}, author = {K. A. Sargent-Cox and Kaarin J. Anstey and Kendig, H. and Skladzien, E.} } @article {7755, title = {Does retirement trigger ill health?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Mar}, pages = {282-300}, publisher = {21}, abstract = {

This paper investigates the effects of retirement on various health outcomes. Data stem from the first three waves of the English Longitudinal Study of Ageing (ELSA). With these informative data, non-parametric matching and instrumental variable (IV) methods are applied to identify causal effects. It is found that retirement significantly increases the risk of being diagnosed with a chronic condition. In particular, it raises the risk of a severe cardiovascular disease and cancer. This is also reflected in increased risk factors (e.g. BMI, cholesterol, blood pressure) and increased problems in physical activities. Furthermore, retirement worsens self-assessed health and an underlying health stock.

}, keywords = {Activities of Daily Living, Cardiovascular Diseases, Chronic disease, England, Health Status, Humans, Longitudinal Studies, Models, Econometric, Neoplasms, Quality of Life, Retirement, Risk Factors}, issn = {1099-1050}, doi = {10.1002/hec.1712}, author = {Stefanie Behncke} } @article {7746, title = {The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Oct}, pages = {1075-84}, abstract = {

BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

}, keywords = {Aged, Aging, Alcohol Drinking, Body Mass Index, Cohort Studies, Female, Health Behavior, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Motor Activity, Smoking, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/gls073}, author = {Anda Botoseneanu and Jersey Liang} } @article {7756, title = {The effects of health shocks on employment and health insurance: the role of employer-provided health insurance.}, journal = {Int J Health Care Finance Econ}, volume = {12}, year = {2012}, month = {2012 Dec}, pages = {253-67}, abstract = {

Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance "locks" people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men{\textquoteright}s dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2 years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse{\textquoteright}s employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse{\textquoteright}s employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI-with men with health shocks and ECHI more likely to continue working-appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self-reported health decline are significantly more likely to lose health insurance than men with insurance through a spouse. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.

}, keywords = {Adult, Aged, Employment, Health Benefit Plans, Employee, Health Status, Hospitalization, Humans, Longitudinal Studies, Lung Diseases, Male, Neoplasms, Occupations, Retirement, Socioeconomic factors, Spouses}, issn = {1573-6962}, doi = {10.1007/s10754-012-9113-2}, author = {Cathy J. Bradley and David Neumark and Meryl Motika} } @article {7758, title = {Health service use among the previously uninsured: is subsidized health insurance enough?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Oct}, pages = {1155-68}, publisher = {21}, abstract = {

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.

}, keywords = {Aged, Female, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Medicare, Middle Aged, Socioeconomic factors, United States}, issn = {1099-1050}, doi = {10.1002/hec.1780}, author = {Decker, Sandra L and Jalpa A Doshi and Amy E. Knaup and Daniel Polsky} } @article {7685, title = {The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States.}, journal = {Health Soc Care Community}, volume = {20}, year = {2012}, note = {Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6.}, month = {2012 Jan}, pages = {42-51}, publisher = {20}, abstract = {

Socioeconomic inequalities and lack of private health insurance have been viewed as significant contributors to health disparities in the United States. However, few studies have examined their impact on physical functioning over time, especially in later life. The current study investigated the impact of socioeconomic inequalities and lack of private health insurance on individuals{\textquoteright} growth trajectories in physical functioning, as measured by activities of daily living. Data from the Health and Retirement Study (1994-2006) were used for this study, 6519 black and white adults who provided in-depth information about health, socioeconomic, financial and health insurance information were analysed. Latent growth curve modelling was used to estimate the initial level of physical functioning and its rate of change over time. Results showed that higher level of income and assets and having private health insurance significantly predicted better physical functioning. In particular, decline in physical functioning was slower among those who had private health insurance. Interestingly, changes in economic status, such as decreases in income and assets, had a greater impact on women{\textquoteright}s physical functioning than on men{\textquoteright}s. Black adults did not suffer more rapid declines in physical functioning than white adults after controlling for socioeconomic status. The current longitudinal study suggested that anti-poverty and health insurance policies should be enhanced to reduce the negative impact of socioeconomic inequalities on physical functioning throughout an individual{\textquoteright}s life course.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Female, Health Status, Healthcare Disparities, Humans, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Poverty, Sex Factors, Socioeconomic factors, Time Factors, United States, White People}, issn = {1365-2524}, doi = {10.1111/j.1365-2524.2011.01012.x}, author = {Kim, Jinhyun and Virginia E. Richardson} } @article {7718, title = {The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.}, journal = {Patient Educ Couns}, volume = {87}, year = {2012}, note = {Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15.}, month = {2012 Apr}, pages = {74-80}, publisher = {87}, abstract = {

OBJECTIVE: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.

METHODS: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.

RESULTS: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress.

CONCLUSION: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.

PRACTICE IMPLICATIONS: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.

}, keywords = {Aged, Blood Glucose Self-Monitoring, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Disease Management, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Multivariate Analysis, Risk Factors, Self Care, Self Efficacy, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires, Treatment Outcome}, issn = {1873-5134}, doi = {10.1016/j.pec.2011.07.013}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21840149}, author = {Donna M Zulman and Ann Marie Rosland and Choi, Hwajung and Kenneth M. Langa and Michele M Heisler} } @article {7739, title = {Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults.}, journal = {Am J Epidemiol}, volume = {176}, year = {2012}, note = {Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28.}, month = {2012 Jul 15}, pages = {127-34}, publisher = {176}, abstract = {

The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80\% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95\% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95\% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50\% (OR = 1.69, 95\% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.

}, keywords = {Activities of Daily Living, Aged, Chronic disease, Cohort Studies, Comorbidity, Diabetes Mellitus, Female, Health Services, Health Status, Heart Diseases, Hospitalization, Humans, Incidence, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Middle Aged, Neoplasms, Odds Ratio, Peak Expiratory Flow Rate, Population Surveillance, Stroke, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwr503}, author = {Melissa H. Roberts and Douglas W Mapel} } @article {7692, title = {Loneliness, health, and mortality in old age: a national longitudinal study.}, journal = {Soc Sci Med}, volume = {74}, year = {2012}, month = {2012 Mar}, pages = {907-14}, publisher = {74}, abstract = {

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, depression, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.11.028}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ye Luo and Louise C Hawkley and Linda J. Waite and John T. Cacioppo} } @article {7760, title = {Maternal age and offspring adult health: evidence from the health and retirement study.}, journal = {Demography}, volume = {49}, year = {2012}, month = {2012 Nov}, pages = {1231-57}, abstract = {

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age-offspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25-34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age-offspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.

}, keywords = {Adolescent, Adult, Adult children, Aging, Body Weights and Measures, Educational Status, Female, Health Status, Humans, Maternal Age, Middle Aged, Mortality, Prospective Studies, Socioeconomic factors, Young Adult}, issn = {0070-3370}, doi = {10.1007/s13524-012-0132-x}, author = {Mikko Myrskyl{\"a} and Andrew Fenelon} } @article {7620, title = {Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes.}, journal = {Med Care}, volume = {50}, year = {2012}, note = {Medical care Med Care. 2011 Dec 20.}, month = {2012 May}, pages = {441-5}, abstract = {

OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95\% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95\% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95\% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95\% CI, 0.19-0.61).

CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients{\textquoteright} beliefs about how much physical activity is adequate.

}, keywords = {Age Factors, Data collection, Diabetes Mellitus, Disclosure, Dyspnea, Exercise, Female, Guideline Adherence, Guidelines as Topic, Health Status, Humans, Male, Middle Aged, Sedentary Behavior, Sex Factors, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3182422a52}, author = {Mary R Janevic and Sara J McLaughlin and Cathleen M. Connell} } @article {7710, title = {Predictors of self-report of heart failure in a population-based survey of older adults.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {5}, year = {2012}, month = {2012 May}, pages = {396-402}, publisher = {5}, abstract = {

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged >= 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6\%. Self-report of HF and claims agreement was 87\% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95\% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with >= 4 HF claims (OR, 2.74; 95\% CI, 1.36-5.52). Blacks (OR, 0.28; 95\% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95\% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Awareness, Chi-Square Distribution, Comorbidity, Female, Health Knowledge, Attitudes, Practice, Health Status, Health Surveys, Heart Failure, Humans, Insurance Claim Review, Logistic Models, Male, Medicare, Odds Ratio, Patients, Predictive Value of Tests, Self Report, Socioeconomic factors, United States}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.111.963116}, author = {Tanya R Gure and Ryan J McCammon and Christine T Cigolle and Todd M Koelling and Caroline S Blaum and Kenneth M. Langa} } @article {7693, title = {Race/ethnic and nativity disparities in later life physical performance: the role of health and socioeconomic status over the life course.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Mar}, pages = {238-48}, publisher = {67B}, abstract = {

OBJECTIVES: We examine race/ethnic and nativity differences in objective measures of physical performance (i.e., peak expiratory flow, grip strength, and gait speed) in a nationally representative sample of older Whites, Blacks, and Hispanics. We also examine whether detailed measures of childhood and adult health and socioeconomic status (SES) mediate race/ethnic differences in physical performance.

METHOD: We use data from the Health and Retirement Study, a population-based sample of older Americans born before 1947, and 3 measures of physical performance. Nested ordinary least squares models examine whether childhood and adult health and SES mediate race/ethnic differences in performance.

RESULTS: We find large and significant race/ethnic and nativity differences in lung function, grip strength, and gait speed. Adjusting for childhood and current adult health and SES reduces race/ethnic differences in physical performance but does not eliminate them entirely. Childhood health and SES as well as more proximal levels of SES are important determinants of race/ethnic disparities in later life physical performance.

DISCUSSION: The analysis highlights that a large proportion of race/ethnic and nativity disparities result from health and socioeconomic disadvantages in both early life and adulthood and thus suggests multiple intervention points at which disparities can be reduced.

}, keywords = {Aged, Aged, 80 and over, Aging, ethnicity, Female, Gait, Hand Strength, Health Status, Health Status Disparities, Health Surveys, Humans, Male, Middle Aged, Racial Groups, Respiratory Function Tests, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr155}, author = {Steven A Haas and Patrick M. Krueger and Leah Rohlfsen} } @article {7677, title = {Self-rated health and the "first move" around retirement: a longitudinal study of older Americans.}, journal = {J Rural Health}, volume = {28}, year = {2012}, month = {2012 Spring}, pages = {183-91}, publisher = {28}, abstract = {

PURPOSE: I examine whether less favorable self-rated health raises the risk of outmigration more for young-old adults (aged 53-63 at the start of the 10-year longitudinal study in 1994) in nonmetro than metro counties and increases the odds that both groups of outmigrants will choose metro over nonmetro destinations. Finally, I examine whether nonmetro outmigrants are more likely than metro outmigrants to cite a health concern or a desire to get closer to relatives or friends as a reason for the migration.

METHODS: I use the Health and Retirement Study (HRS) to track the main residences of nonmetro and metro older adults from 1994-2003. With a discrete-time Event History Analysis, I assess the joint effects of nonmetro/metro residence in 1994 and self-rated health (updated at each biennial wave) upon the risk of a first migration. Those who migrated were asked to recall why.

FINDINGS: At worse levels of self-rated health, the odds of remaining in a nonmetro county of residence drop in favor of migrating to another nonmetro county. Among migrants, the worse the self-rated health, the higher the odds of within-type migration (nonmetro-nonmetro and metro-metro) over cross-type migration (nonmetro-metro and metro-nonmetro). The percentages of migrants citing a health concern or a desire to live closer to relatives or friends as a reason for migration do not differ by county type of origin.

CONCLUSIONS: An implication for rural health policy is that young-old adults with worse self-rated health tend to remain in nonmetro areas, even when they migrate.

}, keywords = {Aged, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Population Dynamics, Retirement}, issn = {1748-0361}, doi = {10.1111/j.1748-0361.2011.00388.x}, author = {Nan E. Johnson} } @article {7777, title = {Social isolation, loneliness and health among older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, month = {2012 Dec}, pages = {1346-63}, publisher = {24}, abstract = {

OBJECTIVE: To examine the relationship of social isolation, loneliness and health outcomes among older adults.

METHODS: Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression.

RESULTS: Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one{\textquoteright}s health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000).

DISCUSSION: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.

}, keywords = {Aged, Cross-Sectional Studies, Diagnostic Self Evaluation, Female, Health Status, Humans, Logistic Models, Loneliness, Male, Mental Disorders, Middle Aged, Risk Factors, social isolation}, issn = {1552-6887}, doi = {10.1177/0898264312460275}, author = {Caitlin E. Coyle and Dugan, Elizabeth} } @article {7600, title = {Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {457-67}, publisher = {66B}, abstract = {

OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities.

METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control.

RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe.

DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Culture, Disabled Persons, England, Female, Gait, Health Status, Humans, Internal-External Control, Longitudinal Studies, Male, Mobility Limitation, Politics, Social Values, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr054}, author = {Philippa J Clarke and Jacqui Smith} } @article {7643, title = {Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: overall trends and differences by race/ethnicity.}, journal = {Am J Epidemiol}, volume = {174}, year = {2011}, note = {Sheffield, Kristin M Peek, M Kristen T32-AG00270/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States American journal of epidemiology Am J Epidemiol. 2011 Aug 1;174(3):274-83. Epub 2011 May 27.}, month = {2011 Aug 01}, pages = {274-83}, publisher = {174}, abstract = {

The authors used data from 6 waves of the Health and Retirement Study to evaluate changes in the prevalence of cognitive impairment among adults 70 years of age or older from 1993 to 2004. Having sampling weights for each wave enabled the authors to create merged waves that represented cross-sections of the community-dwelling older population for that year. Logistic regression analyses with year as the predictor were used to estimate trends and determine the contribution of sociodemographic and health status variables to decreasing trends in the prevalence of cognitive impairment over time (score <=8 on a modified Telephone Interview Cognitive Screen). Results showed an annual decline in the prevalence of cognitive impairment of 3.4\% after adjustment for age, gender, and prior test exposure (odds ratio (OR) = 0.966, 95\% confidence interval (CI): 0.941, 0.992). The addition of socioeconomic variables to the model attenuated the trend by 72.1\%. The annual percentage of decline in impairment was larger for blacks (OR = 0.943, 95\% CI: 0.914, 0.973) and Hispanics (OR = 0.954, 95\% CI: 0.912, 0.997) than for whites (OR = 0.971, 95\% CI: 0.936, 1.006), although the differences were not statistically significant. Linear probability models used in secondary analyses showed larger percentage-point declines for blacks and Hispanics. Improvements in educational level contributed to declines in cognitive impairment among older adults-particularly blacks and Hispanics-in the United States.

}, keywords = {Age Factors, Aged, Black People, Chi-Square Distribution, Cognition Disorders, Confidence Intervals, ethnicity, Female, Health Behavior, Health Status, Hispanic or Latino, Humans, Logistic Models, Longitudinal Studies, Male, Odds Ratio, Prevalence, Racial Groups, Socioeconomic factors, United States, White People}, issn = {1476-6256}, doi = {10.1093/aje/kwr074}, author = {Sheffield, Kristin M and M. Kristen Peek} } @article {7634, title = {Childhood health and labor market inequality over the life course.}, journal = {J Health Soc Behav}, volume = {52}, year = {2011}, note = {Haas, Steven A Glymour, M Maria Berkman, Lisa F AG023399/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Journal of health and social behavior J Health Soc Behav. 2011;52(3):298-313. doi: 10.1177/0022146511410431.}, month = {2011 Sep}, pages = {298-313}, publisher = {52}, abstract = {

The authors use data from the Health and Retirement Study{\textquoteright}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.

}, keywords = {Child, Employment, Female, Health Status, Humans, Income, Male, Middle Aged, Models, Econometric, Retirement, Social Class, Social Security, Socioeconomic factors, United States}, issn = {2150-6000}, doi = {10.1177/0022146511410431}, author = {Steven A Haas and M. Maria Glymour and Lisa F Berkman} } @article {7644, title = {Conscientiousness and longevity: an examination of possible mediators.}, journal = {Health Psychol}, volume = {30}, year = {2011}, note = {Hill, Patrick L Turiano, Nicholas A Hurd, Michael D Mroczek, Daniel K Roberts, Brent W R01 AG021178-09/AG/NIA NIH HHS/United States United States Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol. 2011 Sep;30(5):536-41.}, month = {2011 Sep}, pages = {536-41}, publisher = {30}, abstract = {

OBJECTIVE: Conscientious individuals tend to experience a number of health benefits, not the least of which being greater longevity. However, it remains an open question as to why this link with longevity occurs. The current study tested two possible mediators (physical health and cognitive functioning) of the link between conscientiousness and longevity.

METHOD: We tested these mediators using a 10-year longitudinal sample (N = 512), a subset of the long-running Health and Retirement Study of aging adults. Measures included an adjective-rating measure of conscientiousness, self-reported health conditions, and three measures of cognitive functioning (word recall, delayed recall, and vocabulary) included in the 1996 wave of the HRS study.

RESULTS: Our results found that conscientiousness significantly predicted greater longevity, even in a model including the two proposed mediator variables, gender, age, and years of education. Moreover, cognitive functioning appears to partially mediate this relationship.

CONCLUSIONS: This study replicates previous research showing that conscientious individuals tend to lead longer lives, and provides further insight into why this effect occurs. In addition, it underscores the importance of measurement considerations.

}, keywords = {Adult, Aged, Chronic disease, Cognition, Educational Status, Female, Health Behavior, Health Status, Humans, Longevity, Longitudinal Studies, Male, Middle Aged, Personality, Proportional Hazards Models, Psychological Tests}, issn = {1930-7810}, doi = {10.1037/a0023859}, author = {Patrick L Hill and Nicholas A. Turiano and Michael D Hurd and Daniel K. Mroczek and Brent W Roberts} } @article {7660, title = {Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence.}, journal = {Am Econ Rev}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {3047-77}, publisher = {101}, abstract = {

We investigate the effects of the institutional settings of the US health care system on individuals{\textquoteright} life-cycle medical expenditures. Health is a form of general human capital; labor turnover and labor-market frictions prevent an employer-employee pair from capturing the entire surplus from investment in an employee{\textquoteright}s health. Thus, the pair underinvests in health during working years, thereby increasing medical expenditures during retirement. We provide empirical evidence consistent with the comparative statics predictions of our model using the Medical Expenditure Panel Survey (MEPS) and the Health and Retirement Study (HRS). Our estimates suggest significant inefficiencies in health investment in the United States.

}, keywords = {Employment, Health Benefit Plans, Employee, Health Expenditures, Health Status, Humans, Income, Personnel Turnover, Retirement, United States}, issn = {0002-8282}, doi = {10.1257/aer.101.7.3047}, author = {Fang, H. and Alessandro Gavazza} } @article {7605, title = {Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the AHEAD study.}, journal = {Psychol Aging}, volume = {26}, year = {2011}, month = {2011 Sep}, pages = {546-58}, publisher = {26}, abstract = {

This study examined competing substantive hypotheses about dynamic (i.e., time-ordered) links between memory and functional limitations in old age. We applied the Bivariate Dual Change Score Model to 13-year longitudinal data from the Asset and Health Dynamics Among the Oldest Old Study (AHEAD; N = 6,990; ages 70 - 95). Results revealed that better memory predicted shallower increases in functional limitations. Little evidence was found for the opposite direction that functional limitations predict ensuing changes in memory. Spline models indicated that dynamic associations between memory and functional limitations were substantively similar between participants aged 70-79 and those aged 80-95. Potential covariates (gender, education, health conditions, and depressive symptoms) did not account for these differential lead-lag associations. Applying a multivariate approach, our results suggest that late-life developments in two key components of successful aging are intrinsically interrelated. Our discussion focuses on possible mechanisms why cognitive functioning may serve as a source of age-related changes in health both among the young-old and the old-old.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Memory, Memory Disorders, Memory, Episodic, Models, Statistical, Neuropsychological tests}, issn = {1939-1498}, doi = {10.1037/a0023023}, author = {Frank J Infurna and Denis Gerstorf and Lindsay H Ryan and Jacqui Smith} } @article {7503, title = {Gender differences in health: results from SHARE, ELSA and HRS.}, journal = {Eur J Public Health}, volume = {21}, year = {2011}, month = {2011 Feb}, pages = {81-91}, abstract = {

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

}, keywords = {Activities of Daily Living, Aged, Aging, Body Weights and Measures, Chronic disease, Employment, Female, Global Health, Health Behavior, Health Status, Humans, Male, Middle Aged, Self Report, Sex Factors}, issn = {1464-360X}, doi = {10.1093/eurpub/ckq022}, author = {Eileen M. Crimmins and Jung K Kim and Sole-Auro, Aida} } @article {7568, title = {Gender, marital power, and marital quality in later life.}, journal = {J Women Aging}, volume = {23}, year = {2011}, month = {2011}, pages = {3-22}, publisher = {23}, abstract = {

This study uses data from the 1992 Health and Retirement Study to examine gender differences in marital power and marital quality among older adults and to assess whether there are gender differences in the correlates of marital quality and marital power in later life. Results show that women report lower marital happiness, marital interaction, and marital power than do men, on average. These differences persist even after controlling for a number of life-course events and transitions. Further, results show that gender differences are also evident in the relationship of employment, childrearing, caregiving, and health factors with marital quality and power.

}, keywords = {Female, Health Status, Health Surveys, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Power, Psychological, Quality of Life, Regression Analysis, Sex Distribution, Socioeconomic factors, United States, Women, Working}, issn = {1540-7322}, doi = {10.1080/08952841.2011.540481}, author = {Jennifer R. Bulanda} } @article {7572, title = {Geriatric conditions develop in middle-aged adults with diabetes.}, journal = {J Gen Intern Med}, volume = {26}, year = {2011}, month = {2011 Mar}, pages = {272-9}, publisher = {26}, abstract = {

BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.

OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes.

DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006).

PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908).

MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain.

KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95\% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased.

CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.

}, keywords = {Accidental Falls, Age Factors, Aged, Aged, 80 and over, Aging, Diabetes Mellitus, Dizziness, Female, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, pain, Urinary incontinence}, issn = {1525-1497}, doi = {10.1007/s11606-010-1510-y}, author = {Christine T Cigolle and Pearl G. Lee and Kenneth M. Langa and Lee, Yuo-Yu and Zhiyi Tian and Caroline S Blaum} } @article {7626, title = {Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples.}, journal = {J Gerontol Soc Work}, volume = {54}, year = {2011}, note = {Gaines, Jean M Poey, Judith L Marx, Katherine A Parrish, John M Resnick, Barbara England Journal of gerontological social work J Gerontol Soc Work. 2011 Nov;54(8):788-802. doi: 10.1080/01634372.2011.595476.}, month = {2011 Nov}, pages = {788-802}, publisher = {54}, abstract = {

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.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Case-Control Studies, Chronic disease, depression, Female, Geriatric Assessment, Health Services, Health Services for the Aged, Health Status, Home Care Services, Hospitalization, Humans, Interview, Psychological, Male, Middle Aged, Multivariate Analysis, Psychometrics, Retirement}, issn = {1540-4048}, doi = {10.1080/01634372.2011.595476}, author = {Gaines, Jean M and Judith L Poey and Marx, Katherine A and J. M. Parrish and Resnick, Barbara} } @article {7659, title = {Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {2293-8}, publisher = {101}, abstract = {

OBJECTIVES: We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years.

METHODS: In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not.

RESULTS: Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95\% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95\% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95\% CI = 3.72, 20.16) during follow-up.

CONCLUSIONS: Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.

}, keywords = {depression, Drug Costs, Economic Recession, Female, Health Services Accessibility, Health Status, Housing, Humans, Male, Medication Adherence, Middle Aged, Socioeconomic factors, Stress, Psychological, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300245}, author = {Dawn E Alley and Jennifer Lloyd and Jos{\'e} A Pag{\'a}n and Craig E Pollack and Michelle Shardell and Carolyn Cannuscio} } @article {7576, title = {Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education.}, journal = {Gerontologist}, volume = {51}, year = {2011}, month = {2011 Feb}, pages = {51-63}, publisher = {51}, abstract = {

PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education.

DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50.

RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model.

IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Educational Status, ethnicity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Models, Theoretical, Racial Groups, Sex Distribution, Time Factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnq069}, author = {Chiu, Ching-Ju and Linda A. Wray} } @article {7621, title = {Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, note = {Ailshire, Jennifer A Beltran-Sanchez, Hiram Crimmins, Eileen M United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2241-8. doi: 10.1111/j.1532-5415.2011.03723.x.}, month = {2011 Dec}, pages = {2241-8}, publisher = {59}, abstract = {

OBJECTIVES: To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status.

DESIGN: Nationally representative longitudinal study of older Americans.

SETTING: United States.

PARTICIPANTS: One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older.

MEASUREMENTS: Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function.

RESULTS: At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97~years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts.

CONCLUSION: On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.

}, keywords = {Age Factors, Aged, 80 and over, Female, Geriatric Assessment, Health Status, Humans, Longevity, Longitudinal Studies, Male, Social Class, Sociology, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03723.x}, author = {Jennifer A Ailshire and Hiram Beltr{\'a}n-S{\'a}nchez and Eileen M. Crimmins} } @article {7603, title = {Volunteer transitions among older adults: the role of human, social, and cultural capital in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {490-501}, publisher = {66B}, abstract = {

OBJECTIVES: We aim to understand how human, social, and cultural capitals are associated with the volunteer process, that is, engagement (starting), intensity (number of hours), and cessation (stopping), among older adults.

METHOD: Data from the 2000 through 2008 Health and Retirement Study and the 2001 through 2009 Consumption and Activity Mail Survey provide a sample of 4,526 respondents. Random-effects pooled time series analyses incorporate not only the presence of various types of capital but also the quality of that capital.

RESULTS: Human and cultural capitals were positively associated with increased volunteer involvement. Effects of social capital (relationships in the family, employment status, and the community) depended on the quality of the relationships, not necessarily on their presence alone.

DISCUSSION: Results suggest that bolstering older adults{\textquoteright} capitals, particularly among lower socioeconomic status groups, can increase volunteer engagement and intensity and reduce cessation. Additionally, a variety of organizational policies including respite programs for caregivers and employer policies allowing employees to reduce their work hours might indirectly affect participation rates and commitment. Potential pools of volunteers exist in families, workplaces, and religious organizations, but more research is necessary to identify how to recruit and retain individuals in social networks where volunteer participatory rates are low.

}, keywords = {Aged, Aging, Caregivers, Community Participation, Cost of Illness, Educational Status, Employment, Female, Health Status, Health Surveys, Humans, Likelihood Functions, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Religion and Psychology, Social Environment, Social Identification, Social Support, Socioeconomic factors, United States, Volunteers}, issn = {1758-5368}, doi = {10.1093/geronb/gbr055}, author = {Tay K. McNamara and Guillermo Ernest Gonzales} } @article {7575, title = {Volunteering and hypertension risk in later life.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Feb}, pages = {24-51}, publisher = {23}, abstract = {

OBJECTIVE: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment.

METHOD: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons.

RESULTS: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension.

DISCUSSION: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Confidence Intervals, Female, Health Behavior, health policy, Health Status, Humans, Hypertension, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Psychometrics, Regression Analysis, Risk Factors, Social Support, Surveys and Questionnaires, Volunteers}, issn = {1552-6887}, doi = {10.1177/0898264310388272}, author = {Jeffrey A Burr and Jane Tavares and Jan E Mutchler} } @article {7656, title = {Volunteering, driving status, and mortality in U.S. retirees.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, note = {Lee, Sei J Steinman, Michael A Tan, Erwin J K23 AG030999/AG/NIA NIH HHS/United States KL2RR024130/RR/NCRR NIH HHS/United States P30-AG02133/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Journal of the American Geriatrics Society Nihms289698 J Am Geriatr Soc. 2011 Feb;59(2):274-80. doi: 10.1111/j.1532-5415.2010.03265.x.}, month = {2011 Feb}, pages = {274-80}, publisher = {59}, abstract = {

OBJECTIVES: To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees.

DESIGN: Observational prospective cohort.

SETTING: Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006.

PARTICIPANTS: Retirees aged 65 and older (N=6,408).

MEASUREMENTS: Participants self-reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome.

RESULTS: For drivers, mortality in volunteers (9\%) and nonvolunteers (12\%) was similar; for limited or non-drivers, mortality for volunteers (15\%) was markedly lower than for nonvolunteers (32\%). Adjusted results showed that, for drivers, the volunteering-mortality odds ratio (OR) was 0.90 (95\% confidence interval (CI)=0.66-1.22), whereas for limited or nondrivers, the OR was 0.62 (95\% CI=0.49-0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81).

CONCLUSION: The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.

}, keywords = {Activities of Daily Living, Aged, Automobile Driving, Female, Health Status, Humans, Male, Prospective Studies, Retirement, Risk Factors, Social Behavior, Survival Rate, United States, Volunteers}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03265.x}, author = {Sei J. Lee and Michael A Steinman and Erwin J Tan} } @article {7460, title = {Alcohol-consumption trajectories and associated characteristics among adults older than age 50.}, journal = {J Stud Alcohol Drugs}, volume = {71}, year = {2010}, month = {2010 Mar}, pages = {169-79}, publisher = {71}, abstract = {

OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category.

RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95\% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95\% CI [1.09, 1.31]), male, White (RRR = 3.54, 95\% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

}, keywords = {Age Factors, Alcohol Drinking, Alcohol-Related Disorders, Educational Status, Female, Follow-Up Studies, Health Status, Health Surveys, Humans, Life Change Events, Linear Models, Male, Middle Aged, Sex Factors, Socioeconomic factors, Time Factors}, issn = {1938-4114}, doi = {10.15288/jsad.2010.71.169}, author = {Alyssa C Platt and Frank A Sloan and Philip Costanzo} } @article {7451, title = {[The association between self-rated health and health care utilization in retired].}, journal = {Acta Med Port}, volume = {23}, year = {2010}, month = {2010 Jan-Feb}, pages = {101-6}, publisher = {23}, abstract = {

OBJECTIVE: This article attests the association between self-rated health and health care utilization in a retired population by a narrative review.

METHOD: A systematic review was carried out from 1967 to 2007 to identify studies on self-rated health, in the databases MEDLINE, LILACS e SCIELO. The OVID software was used to Medline research. Contacts with experts were used. The key words retirement, self-rated health, health care utilization and narrative review were used in Portuguese, Spanish and English versions. Al the abstracts were analyzed, but only trials that associated self-rated health in retirement and health care utilization were fully analyzed.

RESULTS: Thirty one out of 443 abstracts were selected to be fully analyzed. Current data indicates that health deterioration, poor self-rated health and increased health care utilization are associated with early retirement, due to disability, but not with individuals who worked until retirement by age.

CONCLUSION: Retirement is probably associated with increased public expenses and increased health care utilization in retired with a poor self-rated health.

}, keywords = {Delivery of Health Care, Health Status, Humans, Self Concept}, issn = {1646-0758}, url = {https://pubmed.ncbi.nlm.nih.gov/20353712/}, author = {F Alo{\'\i}sio Pimenta and Santos Amaral, Carlos and Da Gama Torres, Henrique and Rezende, Nilton} } @article {7512, title = {Causes and consequences of early-life health.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, month = {2010}, pages = {S65-85}, publisher = {47}, abstract = {

We examine the consequences of child health for economic and health outcomes in adulthood, using height as a marker of childhood health. After reviewing previous evidence, we present a conceptual framework that highlights data limitations and methodological problems that complicate the study of this topic. We then present estimates of the associations between height and a range of outcomes--including schooling, employment, earnings, health, and cognitive ability--measured in five data sets from early to late adulthood. These results indicate that, on average, taller individuals attain higher levels of education. Height is also positively associated with better economic, health, and cognitive outcomes. These associations are only partially explained by the higher average educational attainment of taller individuals. We then use data from the National Longitudinal Survey of Youth 1979 Children and Young Adults survey to document the associations between health, cognitive development, and growth in childhood. Even among children with the same mother, taller siblings score better on cognitive tests and progress through school more quickly. Part of the differences found between siblings arises from differences in their birth weights and lengths attributable to mother{\textquoteright}s behaviors while pregnant. Taken together, these results support the hypothesis that childhood health influences health and economic status throughout adulthood.

}, keywords = {Adolescent, Adult, Aged, Body Height, Child, Child Development, Child, Preschool, Educational Status, Employment, Family Characteristics, Female, Health Status, Humans, Income, Infant, Infant, Newborn, Longitudinal Studies, Male, Middle Aged, Pregnancy, Prenatal Exposure Delayed Effects, Regression Analysis, Socioeconomic factors, United Kingdom}, issn = {0070-3370}, doi = {10.1353/dem.2010.0007}, author = {Case, Anne and Paxson, Christina} } @article {7436, title = {Characteristics of physical measurement consent in a population-based survey of older adults.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Jan}, pages = {64-71}, publisher = {48}, abstract = {

BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements.

OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one{\textquoteright}s demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics.

RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements.

RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender.

CONCLUSIONS: Physical measurement consent is not strongly associated with one{\textquoteright}s health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation.

}, keywords = {Age Factors, Aged, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Physical Examination, Socioeconomic factors}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181adcbd3}, author = {Joseph W Sakshaug and Mick P. Couper and Mary Beth Ofstedal} } @article {7452, title = {Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Apr}, pages = {327-34}, publisher = {48}, abstract = {

BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.

OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics.

DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.

SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).

MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.

RESULTS: Nearly 22\% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10\% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6\% vs. 7.3\%, P < 0.04.).

CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.

}, keywords = {Aged, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Type 2, Female, Glycemic Index, Health Status, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Self Care, Severity of Illness Index, Treatment Failure, United States}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181ca4035}, author = {Caroline S Blaum and Christine T Cigolle and Cynthia Boyd and Jennifer L. Wolff and Zhiyi Tian and Kenneth M. Langa and David R Weir} } @article {7502, title = {Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.}, journal = {Eur J Epidemiol}, volume = {25}, year = {2010}, month = {2010 Jul}, pages = {471-80}, publisher = {25}, abstract = {

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

}, keywords = {Aged, Aged, 80 and over, Denmark, Disability Evaluation, Female, Health Status, Humans, Japan, Male, Middle Aged, Mortality, Sex Distribution, United States}, issn = {1573-7284}, doi = {10.1007/s10654-010-9460-6}, author = {Oksuzyan, Anna and Eileen M. Crimmins and Saito, Yasuhiko and Angela M O{\textquoteright}Rand and James W Vaupel and Christensen, Kaare} } @article {7531, title = {Depression among older adults in the United States and England.}, journal = {Am J Geriatr Psychiatry}, volume = {18}, year = {2010}, month = {2010 Nov}, pages = {1036-44}, publisher = {11}, abstract = {

CONTEXT: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States.

OBJECTIVE: The authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries.

DESIGN AND SETTING: The authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing.

PARTICIPANTS: A total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents.

MAIN OUTCOME MEASURES: The authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors.

RESULTS: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score >=4) were more prevalent in English than U.S. adults (17.6\% versus 14.6\%, adjusted Wald test F([1, 1593]) = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19\% higher compared with the United States (odds ratio: 1.19, 95\% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States.

CONCLUSIONS: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.

}, keywords = {Aged, Aged, 80 and over, depression, England, Female, Health Behavior, Health Status, Health Surveys, Humans, Male, Prevalence, Risk Factors, United States, White People}, issn = {1545-7214}, doi = {10.1097/JGP.0b013e3181dba6d2}, author = {Zivin, Kara and David J Llewellyn and Iain A Lang and Sandeep Vijan and Mohammed U Kabeto and Erin M Miller and Kenneth M. Langa} } @article {7339, title = {Diabetes-related support, regimen adherence, and health decline among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 May}, pages = {390-9}, publisher = {10}, abstract = {

UNLABELLED: OBJECTIVES. Social support is generally conceptualized as health promoting; however, there is little consensus regarding the mechanisms through which support is protective. Illness support has been proposed to promote regimen adherence and subsequent prevention of health decline. We hypothesize that (a) support for regimen adherence is negatively associated with self-reported health decline among older diabetic adults and that (b) regimen adherence is negatively associated with health decline among older diabetic adults.

METHODS: We used the Health and Retirement Study data on individuals over the age of 60 years with type 2 diabetes mellitus (n = 1,788), examining change in self-reported health status over a 2-year period using binomial and cumulative ordinal logistic regression models.

RESULTS: Diabetic support is not significantly associated with health decline, but it is strongly associated with adherence to health-promoting activities consisting of a diabetic regimen. Therefore, the extent to which one receives illness support for a given regimen component is highly positively associated with adhering to that component, although this adherence does not necessarily translate into protection against perceived decline in health.

CONCLUSIONS: Illness-related support appears to be a mechanism through which social support matters in the diabetic population. Although this relationship did not extend to prevention of health status decline among diabetics, the relationship between support and illness management is promising.

}, keywords = {Activities of Daily Living, Aged, Diabetes Mellitus, Type 2, Disability Evaluation, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Quality of Life, Social Support, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp050}, author = {Emily J Nicklett and Jersey Liang} } @article {7513, title = {Disease prevalence, disease incidence, and mortality in the United States and in England.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, month = {2010}, pages = {S211-31}, publisher = {47}, abstract = {

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55-64 and 70-80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factors (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55-64 in both countries and a significant part among Americans 70-80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.

}, keywords = {Aged, Aged, 80 and over, England, Health Status, Health Status Disparities, Humans, Incidence, Life Tables, Middle Aged, Morbidity, Mortality, Prevalence, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2010.0008}, author = {James Banks and Muriel, Alastair and James P Smith} } @article {7481, title = {Early-life characteristics, psychiatric history, and cognition trajectories in later life.}, journal = {Gerontologist}, volume = {50}, year = {2010}, note = {Using Smart Source Parsing pp. Oct Gerontological Society of America, Washington DC}, month = {2010 Oct}, pages = {646-56}, publisher = {50}, abstract = {

PURPOSE OF THE STUDY: Although considerable attention has been paid to the relationship between later-life depression and cognitive function, the relationship between a history of psychiatric problems and cognitive function is not very well documented. Few studies of relationships between childhood health, childhood disadvantage, and cognitive function in later life consider both childhood health and disadvantage, include measures for psychiatric history, or use nationally representative longitudinal data.

DESIGN AND METHODS: This study uses growth curve models to analyze the relationships between childhood health and disadvantage, psychiatric history, and cognitive function using 6 waves of the Health and Retirement Study, controlling for demographics, health behavior, and health status.

RESULTS: A history of psychiatric problems is associated with lower cognitive function and steeper declines in cognitive function with age. The influence of childhood health is mediated by later-life health status and behaviors. A combined history of childhood disadvantage and psychiatric problems more strongly affects cognitive function, but cognitive declines remain consistent with those associated with psychiatric history. These effects are partially mediated by later-life demographic, socioeconomic, or health characteristics.

IMPLICATIONS: These findings demonstrate that cumulative disadvantage and a history of psychiatric problems shape later-life cognition and cognitive decline. This evidence can enhance public understanding of the trajectories of cognitive decline experienced by groups living with disadvantage and can enable policy makers and human services providers to better design and implement preventative interventions and support services for affected populations.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Cohort Studies, Female, Health Status, Humans, Male, Mental Disorders, Middle Aged, Psychiatric Status Rating Scales, Social Environment, Socioeconomic factors, Time Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq049}, author = {Maria T. Brown} } @article {7491, title = {Education and physical activity mediate the relationship between ethnicity and cognitive function in late middle-aged adults.}, journal = {Ethn Health}, volume = {15}, year = {2010}, note = {Using Smart Source Parsing pp. Jun Taylor and Francis, Abingdon UK}, month = {2010 Jun}, pages = {283-302}, publisher = {15}, abstract = {

OBJECTIVE: Minority status has been implicated as a risk factor for disparate scores on cognitive function tests in older adults. Research on ethnicity and cognitive function has yielded socioeconomic status, particularly education, as a primary reason for the discrepancy. Other factors, such as physical activity may provide insight into the relationship. Despite this knowledge, few studies have thoroughly examined the mediating characteristics of education or physical activity in the relationship between ethnicity and cognitive function in younger aged groups. Most research conducted focuses only on older adults during a time when degeneration of brain tissue may complicate the exploration of the relationships among ethnicity and cognitive function. The current research will expand existing knowledge about education, physical activity, and cognitive function in minority groups.

DESIGN: The study presents data from the Health and Retirement Study, a nationally representative sample of late middle-aged White, Black, and Hispanic adults (n=9204, mean age+/-SD = 55.8+/-3.1). Regression and mediation testing determined the mediating effects of education and physical activity in the relationship between ethnicity and cognitive function.

RESULTS: Significant association between White ethnicity and higher scores on cognitive tests was evident as early as late middle age. The magnitude of the association significantly diminished on adjusting for education and leisure time physical activity.

CONCLUSION: Our data suggest a potential mediating role of education and physical activity on the ethnic differences in cognitive tests in late middle-aged White, Black, and Hispanic adults. Our findings suggest a need for studies to understand if adult education and culturally appropriate physical activity interventions in middle age influence ethnic disparities in prevalence of cognitive impairment in old age.

}, keywords = {Black People, Body Mass Index, Brief Psychiatric Rating Scale, Cognition Disorders, Educational Status, Exercise, Female, Health Status, Hispanic or Latino, Humans, Longitudinal Studies, Male, Memory Disorders, Middle Aged, United States, White People}, issn = {1465-3419}, doi = {10.1080/13557851003681273}, author = {Meredith C. Masel and Raji, Mukaila and M. Kristen Peek} } @article {7406, title = {Ethnicity and changing functional health in middle and late life: a person-centered approach.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {470-81}, publisher = {65}, abstract = {

OBJECTIVES: Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans.

METHODS: Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis.

RESULTS: Five trajectories were identified: (a) excellent functional health (61\%), (b) good functional health with small increasing disability (25\%), (c) accelerated increase in disability (7\%), (d) high but stable disability (4\%), and (e) persistent severe impairment (3\%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53\%), moderate functional decrement (40\%), and (c) large functional decrement (8\%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics.

CONCLUSIONS: Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.

}, keywords = {Age Factors, Aged, Black or African American, Disabled Persons, disease progression, ethnicity, Female, Health Status, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Likelihood Functions, Male, Marital Status, Middle Aged, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbp114}, author = {Jersey Liang and Xiao Xu and Joan M. Bennett and Wen Ye and Ana R Qui{\~n}ones} } @article {7476, title = {Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach.}, journal = {Value Health}, volume = {13}, year = {2010}, month = {2010 Jun-Jul}, pages = {338-45}, publisher = {13}, abstract = {

OBJECTIVE: Although multiple noncost factors likely influence a patient{\textquoteright}s propensity to forego treatment in the face of cost pressures, little is known about how patients{\textquoteright} sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

METHODS: We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone{\textquoteright}s risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.

RESULTS: Of the 3071 respondents who met study criteria, 20\% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65-74) and depressive symptoms were consistent independent risk factors for CRN.

CONCLUSIONS: Noncost factors influenced patients{\textquoteright} propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients{\textquoteright} cost pressures.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Female, Financing, Personal, Health Status, Humans, Logistic Models, Male, Medication Adherence, Models, Econometric, Multivariate Analysis, Prescription Fees, Risk Factors, Socioeconomic factors, United States}, issn = {1524-4733}, doi = {10.1111/j.1524-4733.2009.00679.x}, author = {Zivin, Kara and Scott M Ratliff and Michele M Heisler and Kenneth M. Langa and John D Piette} } @article {7489, title = {Health outcomes of Experience Corps: a high-commitment volunteer program.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {414-420}, publisher = {71}, abstract = {

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{\textquoteright} 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.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Health Promotion, Health Status, Humans, Male, Middle Aged, Program Evaluation, Regression Analysis, Self Concept, Volunteers}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.04.009}, author = {S I Hong and Morrow-Howell, Nancy} } @article {7511, title = {Health trajectories among older movers.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {862-81}, publisher = {22}, abstract = {

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{\textquoteright}s (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Middle Aged, Multivariate Analysis, Regression Analysis, Social Class, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310375985}, author = {Janet M Wilmoth} } @article {7520, title = {Lifetime marital history and mortality after age 50.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Dec}, pages = {1198-212}, publisher = {22}, abstract = {

OBJECTIVES: This article examines the relationship between lifetime marital history and mortality after age 50.

METHOD: Data are drawn from the Health and Retirement Study birth cohort of 1931 to 1941. The analysis utilizes three measures of marital history: number of marriages, proportion time married, and age at first marriage.

RESULTS: Three or more marriages and a lower proportion of adult life spent married are each associated with a higher hazard of dying after age 50 for both men and women even after controlling for current marital status and socioeconomic status. Smoking behavior accounts for part of the relationship of marital history and status with mortality.

DISCUSSION: Research on marital status and health should consider marital history as well as current status. Two topics are particularly important: examining the relationship in different cohorts and disentangling the potentially causal role of health behaviors such as smoking.

}, keywords = {Age Factors, Aging, Cohort Studies, Female, Health Status, Humans, Interpersonal Relations, Male, Marital Status, Middle Aged, Mortality, Multivariate Analysis, Proportional Hazards Models, Residence Characteristics, Risk Assessment, Risk-Taking, Smoking, Time Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264310374354}, author = {John C Henretta} } @article {7538, title = {Loneliness matters: a theoretical and empirical review of consequences and mechanisms.}, journal = {Ann Behav Med}, volume = {40}, year = {2010}, month = {2010 Oct}, pages = {218-27}, publisher = {40}, abstract = {

As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.

}, keywords = {Cognition, Gene Expression, Health Status, Humans, Hypothalamo-Hypophyseal System, Immune System, Loneliness, Mental Health, Mortality, Pituitary-Adrenal System}, issn = {1532-4796}, doi = {10.1007/s12160-010-9210-8}, author = {Louise C Hawkley and John T. Cacioppo} } @article {7528, title = {Long-term cognitive impairment and functional disability among survivors of severe sepsis.}, journal = {JAMA}, volume = {304}, year = {2010}, month = {2010 Oct 27}, pages = {1787-94}, publisher = {304}, abstract = {

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients{\textquoteright} long-term cognitive and functional limitations after sepsis is unknown.

OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.

DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.

MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.

RESULTS: Survivors{\textquoteright} mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95\% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95\% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95\% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95\% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95\% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95\% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.

CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients{\textquoteright} ability to live independently.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case-Control Studies, Cognition Disorders, Disabled Persons, Female, Health Status, Hospitalization, Humans, Male, Prospective Studies, Sepsis, Severity of Illness Index, Survivors, United States}, issn = {1538-3598}, doi = {10.1001/jama.2010.1553}, url = {http://jama.ama-assn.org/content/304/16/1787.abstract}, author = {Theodore J Iwashyna and E Wesley Ely and Dylan M Smith and Kenneth M. Langa} } @article {7514, title = {Migration and psychological well-being among older adults: a growth curve analysis based on panel data from the Health and Retirement Study, 1996-2006.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {882-913}, publisher = {22}, abstract = {

PURPOSE: A vibrant body of research examines migration among older adults. Existing research, however, grants scarce attention to the implications of later-life migration for the migrants themselves. Our research focuses on the impacts of migration on depressive symptomatology among older U.S. adults.

METHODS: Our analysis employs six waves of panel data from the Health and Retirement Study, 1996-2006. Growth curve modeling techniques are employed.

RESULTS: Net of other stressful life events, migration effects appear to vary significantly across persons. Findings highlight the particularly depressive impact of moves motivated by negative life events or circumstances. Results further suggest that later life moves may be especially stressful for women and as individuals age.

DISCUSSION: The stress of moving late in life may depend on social integration at destination. Further research should pursue this issue. Study limitations and additional directions for further research are delineated.

}, keywords = {Adaptation, Psychological, Age Factors, Aging, depression, Female, Happiness, Health Status, Humans, Life Change Events, Male, Mental Health, Middle Aged, Models, Psychological, Models, Theoretical, Multivariate Analysis, Psychometrics, Retirement, Stress, Psychological, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310368430}, author = {Don E Bradley and Van Willigen, Marieke} } @article {7516, title = {Military service and men{\textquoteright}s health trajectories in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Nov}, pages = {744-55}, publisher = {65B}, abstract = {

OBJECTIVES: This study examines differences in the relationship between veteran status and men{\textquoteright}s trajectories of health conditions, activities of daily living limitations, and self-rated health.

METHODS: We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars.

RESULTS: The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars.

DISCUSSION: Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life.

}, keywords = {Activities of Daily Living, Aged, Aging, Health Status, Humans, Korean War, Male, Middle Aged, Military Personnel, Multivariate Analysis, Racial Groups, Self-Assessment, Veterans, Vietnam Conflict, World War II}, issn = {1758-5368}, doi = {10.1093/geronb/gbq072}, author = {Janet M Wilmoth and Andrew S London and Wendy M Parker} } @article {7445, title = {Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Apr}, pages = {384-98}, publisher = {22}, abstract = {

OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline.

METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status.

RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998.

DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

}, keywords = {Activities of Daily Living, Age Factors, Aging, Chi-Square Distribution, Cohort Studies, Confidence Intervals, depression, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Multivariate Analysis, Obesity, Odds Ratio, Psychometrics, Self Report, Sex Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264309359421}, author = {Dianna D Carroll and Heidi M Blanck and Mary K. Serdula and David R Brown} } @article {7458, title = {Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {438-48}, abstract = {

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands{\textquoteright} stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives{\textquoteright} health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

}, keywords = {Age Factors, Aged, Chi-Square Distribution, Chronic disease, Cohort Studies, depression, Female, Health Status, Humans, Hypertension, Least-Squares Analysis, Male, Marriage, Middle Aged, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Socioeconomic factors, Spouses, Stroke}, issn = {1758-5368}, doi = {10.1093/geronb/gbq033}, author = {Brian J Ayotte and Frances Margaret Yang and Richard N Jones} } @article {7494, title = {Predicting positive well-being in older men and women.}, journal = {Int J Aging Hum Dev}, volume = {70}, year = {2010}, month = {2010}, pages = {181-97}, publisher = {70}, abstract = {

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults{\textquoteright} well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old (M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32\% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35\% of the variance in women{\textquoteright}s positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

}, keywords = {Aged, Aged, 80 and over, Aging, depression, Female, Health Status, Humans, Male, Marriage, Middle Aged, Personal Satisfaction, Predictive Value of Tests, Quality of Life, Regression Analysis, Religion and Psychology, Self Concept, Sex Distribution, Social Behavior, Surveys and Questionnaires, Volunteers}, issn = {0091-4150}, doi = {10.2190/AG.70.3.a}, author = {Erin L. Waddell and Joy M Jacobs-Lawson} } @article {7500, title = {The Process of Retirement Planning Scale (PRePS): development and validation.}, journal = {Psychol Assess}, volume = {22}, year = {2010}, month = {2010 Sep}, pages = {520-31}, publisher = {22}, abstract = {

Although a substantial proportion of the western population is approaching retirement age, little is known about how they are preparing for the future. Much attention has been paid to the consumption of educational material and retirement wealth in the present literature, but the process of retirement planning has been ignored. S. L. Friedman and E. K. Scholnick{\textquoteright}s (1997) theoretical model provided the basis for a comprehensive measure of retirement planning. According to their process theory, individuals develop an understanding of the problem, set goals, make a decision to start preparing, and finally undertake the behaviors needed to fulfill their goals. Fifty-two items were developed to assess each stage of the planning process for financial, health, lifestyle, and psychosocial retirement planning. These were tested on a population sample of 1,449 New Zealanders aged 49-60. Confirmatory factor analysis, bivariate correlations, and hierarchical regression provided support for the valid use of the measure. Necessary antecedents, such as the tendency to look to the future, and locus of control were significantly related to the Process of Retirement Planning Scale (PRePS). The PRePS also outperformed retirement planning measures used in the Health and Retirement Study (F. T. Juster \& R. Suzman, 1995) after controlling for socioeconomic and psychological variables. This measure will enable social policy makers to determine which stages of retirement planning require support and intervention. The PRePS will also help to determine which domains of retirement planning predict well-being in later life and the factors which differentiate those who are planning from those who are not.

}, keywords = {Age Factors, Aged, Educational Status, Factor Analysis, Statistical, Female, Financing, Personal, Goals, Health Status, Humans, Internal-External Control, Male, Middle Aged, Pilot Projects, Planning Techniques, Psychological Tests, Psychology, Reproducibility of Results, Retirement, Surveys and Questionnaires}, issn = {1939-134X}, doi = {10.1037/a0019512}, author = {Jack H Noone and Christine Stephens and Fiona M. Alpass} } @article {7457, title = {Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of U.S. older adults.}, journal = {Res Gerontol Nurs}, volume = {3}, year = {2010}, month = {2010 Apr}, pages = {113-25}, publisher = {3}, abstract = {

This study assesses sociodemographic and health-related factors associated with loneliness and outcome differences between loneliness groups using a sample of 13,812 older adults from the U.S Health and Retirement Study. Descriptive and bivariate analyses were followed by logistic regression to evaluate risks and analysis of covariance testing to determine outcome differences. Overall, prevalence of loneliness was 16.9\%. Nonmarried status, poorer self-report of health, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household were all associated with loneliness. The chronically lonely group reported less exercise, more tobacco use, less alcohol use, a greater number of chronic illnesses, higher depression scores, and greater average number of nursing home stays. Future research evaluating the effectiveness of both prevention and treatment interventions for loneliness in older adults would provide empirical data to further guide gerontological nursing practice.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, Humans, Logistic Models, Loneliness, Male, Middle Aged, Multivariate Analysis, Risk Factors, Socioeconomic factors, United States}, issn = {1940-4921}, doi = {10.3928/19404921-20091103-99}, author = {Laurie A. Theeke} } @article {7465, title = {Stability and changes in living arrangements: relationship to nursing home admission and timing of placement.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Nov}, pages = {783-91}, publisher = {65}, abstract = {

OBJECTIVES: To examine whether stability of living arrangements and changes in household composition-both types and frequency-influence nursing home placement or timing to entry among older people.

METHODS: Data from the first 5 waves of the Assets and Health Dynamics of the Elderly (1993-2002) on 8,093 persons aged 70 years or older at baseline are used in probit and hazard models to predict nursing home entry and time to entry.

RESULTS: Stable living arrangements carry different risks of institutionalization. Those living continuously alone or with others were at highest risk; at lowest risk were those living continuously with a spouse or the same child (lowest overall). Changes in household composition were protective against nursing home entry and slowed time to entry; types of change were not influential when number of changes was taken into account.

DISCUSSION: Results suggest that stability of living arrangements in and of itself is not protective against institutionalization. Having options that allow one to change living arrangements over time in response to changing needs for assistance is of importance if the goal is to avoid institutional care or extend community residence prior to entry.

}, keywords = {Aged, Aged, 80 and over, Family Characteristics, Female, Health Status, Homes for the Aged, Humans, Institutionalization, Male, Marital Status, Multivariate Analysis, Nursing homes, Risk Factors, Single Person, Socioeconomic factors, Time Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbq023}, author = {Judith D Kasper and Liliana E Pezzin and Rice, J Bradford} } @article {7456, title = {Successful aging in the United States: prevalence estimates from a national sample of older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 Mar}, pages = {216-26}, publisher = {65B}, abstract = {

OBJECTIVES: To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn{\textquoteright}s concept of successful aging.

METHODS: Using data from the Health and Retirement Study, the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn{\textquoteright}s definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities.

RESULTS: No greater than 11.9\% of older adults were aging "successfully" in any year. The adjusted odds of successful aging were generally lower for those of advanced age, male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25\%, after accounting for demographic changes in the older population.

DISCUSSION: Few older adults meet the criteria put forth in Rowe and Kahn{\textquoteright}s definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging.

}, keywords = {Affect, Aged, Aging, Female, Health Status, Humans, Male, Middle Aged, Prevalence, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp101}, author = {Sara J McLaughlin and Cathleen M. Connell and Steven G Heeringa and Lydia W Li and J Scott Roberts} } @article {7446, title = {Urban neighborhood context and mortality in late life.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Mar}, pages = {197-218}, publisher = {22}, abstract = {

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults.

METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census.

RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic.

DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

}, keywords = {Age Factors, Aged, Aging, Cognition, Confidence Intervals, depression, Female, Health Status, Humans, Los Angeles, Male, Middle Aged, Mortality, Odds Ratio, Poverty, Psychometrics, Residence Characteristics, Self Report, Socioeconomic factors, Statistics as Topic, Urban Population}, issn = {1552-6887}, doi = {10.1177/0898264309355980}, author = {Richard G Wight and Janet R. Cummings and Arun S Karlamangla and Carol S Aneshensel} } @article {7379, title = {The aftermath of hip fracture: discharge placement, functional status change, and mortality.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Nov 15}, pages = {1290-9}, publisher = {170}, abstract = {

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73\% of fracture patients were white women, 45\% had pertrochanteric fractures, and 55\% underwent surgical pinning. Most patients (58\%) were discharged to a nursing facility, with 14\% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7\%, 19\%, and 26\%, respectively. Declines in functional-status-scale scores ranged from 29\% on the fine motor skills scale to 56\% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Health Status, Health Status Indicators, Hip Fractures, Humans, Interviews as Topic, Iowa, Length of Stay, Logistic Models, Medicare, Patient Discharge, Prospective Studies, Psychometrics, Socioeconomic factors, Time Factors, Treatment Outcome, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp266}, author = {Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert B Wallace and Robert L. Ohsfeldt and Michael P Jones and Gary E Rosenthal and Frederic D Wolinsky} } @article {7375, title = {Bridge employment and retirees{\textquoteright} health: a longitudinal investigation.}, journal = {J Occup Health Psychol}, volume = {14}, year = {2009}, note = {PMID: 19839658}, month = {2009 Oct}, pages = {374-89}, publisher = {14}, abstract = {

The present study examined the relationship between bridge employment and retirees{\textquoteright} health outcomes (i.e., major diseases, functional limitations, and mental health). We used a nationally representative sample of 12,189 retirees from the first 4 waves of the Health and Retirement Study. Hierarchical regression analyses showed that compared with full retirement, engaging in bridge employment either in a career field or in a different field was associated with fewer major diseases and functional limitations, whereas engaging in career bridge employment was associated with better mental health. The findings highlight the health benefits of engaging in bridge employment for retirees. The practical implications of this study are discussed at both the individual and policy levels. Limitations of the current findings are also noted in conjunction with future research directions.

}, keywords = {Employment, Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Retirement, United States}, issn = {1939-1307}, doi = {10.1037/a0015285}, author = {Zhan, Yujie and Wang, Mo and Liu, Songqi and Kenneth S. Shultz} } @article {7404, title = {Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty.}, journal = {Med Care}, volume = {47}, year = {2009}, month = {2009 Jul}, pages = {742-8}, publisher = {47}, abstract = {

BACKGROUND: This study assessed changes in physical functional status following receipt of total knee arthroplasty (TKA) for patients diagnosed with osteoarthritis (OA) of the knee in a national sample of persons aged 65+ in the United States relative to a sample of similar OA patients who did not receive TKA.

METHODS: Data from the Health Retirement Survey (HRS) and linked Medicare claims from 1994 to 2006 were used to identify persons with diagnoses of OA of the lower leg who received a TKA (n = 516) and those who did not receive TKA (n = 1756). Predicted probabilities of receiving total knee arthroplasty from logit analysis were used for matching TKA and comparison groups on demographic, socioeconomic, and baseline functional status factors. Functional status measures were: mobility, gross motor function, large muscle, and limitations in activities of daily living (ADL). Average treatment effects of the treated (ATT), which compares changes in functional status between those who received TKA with similar individuals who did not receive TKA, were computed using propensity score matching.

RESULTS: Mobility (average treatment effect of the treated (ATT = 0.315; 95\% CI: 0.118-0.512), gross motor function (ATT = 0.314; 95\% CI: 0.156-0.472), and ADL limitations (ATT = 0.174; 95\% CI: 0.055-0.293), improved among persons receiving TKA relative to the comparison group. Relative to the mean values of the physical function at baseline, mobility, gross motor function, and ADL limitations persons receiving TKA had better functional outcomes than the comparison group by 17.5, 39.3, and 46.9 percent, respectively.

CONCLUSIONS: TKA is effective in improving functional status in elderly persons.

}, keywords = {Activities of Daily Living, Aged, Arthroplasty, Replacement, Knee, Attitude to Health, Geriatric Assessment, Health Care Surveys, Health Status, Health Surveys, Humans, Insurance Claim Reporting, Logistic Models, Longitudinal Studies, Medicare, Mobility Limitation, Multivariate Analysis, Muscle Weakness, Osteoarthritis, Knee, pain, Sensitivity and Specificity, Surveys and Questionnaires, Treatment Outcome, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31819a5ae3}, author = {Frank A Sloan and Ruiz, David and Alyssa C Platt} } @article {7346, title = {Cognitive health among older adults in the United States and in England.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, note = {PMID: 19555494}, month = {2009 Jun 25}, pages = {23}, publisher = {9}, abstract = {

BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.

METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87\% for the HRS vs. 67\% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).

RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction).

CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, England, Female, Health Status, Humans, Longitudinal Studies, Male, Neuropsychological tests, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-23}, author = {Kenneth M. Langa and David J Llewellyn and Iain A Lang and David R Weir and Robert B Wallace and Mohammed U Kabeto and Felicia A Huppert} } @article {7309, title = {Compensatory conscientiousness and health in older couples.}, journal = {Psychol Sci}, volume = {20}, year = {2009}, month = {2009 May}, pages = {553-9}, publisher = {20}, abstract = {

The present study tested the effect of conscientiousness and neuroticism on health and physical limitations in a representative sample of older couples (N= 2,203) drawn from the Health and Retirement Study. As in past research, conscientiousness predicted better health and physical functioning, whereas neuroticism predicted worse health and physical functioning. Unique to this study was the finding that conscientiousness demonstrated a compensatory effect, such that husbands{\textquoteright} conscientiousness predicted wives{\textquoteright} health outcomes above and beyond wives{\textquoteright} own personality. The same pattern held true for wives{\textquoteright} conscientiousness as a predictor of husbands{\textquoteright} health outcomes. Furthermore, conscientiousness and neuroticism acted synergistically, such that people who scored high for both traits were healthier than others. Finally, we found that the combination of high conscientiousness and high neuroticism was also compensatory, such that the wives of men with this combination of personality traits reported better health than other women.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, Conscience, Female, Health Status, Humans, Longevity, Longitudinal Studies, Male, Middle Aged, Neurotic Disorders, Personality Inventory, Social Conformity, Spouses}, issn = {1467-9280}, doi = {10.1111/j.1467-9280.2009.02339.x}, author = {Brent W Roberts and Jacqui Smith and Joshua J Jackson and Edmonds, Grant} } @article {7355, title = {Does job loss cause ill health?}, journal = {Health Econ}, volume = {18}, year = {2009}, month = {2009 Sep}, pages = {1075-89}, publisher = {18}, abstract = {

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers{\textquoteright} business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality.

}, keywords = {Activities of Daily Living, Age Factors, Cohort Studies, Cross-Sectional Studies, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Sex Factors, Smoking, Socioeconomic factors}, issn = {1099-1050}, doi = {10.1002/hec.1537}, author = {Salm, Martin} } @article {7299, title = {Early Life Health and Cognitive Function in Old Age.}, journal = {Am Econ Rev}, volume = {99}, year = {2009}, month = {2009 May}, pages = {104-109}, publisher = {99}, keywords = {Adult, Aged, Child, Cognition Disorders, Communicable Diseases, Health Status, Humans, Infant, Infant Mortality, United States}, issn = {0002-8282}, doi = {10.1257/aer.99.2.104}, author = {Case, Anne and Paxson, Christina} } @article {7351, title = {The effect of retirement on weight.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Sep}, pages = {656-65}, publisher = {64B}, abstract = {

OBJECTIVES: People who are close to retirement age show the highest rates of weight gain and obesity. We investigate the effect of retirement on the change in body mass index (BMI) in diverse groups varying by wealth status and occupation type.

METHODS: Six panels of the Health and Retirement Study (1992-2002) on individuals aged 50-71 were used (N = 37,807). We used fixed-effects regression models with instrumental variables method to estimate the causal effect of retirement on change in the BMI.

RESULTS: Retirement leads to modest weight gain, 0.24 BMI on average. Weight gain with retirement was found among people who were already overweight and those with lower wealth retiring from physically demanding occupations. The cumulative effect of aging among people in their 50s, however, outweighs the effect of retirement; the average BMI gain between ages 50 and 60 is 1.30, 5 times the effect of retirement.

CONCLUSIONS: Given the increasing number of people approaching retirement age, the population level impact of the weight gain ascribed to retirement on health outcomes and health care system might be significant. Future research should evaluate programs targeted to older adults who are most likely to gain weight with retirement.

}, keywords = {Aged, Aging, Body Mass Index, Cohort Studies, Cross-Sectional Studies, Female, Geriatric Assessment, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Motor Activity, Obesity, Overweight, Pensions, Retirement, Social Security, Socioeconomic factors, United States, Weight Gain}, issn = {1758-5368}, doi = {10.1093/geronb/gbn044}, author = {Chung, Sukyung and Marisa E Domino and Sally C. Stearns} } @article {7328, title = {Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work.}, journal = {Soc Work Health Care}, volume = {48}, year = {2009}, month = {2009}, pages = {154-68}, publisher = {48}, abstract = {

Two statistical methods were compared to identify key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Social Work{\textquoteright}s interest in services to the elderly makes this research critical to the profession. Effectively transitioning the "baby boomer" population into appropriate long-term care will be a great societal challenge. It remains a challenge paramount to the practice of social work. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. Multivariable logistic regression and Cox proportional hazards model were performed and compared. Older age, lower self-perceived health, worse instrumental activities of daily living (IADL), psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic; owning a home; and having lower level of cognitive impairment reduced the admission risk. Home ownership showed a significant effect in logistic regression, but a marginal effect in the Cox model. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression, used frequently in analyses, can provide a good approximation to the Cox model in identifying factors of LSNH admission. However, the Cox model gives more information on how soon the LSNH admission may happen. Our analyses, based on two models, dually identified the factors associated with LSNH admission; therefore, results discussed confidently provide implications for both public and private long-term care policies, as well as improving the assessment capabilities of social work practitioners for development of screening programs among at-risk elderly. Given the predicted surge in this population, significant factors found from this study can be utilized in a strengths-based empowerment approach by social workers to aid in avoiding LSNH utilization.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment, Health Status, Homes for the Aged, Humans, Logistic Models, Male, Mental Health, Nursing homes, Proportional Hazards Models, Risk Factors, Sex Factors, Social work, Socioeconomic factors, United States}, issn = {0098-1389}, doi = {10.1080/00981380802580588}, author = {Cai, Qian and J. Warren Salmon and Mark E. Rodgers} } @article {7341, title = {Fall risk in older adults: roles of self-rated vision, home modifications, and limb function.}, journal = {J Aging Health}, volume = {21}, year = {2009}, month = {2009 Aug}, pages = {655-76}, publisher = {21}, abstract = {

Objective. To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method. Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results. Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion. Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Disabled Persons, Educational Status, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Musculoskeletal Physiological Phenomena, Risk, Risk Factors, Self-Assessment, Self-Help Devices, Surveys and Questionnaires, Vision, Low, Visual Acuity, White People}, issn = {0898-2643}, doi = {10.1177/0898264309338295}, author = {Bernard A Steinman and Pynoos, Jon and Anna Q D Nguyen} } @article {7393, title = {Health and well-being in older married female cancer survivors.}, journal = {J Am Geriatr Soc}, volume = {57 Suppl 2}, year = {2009}, month = {2009 Nov}, pages = {S286-8}, publisher = {57}, abstract = {

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.

}, keywords = {Age Factors, Case-Control Studies, Depressive Disorder, Female, Health Status, Health Status Indicators, Health Surveys, Humans, Marriage, Middle Aged, Neoplasms, Predictive Value of Tests, Risk Factors, Survivors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02514.x}, author = {Aloen L. Townsend and Karen J Ishler and Karen F Bowman and Rose, Julia Hannum and Peak, Nicole Juszczak} } @article {7304, title = {The health effects of Medicare for the near-elderly uninsured.}, journal = {Health Serv Res}, volume = {44}, year = {2009}, month = {2009 Jun}, pages = {926-45}, publisher = {44}, abstract = {

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.

}, keywords = {Aged, Attitude to Health, Female, Follow-Up Studies, Health Services Accessibility, Health Services Research, Health Status, Health Surveys, Humans, Insurance Coverage, Logistic Models, Male, Medically Uninsured, Medicare, Mortality, Multivariate Analysis, Program Evaluation, Retirement, Socioeconomic factors, Statistics, Nonparametric, United States}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.00964.x}, author = {Daniel Polsky and Jalpa A Doshi and Jos{\'e} J Escarce and Manning, Willard and Susan M Paddock and Cen, Liyi and Jeannette Rogowski} } @article {7384, title = {The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey.}, journal = {BMC Public Health}, volume = {9}, year = {2009}, month = {2009 Nov 14}, pages = {412}, publisher = {9}, abstract = {

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{\textquoteright} 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.

}, keywords = {Aged, Bereavement, Educational Status, Female, Follow-Up Studies, Health Status, Health Surveys, Humans, Lung Diseases, Obstructive, Male, Marriage, Middle Aged, Outcome Assessment, Health Care, Proportional Hazards Models, Smoking, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-9-412}, author = {Noda, Tatsuya and Ojima, Toshiyuki and Hayasaka, Shinya and Hagihara, Okihito and Takayanagi, Ryoichi and Nobutomo, Koichi} } @article {7353, title = {Marital biography and health at mid-life.}, journal = {J Health Soc Behav}, volume = {50}, year = {2009}, month = {2009 Sep}, pages = {344-58}, publisher = {50}, abstract = {

This article develops a series of hypotheses about the long-term effects of one{\textquoteright}s history of marriage, divorce, and widowhood on health, and it tests those hypotheses using data from the Health and Retirement Study. We examine four dimensions of health at mid-life: chronic conditions, mobility limitations, self-rated health, and depressive symptoms. We find that the experience of marital disruption damages health, with the effects still evident years later; among the currently married, those who have ever been divorced show worse health on all dimensions. Both the divorced and widowed who do not remarry show worse health than the currently married on all dimensions. Dimensions of health that seem to develop slowly, such as chronic conditions and mobility limitations, show strong effects of past marital disruption, whereas others, such as depressive symptoms, seem more sensitive to current marital status. Those who spent more years divorced or widowed show more chronic conditions and mobility limitations.

}, keywords = {Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Marital Status, Middle Aged, United States}, issn = {0022-1465}, doi = {10.1177/002214650905000307}, author = {Mary Elizabeth Hughes and Linda J. Waite} } @article {7400, title = {Medicare savings programs: analyzing options for expanding eligibility.}, journal = {Inquiry}, volume = {46}, year = {2009}, note = {Journal Article}, month = {2009-2010 Winter}, pages = {391-404}, publisher = {46}, abstract = {

The Medicare Savings Programs (MSPs) are designed to provide financial assistance to Medicare beneficiaries who do not qualify for full Medicaid coverage. This paper considers changes in eligibility that would better align MSP program rules with those related to receiving low-income subsidies for the Medicare Part D drug benefit. These changes would make more people eligible for the MSPs and could encourage greater participation; similar changes were incorporated in recently passed legislation. Our analysis, based on 2006 data from the Health and Retirement Study, shows there is a trade-off between making larger numbers of beneficiaries eligible by eliminating resource requirements and better targeting of individuals with greater health care needs by expanding income standards.

}, keywords = {Aged, Demography, Disabled Persons, Eligibility Determination, Female, Health Status, Humans, Income, Male, Medical Assistance, Medicare, Medicare Part D, Public Policy, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.4.391}, url = {URL:http://www.inquiryjournal.org Publisher{\textquoteright}s URL}, author = {Zuckerman, Stephen and Shang, Baoping and Timothy A Waidmann} } @article {7396, title = {Memory and depressive symptoms are dynamically linked among married couples: longitudinal evidence from the AHEAD study.}, journal = {Dev Psychol}, volume = {45}, year = {2009}, note = {PMID: 19899917}, month = {2009 Nov}, pages = {1595-610}, publisher = {45}, abstract = {

This study examined dyadic interrelations between episodic memory and depressive symptom trajectories of change in old and advanced old age. The authors applied dynamic models to 10-year incomplete longitudinal data of initially 1,599 married couples from the study of Asset and Health Dynamics Among the Oldest Old (M(age) = 75 years at Time 1). The authors found domain-specific lead-lag associations (time lags of 2 years) among wives and husbands as well as between spouses. For memory, better performance among husbands protected against subsequent memory decline among wives, with no evidence of a directed effect in the other direction. For depressive symptoms, wives{\textquoteright} scores predicted subsequent depression increase and memory decline among husbands. Possible individual covariates (age, education, functional limitations) and spousal covariates (length of marriage, number of children, and whether the couple remained intact over the study period) did not account for differential lead-lag associations. The findings of antecedent-consequent relations between wives and husbands are consistent with life-span notions that individual development both influences and is influenced by contextual factors such as close social relationships.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interpersonal Relations, Longitudinal Studies, Male, Marriage, Mental Recall, Models, Psychological, Quality of Life, Spouses}, issn = {1939-0599}, doi = {10.1037/a0016346}, author = {Denis Gerstorf and Christiane A Hoppmann and Kelly M Kadlec and John J McArdle} } @article {7348, title = {Neighborhood safety, socioeconomic status, and physical activity in older adults.}, journal = {Am J Prev Med}, volume = {37}, year = {2009}, month = {2009 Sep}, pages = {207-13}, publisher = {37}, abstract = {

BACKGROUND: Neighborhood environment can have a substantial influence on the level of physical activity among older adults. Yet, the moderating influence of various measures of SES on the association between perceived neighborhood safety and leisure-time physical activity (LTPA) among older adults remains unknown.

PURPOSE: The study was designed to investigate the association between perceived neighborhood safety and LTPA in a nationally representative sample of older adults, and to evaluate SES characteristics as potential effect modifiers in the association between perceived neighborhood safety and LTPA.

METHODS: Cross-sectional data from the 2004 Health and Retirement Study of older adults aged >or=50 years were used to examine the association between perceived neighborhood safety and LTPA. Differences in LTPA were evaluated across three measures of SES: education, household income, and household wealth. SES was also evaluated as a potential effect modifier in the association between perceived neighborhood safety and LTPA. The analysis was conducted in 2008.

RESULTS: An SES gradient in LTPA was noted across measures of SES used in this study. After controlling for SES and demographic characteristics and functional limitations, older adults who perceived their neighborhood as safe had an 8\% higher mean rate of LTPA compared to older adults who perceived their neighborhood as unsafe. The association was no longer significant when self-rated health was added. Additionally, SES was not a significant effect modifier in the association between perceived neighborhood safety and LTPA.

CONCLUSIONS: SES, demographic characteristics, and functional limitations substantially attenuated the positive association between perceived neighborhood safety and LTPA; however, with the inclusion of self-rated health, the association was no longer present. This finding suggests that self-rated health may mediate this association. The lack of significance in the interaction between perceived neighborhood safety and SES suggests that prevention efforts to increase physical activity among older adults should consider perceptions of neighborhood safety as a potential barrier regardless of SES.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Florida, Health Status, Humans, Leisure activities, Male, Middle Aged, Motor Activity, Recreation, Residence Characteristics, Safety, Sex Distribution, Social Support, Socioeconomic factors, Surveys and Questionnaires}, issn = {1873-2607}, doi = {10.1016/j.amepre.2009.06.005}, author = {Reginald D. Tucker-Seeley and Subramanian, S V and Li, Yi and Sorensen, Glorian} } @article {7362, title = {Predictors of loneliness in U.S. adults over age sixty-five.}, journal = {Arch Psychiatr Nurs}, volume = {23}, year = {2009}, month = {2009 Oct}, pages = {387-96}, publisher = {23}, abstract = {

The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3\%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, Humans, Likelihood Functions, Logistic Models, Loneliness, Male, Prevalence, Risk Factors, Single Person, Socioeconomic factors, United States}, issn = {1532-8228}, doi = {10.1016/j.apnu.2008.11.002}, author = {Laurie A. Theeke} } @article {7336, title = {Preferences, beliefs, and self-management of diabetes.}, journal = {Health Serv Res}, volume = {44}, year = {2009}, note = {PMID: 19674433}, month = {2009 Jun}, pages = {1068-87}, publisher = {44}, abstract = {

OBJECTIVE: To assess relationships between self-assessed control over life events, subjective beliefs about longevity, time and risk preference, and other factors on use of recommended care for diabetes mellitus (DM), self-assessed control of diabetes, general health, and laboratory measures of HbA1c levels.

DATA SOURCES: Health and Retirement Study (HRS) and 2003 HRS Diabetes Study (HRS-DS).

STUDY DESIGN: We used logit and ordered logit analyses to assess use of recommended care, and subjective and objective measures of health outcomes.

DATA COLLECTION: Secondary analysis of HRS and HRS-DS data.

PRINCIPAL FINDINGS: Individuals with higher self-assessed control over life events and higher subjective probabilities of living 10 years engaged in more recommended DM care practices and had better self-assessed DM control and general health. However, these beliefs did not influence HbA1c levels. More highly educated and cognitively able persons were more likely to follow care recommendations. There were differences by race/ethnicity in health outcomes, but not in health investment among Hispanics.

CONCLUSIONS: Individuals{\textquoteright} beliefs about control over life events and longevity influenced health investment and subjective health outcomes, although these beliefs did not translate into differences in HbA1c levels. Hispanics may realize lower returns on health investments, at least for diabetes care.

}, keywords = {Black or African American, Choice Behavior, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Hispanic or Latino, Humans, Internal-External Control, Logistic Models, Longevity, Longitudinal Studies, Male, Patient Compliance, Risk Assessment, Self Care, Self-Assessment, Socioeconomic factors, Surveys and Questionnaires}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.00957.x}, author = {Frank A Sloan and Padr{\'o}n, Norma A and Alyssa C Platt} } @article {7349, title = {Prevalence of depression among older Americans: the Aging, Demographics and Memory Study.}, journal = {Int Psychogeriatr}, volume = {21}, year = {2009}, note = {PMID: 19519984}, month = {2009 Oct}, pages = {879-88}, publisher = {21}, abstract = {

BACKGROUND: Previous studies have attempted to provide estimates of depression prevalence in older adults. The Aging, Demographics and Memory Study (ADAMS) is a population-representative study that included a depression assessment, providing an opportunity to estimate the prevalence of depression in late life in the U.S.A.

METHODS: The ADAMS sample was drawn from the larger Health and Retirement Study. A total of 851 of 856 ADAMS participants aged 71 and older had available depression data. Depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF) and the informant depression section of the Neuropsychiatric Inventory (NPI). We estimated the national prevalence of depression, stratified by age, race, sex, and cognitive status. Logistic regression analyses were performed to examine the association of depression and previously reported risk factors for the condition.

RESULTS: When combining symptoms of major or minor depression with reported treatment for depression, we found an overall depression prevalence of 11.19\%. Prevalence was similar for men (10.19\%) and women (11.44\%). Whites and Hispanics had nearly three times the prevalence of depression found in African-Americans. Dementia diagnosis and pain severity were associated with increased depression prevalence, while black race was associated with lower rates of depression.

CONCLUSIONS: The finding of similar prevalence estimates for depression in men and women was not consistent with prior research that has shown a female predominance. Given the population-representativeness of our sample, similar depression rates between the sexes in ADAMS may result from racial, ethnic and socioeconomic diversity.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Black People, Cohort Studies, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status, Hispanic or Latino, Humans, Male, Neuropsychological tests, Personality Assessment, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1041-6102}, doi = {10.1017/S1041610209990044}, author = {David C Steffens and Gwenith G Fisher and Kenneth M. Langa and Guy G Potter and Brenda L Plassman} } @article {7363, title = {Risk factors associated with injury attributable to falling among elderly population with history of stroke.}, journal = {Stroke}, volume = {40}, year = {2009}, month = {2009 Oct}, pages = {3286-92}, publisher = {40}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life.

METHODS: We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model.

RESULTS: We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53\% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46\%, 15\%, and 2.1\% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2).

CONCLUSIONS: This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Aging, Causality, Cohort Studies, Comorbidity, disease progression, Female, Health Status, Humans, Male, Marital Status, Mental Disorders, Movement Disorders, Prevalence, Risk Factors, Risk Reduction Behavior, Sex Distribution, Stroke, Urinary incontinence, Wounds and Injuries}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.109.559195}, author = {Afshin A Divani and Vazquez, Gabriela and Anna M Barrett and Asadollahi, Marjan and Andreas R Luft} } @article {7297, title = {Spouse-rated vs self-rated health as predictors of mortality.}, journal = {Arch Intern Med}, volume = {169}, year = {2009}, month = {2009 Dec 14}, pages = {2156-61}, publisher = {169}, abstract = {

BACKGROUND: The Health and Retirement Study is a national sample of Americans older than 50 years and their spouses. The present study evaluated cross-sectional and longitudinal data from January 2000 through December 2006. The objective of the study was to evaluate the roles of spouse-rated vs self-rated health as predictors of all-cause mortality among adults older than 50 years.

METHODS: A total of 673 dyads of married couples were randomly selected to participate in a Health and Retirement Study module examining spouse-rated health. For each couple, one member was asked to rate his or her overall health status, and his or her spouse was asked to report the partner{\textquoteright}s overall health status. Mortality data were available through 2006.

RESULTS: Our findings demonstrate that spouse-rated health (area under the curve, 0.75) is as strong a predictor of mortality as self-rated health (area under the curve, 0.73) (chi(2)(1) = 0.36, P = .54). Combining spouse-rated and self-rated health predicts mortality better than using self-rated health alone (area under the curve, 0.77) (chi(2)(1) = 6.72, P = .009).

CONCLUSIONS: Spouse ratings of health are at least as strongly predictive of mortality as self-rated health. This suggests that, when self-rated health is elicited as a prognostic indicator, spouse ratings can be used when self-ratings are unavailable. Both measures together may be more informative than either measure alone.

}, keywords = {Aged, Cross-Sectional Studies, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Self-Assessment, Spouses}, issn = {1538-3679}, doi = {10.1001/archinternmed.2009.386}, author = {Liat Ayalon and Kenneth E Covinsky} } @article {7370, title = {Statistical design and estimation for the national social life, health, and aging project.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64 Suppl 1}, year = {2009}, month = {2009 Nov}, pages = {i12-9}, publisher = {64B}, abstract = {

OBJECTIVES: The paper discusses the sample design of the National Social Life, Health, and Aging Project (NSHAP) and how the design affects how estimates should be calculated from the survey data. The NSHAP study allows researchers to study the links between sexuality and health in older adults. The goal of the design was to represent adults aged 57-85 years in six demographic domains.

METHODS: The sample design begins with a national area probability sample of households, carried out jointly with the 2004 round of the Health and Retirement Study. Selection of respondents for NSHAP balanced age and gender subgroups and oversampled African Americans and Latinos. Data collection was carried out from July 2005 to March 2006.

RESULTS: The survey obtained an overall response rate of 75.5\%.

DISCUSSION: The complex sample design requires that the selection probabilities and the field implementation be accounted for in estimating population parameters. The data set contains weights to compensate for differential probabilities of selection and response rates among demographic groups. Analysts should use weights in constructing estimates from the survey and account for the complex sample design in estimating standard errors for survey estimates.

}, keywords = {Aged, Aged, 80 and over, Aging, Bias, Data collection, Data Interpretation, Statistical, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Mass Screening, Middle Aged, Research Design, Sampling Studies, Sexual Behavior, Social Behavior, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp045}, author = {O{\textquoteright}Muircheartaigh, Colm and Eckman, Stephanie and Smith, Stephen} } @article {7320, title = {Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Nov}, pages = {492-7}, publisher = {5}, abstract = {

BACKGROUND: Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point scores to rate global cognitive function.

METHODS: The MMSE, TICS-30, and TICS-40 scores from 746 community-dwelling elders who participated in the Aging, Demographics, and Memory Study (ADAMS) were analyzed with equipercentile equating, a statistical process of determining comparable scores based on percentile equivalents for different forms of an examination.

RESULTS: Scores from the MMSE and TICS-30 and TICS-40 corresponded well, and clinically relevant cut-point scores were determined. For example, an MMSE score of 23 is equivalent to 17 and 20 on the TICS-30 and TICS-40, respectively.

CONCLUSIONS: These findings indicate that TICS and MMSE scores can be linked directly. Clinically relevant and important MMSE cut points and the respective ADAMS TICS-30 and TICS-40 cut-point scores are included, to identify the degree of cognitive impairment among respondents with any type of cognitive disorder. These results will help in the widespread application of TICS in both research and clinical practice.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cognition Disorders, Disability Evaluation, Female, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Male, Mass Screening, Models, Statistical, Neuropsychological tests, Predictive Value of Tests, Psychiatric Status Rating Scales, Remote Consultation, Reproducibility of Results, Sensitivity and Specificity}, issn = {1552-5279}, doi = {10.1016/j.jalz.2009.02.007}, author = {Tamara G Fong and Michael A Fearing and Richard N Jones and Peilin Shi and Edward R Marcantonio and James L Rudolph and Frances Margaret Yang and Dan K Kiely and Sharon K Inouye} } @article {7232, title = {Chronic conditions and mortality among the oldest old.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, note = {PMID 18511714}, month = {2008 Jul}, pages = {1209-14}, publisher = {98}, abstract = {

OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

RESULTS: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

CONCLUSIONS: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Female, Health Behavior, Health Status, Humans, Male, Middle Aged, Models, Statistical, Predictive Value of Tests, Proportional Hazards Models, Reproducibility of Results, Risk Adjustment, Severity of Illness Index, Socioeconomic factors, Survival Analysis, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.130955}, author = {Sei J. Lee and Alan S Go and Lindquist, Karla and Bertenthal, Daniel and Kenneth E Covinsky} } @article {7214, title = {Declines in late-life disability: the role of early- and mid-life factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Apr}, pages = {1588-602}, publisher = {66}, abstract = {

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2\% in 1995 to 26.0\% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother{\textquoteright}s education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Disabled Persons, Female, Frail Elderly, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Male, Morbidity, Population Surveillance, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.037}, author = {Vicki A Freedman and Linda G Martin and Robert F. Schoeni and Jennifer C. Cornman} } @article {10810, title = {Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments.}, journal = {J Epidemiol Community Health}, volume = {62}, year = {2008}, month = {2008 Jun}, pages = {532-7}, abstract = {

BACKGROUND: The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.

METHODS: CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education{\textquoteright}s effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.

RESULTS: After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education{\textquoteright}s effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.

CONCLUSIONS: Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.

}, keywords = {Aged, Aging, Censuses, Child, Cognition, Education, Educational Status, Female, Health Status, Humans, Least-Squares Analysis, Male, Massachusetts, Memory, Schools, Socioeconomic factors}, issn = {1470-2738}, doi = {10.1136/jech.2006.059469}, author = {M. Maria Glymour and Ichiro Kawachi and Jencks, Christopher and Lisa F Berkman} } @article {7307, title = {Effects of social integration on preserving memory function in a nationally representative US elderly population.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, month = {2008 Jul}, pages = {1215-20}, publisher = {98}, abstract = {

OBJECTIVES: We tested whether social integration protects against memory loss and other cognitive disorders in late life in a nationally representative US sample of elderly adults, whether effects were stronger among disadvantaged individuals, and whether earlier cognitive losses explained the association (reverse causation).

METHODS: Using data from the Health and Retirement Study (N = 16,638), we examined whether social integration predicted memory change over 6 years. Memory was measured by immediate and delayed recall of a 10-word list. Social integration was assessed by marital status, volunteer activity, and frequency of contact with children, parents, and neighbors. We examined growth-curve models for the whole sample and within subgroups.

RESULTS: The mean memory score declined from 11.0 in 1998 to 10.0 in 2004. Higher baseline social integration predicted slower memory decline in fully adjusted models (P<.01). Memory among the least integrated declined at twice the rate as among the most integrated. This association was largest for respondents with fewer than 12 years of education. There was no evidence of reverse causation.

CONCLUSIONS: Our study provides evidence that social integration delays memory loss among elderly Americans. Future research should focus on identifying the specific aspects of social integration most important for preserving memory.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Male, Mental Health, Mental Recall, Predictive Value of Tests, Reproducibility of Results, Severity of Illness Index, social isolation, Social Support, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.113654}, author = {Karen A Ertel and M. Maria Glymour and Lisa F Berkman} } @article {7252, title = {Gender differences in functional status in middle and older age: are there any age variations?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Sep}, pages = {S282-92}, publisher = {63B}, abstract = {

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women{\textquoteright}s socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Disabled Persons, Female, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Sex Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s282}, author = {Jersey Liang and Joan M. Bennett and Benjamin A Shaw and Ana R Qui{\~n}ones and Wen Ye and Xiao Xu and Mary Beth Ofstedal} } @article {7234, title = {Health status and health dynamics in an empirical model of expected longevity.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 May}, pages = {564-84}, publisher = {27}, abstract = {

Expected longevity is an important factor influencing older individuals{\textquoteright} 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.

}, keywords = {Chronic disease, Delivery of Health Care, Empirical Research, Female, Health Expenditures, Health Status, Humans, Life Expectancy, Longevity, Male, Models, Econometric}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.09.008}, author = {Hugo Ben{\'\i}tez-Silva and Ni, Huan} } @article {7262, title = {Job loss, retirement and the mental health of older Americans.}, journal = {J Ment Health Policy Econ}, volume = {11}, year = {2008}, month = {2008 Dec}, pages = {167-76}, publisher = {11}, abstract = {

BACKGROUND: Millions of older individuals cope with physical limitations, cognitive changes, and various losses such as bereavement that are commonly associated with aging. Given increased vulnerability to various health problems during aging, work displacement might exacerbate these due to additional distress and to possible changes in medical coverage. Older Americans are of increasing interest to researchers and policymakers due to the sheer size of the Baby Boom cohort, which is approaching retirement age, and due to the general decline in job security in the U.S. labor market.

AIMS OF THE STUDY: This research compares and contrasts the effect of involuntary job loss and retirement on the mental health of older Americans. Furthermore, it examines the impact of re-employment on the depressive symptoms.

METHODS: There are two fundamental empirical challenges in isolating the effect of employment status on mental health. The first is to control for unobserved heterogeneity--all latent factors that could impact mental health so as to establish the correct magnitude of the effect of employment status. The second challenge is to verify the direction of causality. First difference models are used to control for latent effects and a two-stage least squares regression is used to account for reverse causality.

RESULTS: We find that involuntary job loss worsens mental health, and re-employment recaptures the past mental health status. Retirement is found to improve mental health of older Americans.

DISCUSSION: With the use of longitudinal data from the Health and Retirement Study surveys and the adoption of proper measures to control for the possibility of reverse causality, this study provides strong evidence of elevating depressive symptoms with involuntary job displacement even after controlling for other late-life events. Women suffer from greater distress levels than men after job loss due to business closure or lay-off. However, women also exhibit better psychological well-being than men following retirement. The present study is the first to report that the re-employment of involuntary job-loss sufferers leads to a recapturing of past mental health status. Additionally, we find that re-entering the labor force is psychologically beneficial to retirees as well.

IMPLICATIONS FOR HEALTH CARE PROVISION: It is well established that out-of-pocket expenditures on all forms of health care for seniors with self-diagnosed depression significantly exceeds expenditures for seniors with other common ailments such as hypertension and arthritis in the U.S. Thus, our research suggests that re-employment of older Americans displaced from the labor force will be cost-effective with regard to personal mental health outcomes.

IMPLICATIONS FOR HEALTH POLICIES: That re-employment of involuntary job loss sufferers leads to a recapturing of past mental health status illuminates one potential policy trade off - increased resources dedicated to job training and placement for older U.S. workers could reap benefits with regard to reduced private and public mental health expenditures.

IMPLICATIONS FOR FURTHER RESEARCH: Further research could more clearly assess the degree to which the mental health benefits of employment among older Americans would warrant the expansion of job training and employment programs aimed at this group.

}, keywords = {depression, Female, Health Status, Humans, Insurance Coverage, Insurance, Health, Life Change Events, Longitudinal Studies, Male, Mental Health, Middle Aged, Retirement, Socioeconomic factors, Stress, Psychological, Unemployment, United States}, issn = {1091-4358}, doi = {10.2139/ssrn.991134}, author = {Mandal, Bidisha and Roe, Brian} } @article {7282, title = {Life with and without heart disease among women and men over 50.}, journal = {J Women Aging}, volume = {20}, year = {2008}, month = {2008}, pages = {5-19}, publisher = {20}, abstract = {

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Heart Diseases, Humans, Life Expectancy, Male, Middle Aged, Myocardial Infarction, Patient Education as Topic, Prejudice, Risk Factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {0895-2841}, doi = {10.1300/j074v20n01_02}, author = {Eileen M. Crimmins and Mark D Hayward and Ueda, Hiroshi and Saito, Yasuhiko and Jung K Kim} } @article {7203, title = {Long-term effects of cancer survivorship on the employment of older workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {193-210}, publisher = {43}, abstract = {

OBJECTIVE: To estimate the long-term effects of cancer survivorship on the employment of older workers.

DATA SOURCES: Primary data for 504 subjects who were 55-65 in 2002 and were working when diagnosed with cancer in 1997-1999, and secondary data for a comparison group of 3,903 similarly aged workers in the Health and Retirement Study (HRS) in 2002.

STUDY DESIGN: Three employment outcomes (working, working full time, usual hours per week) were compared between the two groups. Both Probit/Tobit regressions and propensity score matching were used to adjust for potentially confounding differences between groups. Sociodemographic characteristics, baseline employment characteristics, and the presence of other health conditions were included as covariates.

DATA COLLECTION METHODS: Four telephone interviews were conducted annually with cancer survivors identified from tumor registries at four large hospitals in Pennsylvania and Maryland. Many of the questions were taken from the HRS to facilitate comparisons.

PRINCIPAL FINDINGS: Cancer survivors of both genders worked an average of 3-5 hours less per week than HRS controls. For females, we found significant effects of survivorship on the probability of working, the probability of working full-time, and hours. For males, survivorship affected the probability of full-time employment and hours without significantly reducing the probability of working. For both genders, these effects were primarily attributable to new cancers. There were no significant effects on the employment of cancer-free survivors.

CONCLUSIONS: Survivors with recurrences or second primary tumors may particularly benefit from employment support services and workplace accommodation. Reassuringly, any long-term effects on the employment of cancer-free survivors are fairly small.

}, keywords = {Age Factors, Aged, Data collection, Demography, Disease-Free Survival, Employment, Female, Health Status, Humans, Male, Maryland, Middle Aged, Neoplasms, Pennsylvania, Probability, Prospective Studies, Registries, Retrospective Studies, Sickness Impact Profile, Survivors, Time Factors}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00752.x}, author = {Pamela F. Short and Joseph J. Vasey and John R. Moran} } @article {7258, title = {Memory decline and depressive symptoms in a nationally representative sample of older adults: the Health and Retirement Study (1998-2004).}, journal = {Dement Geriatr Cogn Disord}, volume = {25}, year = {2008}, month = {2008}, pages = {266-71}, publisher = {25}, abstract = {

BACKGROUND/AIMS: Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at risk have not been specified in previous study designs. We aimed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time.

METHODS: Data from a prospective cohort study (Health and Retirement Study; 1998-2004; n = 18,465), a multistage national probability sample of older adults in the United States, were analyzed. Verbal learning and memory of a 10-word list learning task were the main outcomes. Depressive symptoms (Center for Epidemiologic Studies - Depression Scale) constituted the main predictor.

RESULTS: Depressive symptoms were associated with significantly lower immediate (-0.05; p < 0.001) and delayed (-0.06; p < 0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases.

CONCLUSIONS: In this US national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by the demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation{\textquoteright}s older adult population.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Health Status, Humans, Incidence, Male, Memory Disorders, Neuropsychological tests, Prevalence, Retirement, United States}, issn = {1421-9824}, doi = {10.1159/000115976}, author = {Hector M Gonz{\'a}lez and Mary E Bowen and Gwenith G Fisher} } @article {7223, title = {Productive activities and psychological well-being among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Mar}, pages = {S64-72}, publisher = {63B}, abstract = {

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life.

METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies.

RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants.

DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, depression, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Models, Psychological, Psychological Theory, Psychomotor Performance, Quality of Life, Social Environment, Volunteers}, issn = {1079-5014}, doi = {10.1093/geronb/63.2.s64}, author = {Hao, Yanni} } @article {7239, title = {Retirement and weight changes among men and women in the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S146-53}, publisher = {63B}, abstract = {

OBJECTIVES: Older adults may experience weight changes upon retirement for a number of reasons, such as being less physically active; having less structured meal times; and consuming food in response to losing personal identity, the potential for social interactions, or the sense of accomplishment derived from working. The purpose of this study was to determine whether retirement was associated with either weight gain or weight loss.

METHODS: We used the 1994-2002 Health and Retirement Study to determine whether retirement between biennial interviews was associated with weight change, separately for men (n = 1,966) and women (n = 1,759). We defined weight change as a 5\% increase or decrease in body mass index between interviews.

RESULT: . We did not find a significant association between retirement and weight change among men. Women who retired were more likely to gain weight than women who continued to work at least 20 hr per week (odds ratio [OR] = 1.24, 95\% confidence interval [CI] = 1.04-1.48). We found a significant relationship between retirement and weight gain only for women who were normal weight upon retiring (OR = 1.30, 95\% CI = 1.01-1.69) and who retired from blue-collar jobs (OR = 1.58, 95\% CI = 1.13-2.21).

DISCUSSION: Public health interventions may be indicated for women, particularly those working in blue-collar occupations, in order to prevent weight gain upon retirement.

}, keywords = {Aged, Aging, Body Mass Index, Body Weight, Demography, depression, Female, Health Behavior, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Obesity, Retirement}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s146}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7204, title = {Spousal concordance in health behavior change.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {96-116}, publisher = {43}, abstract = {

OBJECTIVE: This study examines the degree to which a married individual{\textquoteright}s health habits and use of preventive medical care are influenced by his or her spouse{\textquoteright}s behaviors.

STUDY DESIGN: Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a function of changes in his or her spouse{\textquoteright}s health habits. Specifically, we analyze changes in smoking, drinking, exercising, cholesterol screening, and obtaining a flu shot.

DATA SOURCE: This study uses data from the Health and Retirement Study (HRS), a nationally representative sample of individuals born between 1931 and 1941 and their spouses. Beginning in 1992, 12,652 persons (age-eligible individuals as well as their spouses) from 7,702 households were surveyed about many aspects of their life, including health behaviors, use of preventive services, and disease diagnosis.

SAMPLE: The analytic sample includes 6,072 individuals who are married at the time of the initial HRS survey and who remain married and in the sample at the time of the 1996 and 2000 waves.

PRINCIPAL FINDINGS: We consistently find that when one spouse improves his or her behavior, the other spouse is likely to do so as well. This is found across all the behaviors analyzed, and persists despite controlling for many other factors.

CONCLUSIONS: Simultaneous changes occur in a number of health behaviors. This conclusion has prescriptive implications for developing interventions, treatments, and policies to improve health habits and for evaluating the impact of such measures.

}, keywords = {Attitude to Health, Cross-Sectional Studies, Exercise, Family Characteristics, Female, Health Behavior, Health Care Surveys, Health Promotion, Health Status, Humans, Interpersonal Relations, Life Style, Male, Marriage, Middle Aged, Preventive Health Services, Prospective Studies, Risk-Taking, Smoking, Spouses, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00754.x}, author = {Tracy Falba and Jody L Sindelar} } @article {7151, title = {Age group differences in depressive symptoms among older adults with functional impairments.}, journal = {Health Soc Work}, volume = {32}, year = {2007}, month = {2007 Aug}, pages = {177-88}, publisher = {32}, abstract = {

This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Demography, depression, Disabled Persons, Female, Health Status, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, United States}, issn = {0360-7283}, doi = {10.1093/hsw/32.3.177}, author = {Namkee G Choi and Kim, Johnny S.} } @article {7142, title = {All in the family: the impact of caring for grandchildren on grandparents{\textquoteright} health.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Mar}, pages = {S108-19}, publisher = {62}, abstract = {

OBJECTIVES: The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults.

METHODS: Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health.

RESULTS: We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents{\textquoteright} health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit.

DISCUSSION: Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents{\textquoteright} prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Aging, Caregivers, Child Care, Child, Preschool, Family Relations, Female, Health Status, Humans, Intergenerational Relations, Male, Middle Aged, Parenting, Risk Assessment, Stress, Psychological}, issn = {1079-5014}, doi = {10.1093/geronb/62.2.s108}, author = {Mary Elizabeth Hughes and Linda J. Waite and Tracey A. LaPierre and Ye Luo} } @article {7156, title = {Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the Health and Retirement Study, 1992 2002.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jul}, pages = {S209-17}, publisher = {62}, abstract = {

OBJECTIVE: This study analyzed whether socioeconomic status in older middle age continues to be associated with 10-year survival after data are controlled for baseline health status.

METHODS: We confirmed deaths through 2002 for 9,759 participants in the Health and Retirement Study, aged 51 to 61 in 1992. We used discrete time survival models to examine hazard ratios over 10 years of follow-up. We examined associations of demographic characteristics and socioeconomic status measures before and after adjustment by health status and behavioral risk factors.

RESULT: The 10-year mortality rate was 10.9\%, ranging from 4.7\% for respondents reporting excellent health to 35.8\% for those reporting poor health at baseline. Lower levels of education, income, and wealth were strongly associated with higher mortality risk after we controlled for just demographic characteristics. After further adjustment for health status and behavioral risk factors, only household income remained significant.

DISCUSSION: Baseline health by age 50 is an important pathway in the association between midlife socioeconomic status and mortality risk to age 70. The continuing effect of low household income on mortality risk was concentrated among respondents reporting excellent to good health at baseline. Socioeconomic disparities in middle-age health continue to limit disability-free life expectancy at older ages.

}, keywords = {Adult, Aged, Aged, 80 and over, Economics, Education, Follow-Up Studies, Health Status, Humans, Income, Middle Aged, Mortality, Motor Activity, Pilot Projects, Proportional Hazards Models, Retirement, Risk Factors, Risk-Taking, Smoking, Social Class, Thinness, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.4.s209}, author = {Joseph Feinglass and Lin, Suru and Jason A. Thompson and Joseph J Sudano and Dorothy D Dunlop and Song, Jing and David W. Baker} } @article {7165, title = {Childhood social and economic well-being and health in older age.}, journal = {Am J Epidemiol}, volume = {166}, year = {2007}, month = {2007 Nov 01}, pages = {1059-67}, publisher = {166}, abstract = {

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants{\textquoteright} mean age was 67 years; 57\% were women. By race/ethnicity, 76\% were White, 14\% were Black, and 8\% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95\% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95\% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95\% CI: 1.21, 1.47) and Black (AOR = 1.37, 95\% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Child, Confidence Intervals, Educational Status, Female, Frail Elderly, Health Status, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged, Mobility Limitation, Odds Ratio, Poverty, Retrospective Studies, Sampling Studies, San Francisco, Socioeconomic factors, Surveys and Questionnaires, White People}, issn = {0002-9262}, doi = {10.1093/aje/kwm185}, author = {Sandra Y. Moody-Ayers and Lindquist, Karla and Sen, Saunak and Kenneth E Covinsky} } @article {7177, title = {Does more health care improve health among older adults? A longitudinal analysis.}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Dec}, pages = {888-906}, publisher = {19}, abstract = {

OBJECTIVE: This research assesses the association of health services use with subsequent physical health among older Americans, adjusting for the confounding between health care use and prior health.

METHOD: Longitudinal data are from the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Linear and logistic regressions are used to model the linkages between medical care use and health outcomes, including self-rated health, functional limitations, and mortality.

RESULTS: There is limited evidence that increased health care use is correlated with improved subsequent health. Increased use of medical care is largely associated with poorer health outcomes. Moreover, there are no significant interaction effects of health care use and baseline health on Activities of Daily Living and Instrumental Activities of Daily Living, despite the existence of a significant but very small interaction effect on self-rated health.

CONCLUSIONS: The findings have implications for the quality of care delivered by the American health care system.

}, keywords = {Activities of Daily Living, Aged, Health Services, Health Services for the Aged, Health Status, Humans, Longitudinal Studies, United States}, issn = {0898-2643}, doi = {10.1177/0898264307308338}, author = {Ezra Golberstein and Jersey Liang and A. R. Quinones and Frederic D Wolinsky} } @article {8741, title = {Evidence on early-life income and late-life health from America{\textquoteright}s Dust Bowl era.}, journal = {Proceedings of the National Academy of Sciences }, volume = {104}, year = {2007}, month = {2007 Aug 14}, pages = {13244-9}, abstract = {

In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America{\textquoteright}s Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today.

}, keywords = {Aged, Data collection, Female, Health Status, History, 20th Century, Humans, Income, Male, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {0027-8424}, doi = {10.1073/pnas.0700035104}, author = {David M Cutler and Grant Miller and Douglas M Norton} } @article {7137, title = {Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {137-58}, publisher = {44}, abstract = {

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.

}, keywords = {Adult, Age Factors, Child, Child Welfare, Health Status, Humans, Middle Aged, Myocardial Infarction, North Carolina, Poverty, Risk Assessment, Risk Factors, Sex Factors, Social Class, Socioeconomic factors, Time}, issn = {0070-3370}, doi = {10.1353/dem.2007.0004}, author = {Jenifer Hamil-Luker and Angela M O{\textquoteright}Rand} } @article {7174, title = {Health of previously uninsured adults after acquiring Medicare coverage.}, journal = {JAMA}, volume = {298}, year = {2007}, month = {2007 Dec 26}, pages = {2886-94}, publisher = {298}, abstract = {

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.

}, keywords = {Aged, Cardiovascular Diseases, depression, Diabetes Mellitus, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Medically Uninsured, Medicare, Middle Aged, Outcome Assessment, Health Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.298.24.2886}, author = {J. Michael McWilliams and Meara, Ellen and Alan M. Zaslavsky and John Z. Ayanian} } @article {7123, title = {The long-term effects of poor childhood health: an assessment and application of retrospective reports.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {113-35}, publisher = {44}, abstract = {

This study assesses retrospective childhood health reports and examines childhood health as a predictor of adult health. The results suggest that such reports are of reasonable reliability as to warrant their judicious use in population research. They also demonstrate a large positive relationship between childhood and adult health. Compared with excellent, very good, or good childhood health, poor childhood health is associated with more than three times greater odds of having poor adult self-rated health and twice the risk of a work-limiting disability or a chronic health condition. These associations are independent of childhood and current socioeconomic position and health-related risk behaviors.

}, keywords = {Adolescent, Adult, Age Factors, Aged, Child, Child Welfare, Child, Preschool, Chronic disease, Disabled Persons, Female, Health Status, Humans, Infant, Infant, Newborn, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Time, United States}, issn = {0070-3370}, doi = {10.1353/dem.2007.0003}, author = {Steven A Haas} } @article {7144, title = {New evidence of racial differences in access and their effects on the use of nursing homes among older adults.}, journal = {Med Care}, volume = {45}, year = {2007}, month = {2007 Jul}, pages = {672-9}, publisher = {45}, abstract = {

BACKGROUND: Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them.

METHODS: Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated.

RESULTS: After adjusting for baseline covariates, it was found that blacks were 26\% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds.

CONCLUSIONS: The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.

}, keywords = {Aged, Assisted Living Facilities, Attitude to Health, Black or African American, Female, Health Services Accessibility, Health Status, Homes for the Aged, Humans, Male, Nursing homes, Socioeconomic factors, Time Factors, White People}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e3180455677}, author = {Adaeze B Akamigbo and Frederic D Wolinsky} } @article {7130, title = {Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Feb}, pages = {152-77}, publisher = {19}, abstract = {

This study examined the unique effects of four variable groups on changes in older adults{\textquoteright} depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4\%) of variance in the follow-up CES-D score.

}, keywords = {Aged, Caregivers, depression, Employment, Female, Forecasting, Health Behavior, Health Status, Humans, Male, Marital Status, Middle Aged, Netherlands, Regression Analysis, Sweden, United States, Volunteers}, issn = {0898-2643}, doi = {10.1177/0898264306297602}, author = {Namkee G Choi and Bohman, Thomas M.} } @article {7184, title = {The relationship between self-rated health and mortality in older black and white Americans.}, journal = {J Am Geriatr Soc}, volume = {55}, year = {2007}, month = {2007 Oct}, pages = {1624-9}, publisher = {55}, abstract = {

OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.

RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95\% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95\% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Black People, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Mortality, Population Surveillance, Prognosis, Self Disclosure, Sex Distribution, United States, White People}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2007.01360.x}, author = {Sei J. Lee and Sandra Y. Moody-Ayers and C. Seth Landefeld and Louise C Walter and Lindquist, Karla and Mark Segal and Kenneth E Covinsky} } @article {7132, title = {Self-rated health trajectories and mortality among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S22-7}, publisher = {62}, abstract = {

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Attitude to Health, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, Health Status, Health Status Indicators, Humans, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Mortality, Multivariate Analysis, Risk Factors, Sex Factors, Smoking, Socioeconomic factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s22}, author = {Thomas R Miller and Frederic D Wolinsky} } @article {7098, title = {Changes in health for the uninsured after reaching age-eligibility for Medicare.}, journal = {J Gen Intern Med}, volume = {21}, year = {2006}, month = {2006 Nov}, pages = {1144-9}, publisher = {21}, abstract = {

BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.

OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.

DESIGN: Prospective cohort study.

PARTICIPANTS: Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.

MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)).

RESULTS: Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95\% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95\% CI 0.96 to 1.56) or agility (ARR 1.33; 95\% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.

CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.

}, keywords = {Age Factors, Aged, Cohort Studies, Eligibility Determination, Female, Health Status, Humans, Male, Medically Uninsured, Medicare, Middle Aged, Prospective Studies, United States}, issn = {1525-1497}, doi = {10.1111/j.1525-1497.2006.00576.x}, author = {David W. Baker and Joseph Feinglass and Durazo-Arvizu, Ramon and Whitney P. Witt and Joseph J Sudano and Jason A. Thompson} } @article {7083, title = {Cohabitation among older adults: a national portrait.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Mar}, pages = {S71-9}, publisher = {61}, abstract = {

OBJECTIVE: Older adults are increasingly likely to experience cohabitation, or living together unmarried in an intimate, heterosexual union. In order to begin building a conceptual framework, we provide a descriptive portrait of older adult cohabitors, emphasizing how they compare to older remarrieds and unpartnereds.

METHODS: We used data from both Census 2000 and the 1998 Health and Retirement Study ( HRS; Health and Retirement Study, 1998) to estimate the size and composition of the cohabiting population aged 51 and older. Also, using HRS data, we estimated multinomial logistic regression models to identify the correlates associated with cohabitation and remarriage (vs being unpartnered) among women and men who were previously married.

RESULT: More than 1 million older adults, composing 4\% of the unmarried population, currently cohabit. About 90\% of these individuals were previously married. We identify significant differences among cohabitors, remarrieds, and unpartnereds across several dimensions, including sociodemographic characteristics, economic resources, physical health, and social relationships. Cohabitors appear to be more disadvantaged than remarrieds, and this is especially evident for women.

DISCUSSION: Older cohabitors differ from individuals of other marital statuses, and therefore future work on marital status should explicitly incorporate cohabitation.

}, keywords = {Activities of Daily Living, Demography, Female, Health Status, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Residence Characteristics, Sexual Partners, Surveys and Questionnaires, United States}, issn = {1079-5014}, doi = {10.1093/geronb/61.2.s71}, author = {Susan L. Brown and Lee, Gary R. and Jennifer R. Bulanda} } @article {7105, title = {Driving cessation and consumption expenses in the later years.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Nov}, pages = {S347-53}, publisher = {61B}, abstract = {

OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status.

METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out).

RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46\% to 63\% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips).

DISCUSSION: The findings demonstrate the association between older people{\textquoteright}s driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.

}, keywords = {Aged, Automobile Driving, Economics, Female, Health Status, Humans, Male, Sex Factors, Surveys and Questionnaires, Transportation}, issn = {1079-5014}, doi = {10.1093/geronb/61.6.s347}, author = {Hyungsoo Kim and Virginia E. Richardson} } @article {7095, title = {The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study.}, journal = {Health Serv Res}, volume = {41}, year = {2006}, month = {2006 Jun}, pages = {759-87}, publisher = {41}, abstract = {

OBJECTIVE: Primarily, to determine if the presence of private insurance leads to improved health status, as measured by a survey-based health score. Secondarily, to explore sensitivity of estimates to adjustments for endogeneity. The study focuses on adults in late middle age who are nearing entry into Medicare.

DATA SOURCES: The analysis file is drawn from the Health and Retirement Study, a national survey of relatively older adults in the labor force. The dependent variable, an index of 5 health outcome items, was obtained from the 1996 survey. Independent variables were obtained from the 1992 survey. State-level instrumental variables were obtained from the Area Resources File and the TAXSIM file. The final sample consists of 9,034 individuals of which 1,540 were uninsured.

STUDY DESIGN: Estimation addresses endogeneity of the insurance participation decision in health score regressions. In addition to ordinary least squares (OLS), two models are tested: an instrumental variables (IV) model, and a model with endogenous treatment effects due to Heckman (1978). Insurance participation and health behaviors enter with a lag to allow their effects to dissipate over time. Separate regressions were run for groupings of chronic conditions.

PRINCIPAL FINDINGS: The OLS model results in statistically significant albeit small effects of insurance on the computed health score, but the results may be downward biased. Adjusting for endogeneity using state-level instrumental variables yields up to a six-fold increase in the insurance effect. Results are consistent across IV and treatment effects models, and for major groupings of medical conditions. The insurance effect appears to be in the range of about 2-11 percent. There appear to be no significant differences in the insurance effect for subgroups with and without major chronic conditions.

CONCLUSIONS: Extending insurance coverage to working age adults may result in improved health. By conjecture, policies aimed at expanding coverage to this population may lead to improved health at retirement and entry to Medicare, potentially leading to savings. However, further research is needed to determine whether similar results are found when alternative measures of overall health or health scores are used. Future research should also explore the use of alternative instrumental variables. Preliminary results provide no justification for targeting certain subgroups with susceptibility to certain chronic conditions rather than broad policy interventions.

}, keywords = {Chronic disease, Data collection, Female, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Private Sector, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2006.00513.x}, author = {Avi Dor and Joseph J Sudano and David W. Baker} } @article {7089, title = {Insurance coverage and health care use among near-elderly women.}, journal = {Womens Health Issues}, volume = {16}, year = {2006}, note = {Official publication of the Jacobs Institute of Women{\textquoteright}s Health}, month = {2006 May-Jun}, pages = {139-48}, publisher = {16}, abstract = {

OBJECTIVES: Data on near-elderly (ages 55-64) women{\textquoteright}s access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women{\textquoteright}s health insurance coverage in the United States and how it may influence their use of health care services.

METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women{\textquoteright}s use of outpatient services, inpatient services, and prescription medication over a 2-year period.

RESULTS: In 2002, 9.4\% of near-elderly women in the United States were uninsured and 15.4\% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost.

CONCLUSIONS: The nature of a near-elderly woman{\textquoteright}s insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

}, keywords = {Attitude to Health, Female, Health Services Accessibility, Health Services Needs and Demand, Health Status, Humans, Insurance Coverage, Insurance, Health, Medically Uninsured, Middle Aged, Patient Acceptance of Health Care, Socioeconomic factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {1049-3867}, doi = {10.1016/j.whi.2006.02.005}, author = {Xiao Xu and Patel, Divya A. and Vahratian, Anjel and Ransom, Scott B.} } @article {7117, title = {Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses.}, journal = {Psychol Aging}, volume = {21}, year = {2006}, month = {2006 Mar}, pages = {140-51}, publisher = {21}, abstract = {

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.

}, keywords = {Aged, Cross-Sectional Studies, depression, Female, Follow-Up Studies, Health Status, Hostility, Humans, Loneliness, Male, Middle Aged, Risk Factors, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires}, issn = {0882-7974}, doi = {10.1037/0882-7974.21.1.140}, author = {John T. Cacioppo and Mary Elizabeth Hughes and Linda J. Waite and Louise C Hawkley and Ronald A. Thisted} } @article {7110, title = {Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions.}, journal = {Gerontologist}, volume = {46}, year = {2006}, month = {2006 Aug}, pages = {464-73}, publisher = {46}, abstract = {

PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.

DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.

RESULTS: Expectations are not normally distributed: 14\% of the participants refused to answer, 51\% estimated no chance, 10\% indicated a 1\% to 50\% chance, 21\% indicated an 11\% to 50\% chance and 4\% indicated a 51\% to 100\% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.

IMPLICATIONS: Black and White older adults{\textquoteright} expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.

}, keywords = {Age Factors, Aged, Female, Health Status, Homes for the Aged, Humans, Male, Nursing homes, Patient Admission, Risk Factors, Sex Factors, Social Support, Socioeconomic factors}, issn = {0016-9013}, doi = {10.1093/geront/46.4.464}, author = {Adaeze B Akamigbo and Frederic D Wolinsky} } @article {7097, title = {Retirement patterns from career employment.}, journal = {Gerontologist}, volume = {46}, year = {2006}, month = {2006 Aug}, pages = {514-23}, publisher = {46}, abstract = {

PURPOSE: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal.

DESIGN AND METHODS: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model.

RESULTS: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution.

IMPLICATIONS: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment.

}, keywords = {Aged, Aged, 80 and over, Aging, Career Choice, Employment, Female, Health Status, Humans, Income, Male, Middle Aged, Pensions, Retirement, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/46.4.514}, author = {Kevin E. Cahill and Michael D. Giandrea and Joseph F. Quinn} } @article {7080, title = {The tide to come: elderly health in Latin America and the Caribbean.}, journal = {J Aging Health}, volume = {18}, year = {2006}, note = {Article English}, month = {2006 Apr}, pages = {180-206}, publisher = {18}, abstract = {

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status{\textquoteright} connection to early conditions has some merit.

}, keywords = {Aged, Aged, 80 and over, Caribbean Region, Child, Diabetes Mellitus, Forecasting, Health Status, Heart Diseases, Humans, Latin America, Malnutrition, Middle Aged, Mortality, Nutritional Status, United States}, issn = {0898-2643}, doi = {10.1177/0898264305285664}, author = {Alberto Palloni and Mary McEniry and Rebeca Wong and Pelaez, M.} } @article {7021, title = {Health and living arrangements among older Americans: does marriage matter?}, journal = {J Aging Health}, volume = {17}, year = {2005}, month = {2005 Jun}, pages = {305-35}, publisher = {17}, abstract = {

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.

}, keywords = {Adult children, Aged, Demography, Health Status, Humans, Institutionalization, Marital Status, Marriage, Mental Health, Parents, Residence Characteristics, Social Support, Socioeconomic factors, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264305276300}, author = {Jersey Liang and Brown, Joseph W. and Krause, Neal M. and Mary Beth Ofstedal and Joan M. Bennett} } @article {7014, title = {Health events and the smoking cessation of middle aged Americans.}, journal = {J Behav Med}, volume = {28}, year = {2005}, month = {2005 Feb}, pages = {21-33}, publisher = {28}, abstract = {

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.

}, keywords = {Diabetes Mellitus, Female, Health Behavior, Health Status, Heart Failure, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Smoking, Smoking cessation, Social Environment, Socioeconomic factors, United States}, issn = {0160-7715}, doi = {10.1007/s10865-005-2560-1}, author = {Tracy Falba} } @article {7017, title = {Health insurance coverage during the years preceding medicare eligibility.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Apr 11}, pages = {770-6}, publisher = {165}, abstract = {

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.

}, keywords = {Age Factors, Black or African American, Cohort Studies, Female, Health Status, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Middle Aged, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.165.7.770}, author = {David W. Baker and Joseph J Sudano} } @article {7030, title = {Health, wealth, and happiness: financial resources buffer subjective well-being after the onset of a disability.}, journal = {Psychol Sci}, volume = {16}, year = {2005}, month = {2005 Sep}, pages = {663-6}, publisher = {16}, abstract = {

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{\textquoteright} 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.

}, keywords = {Activities of Daily Living, Cross-Sectional Studies, Disability Evaluation, Female, Follow-Up Studies, Happiness, Health Status, Humans, Male, Middle Aged, Quality of Life, Socioeconomic factors}, issn = {0956-7976}, doi = {10.1111/j.1467-9280.2005.01592.x}, author = {Dylan M Smith and Kenneth M. Langa and Mohammed U Kabeto and Peter A. Ubel} } @article {6992, title = {Heavy alcohol use and marital dissolution in the USA.}, journal = {Soc Sci Med}, volume = {61}, year = {2005}, month = {2005 Dec}, pages = {2304-16}, publisher = {61}, abstract = {

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.

}, keywords = {Alcohol Drinking, Alcohol-Related Disorders, Divorce, Female, Health Status, Humans, Male, Middle Aged, Social Class, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2005.07.021}, author = {Ostermann, Jan and Frank A Sloan and Donald H. Taylor Jr.} } @article {7011, title = {The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Mar}, pages = {S93-S101}, publisher = {60B}, abstract = {

OBJECTIVES: To examine the relationships between socioeconomic status (SES) and health across the life course and their variations by gender and race/ethnicity.

METHODS: The sample included 19,949 respondents aged 50 or over from the 1998 Health and Retirement Study.

RESULTS: Lower childhood SES was associated with worse health outcomes in later life. Part of the effect of childhood SES on adult health occurred through childhood health. The impact of childhood SES on education and income in adulthood explained an even larger share of this effect. We also found a stronger effect of adult SES for those with lower childhood SES than for those with more advantaged childhoods. Moreover, childhood SES had a similar impact on health in later life for women and men and for Whites and non-Whites. However, college education seemed more important for women{\textquoteright}s later health, whereas income seemed more important for men{\textquoteright}s health. Education appeared to have a weaker effect on adult health for Blacks and Hispanics than for Whites.

DISCUSSION: Both childhood and adult SES are important for health. The negative impact of low childhood SES can be partially ameliorated if people from a low SES position during childhood mobilize to higher status in adulthood.

}, keywords = {Aged, Aging, Black People, Child, Cognition, Cohort Studies, Data collection, Education, ethnicity, Female, Health Status, Hispanic or Latino, Humans, Income, Male, Mental Health, Middle Aged, Quality of Life, Retirement, Sex Factors, Social Class, White People}, issn = {1079-5014}, doi = {10.1093/geronb/60.2.s93}, author = {Ye Luo and Linda J. Waite} } @article {7040, title = {The impact of diabetes on employment and work productivity.}, journal = {Diabetes Care}, volume = {28}, year = {2005}, month = {2005 Nov}, pages = {2662-7}, publisher = {28}, abstract = {

OBJECTIVE: The purpose of this study was to longitudinally examine the effect of diabetes on labor market outcomes.

RESEARCH DESIGN AND METHODS: Using secondary data from the first two waves (1992 and 1994) of the Health and Retirement Study, we identified 7,055 employed respondents (51-61 years of age), 490 of whom reported having diabetes in wave 1. We estimated the effect of diabetes in wave 1 on the probability of working in wave 2 using probit regression. For those working in wave 2, we modeled the relationships between diabetic status in wave 1 and the change in hours worked and work-loss days using ordinary least-squares regressions and modeled the presence of health-related work limitations using probit regression. All models control for health status and job characteristics and are estimated separately by sex.

RESULTS: Among individuals with diabetes, the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes. Change in weekly hours worked was not statistically significantly associated with diabetes. Women with diabetes had 2 more work-loss days per year compared with women without diabetes. Compared with individuals without diabetes, men and women with diabetes were 5.4 and 6 percentage points (absolute increase), respectively, more likely to have work limitations.

CONCLUSIONS: This article provides evidence that diabetes affects patients, employers, and society not only by reducing employment but also by contributing to work loss and health-related work limitations for those who remain employed.

}, keywords = {Diabetes Mellitus, Efficiency, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Odds Ratio, United States, Work}, issn = {0149-5992}, doi = {10.2337/diacare.28.11.2662}, author = {Tunceli, Kaan and Cathy J. Bradley and Nerenz, David and L Keoki Williams and Pladevall, Manel and Elston, Lafata J.} } @article {7026, title = {The impact of obesity on active life expectancy in older American men and women.}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Aug}, pages = {438-44}, publisher = {45}, abstract = {

PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans.

DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability.

RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled.

IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Health Surveys, Humans, Life Expectancy, Life Tables, Logistic Models, Male, Markov chains, Obesity, Risk Factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.4.438}, author = {Sandra L Reynolds and Saito, Yasuhiko and Eileen M. Crimmins} } @article {7051, title = {Men who work at age 70 or older.}, journal = {J Gerontol Soc Work}, volume = {45}, year = {2005}, month = {2005}, pages = {41-63}, publisher = {45}, abstract = {

The federal policy on older workers has shifted from the encouragement of early withdrawal from the labor force to the encouragement of continuous participation in the labor force. In this light, it is instructive to investigate the backgrounds of elderly people who work at age 70 or older. This article presents the findings of a study, using data from the 1993 Asset and Health Dynamics of the Oldest Old Study, that investigated the effects of health, economic conditions (net worth, employer-provided pensions, and supplemental medical insurance coverage), education, and spouse{\textquoteright}s work status on the probability of working among men aged 70 or older. The study addressed the probability of working, the probability of working fulltime and of working part-time, and the probability of being self-employed and of being employed by others. Implications for policy are discussed.

}, keywords = {Aged, Employment, Health Status, Humans, Logistic Models, Male, Multivariate Analysis, Public Policy, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v45n04_04}, author = {Martha N. Ozawa and Terry Y S Lum} } @article {7044, title = {Physical and mental health status of older long-term cancer survivors.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2145-52}, publisher = {53}, abstract = {

OBJECTIVES: To assess the physical and mental health status of older long-term cancer survivors.

DESIGN: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls.

SETTING: General community population in the United States.

PARTICIPANTS: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study.

MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy.

RESULTS: Cancer survivors reported higher rates of lung disease (13.9\% vs 9.6\%; P=.001), heart condition (29.3\% vs 22.9\%; P<.001), arthritis (69.4\% vs 59.4\%; P<.001), incontinence (26.6\% vs 19.7\%; P=.001), frequent pain (36.4\% vs 29.4\%; P=.005), and obesity (27.0\% vs 24.2\%; P=.001) than individuals without cancer but lower rates of smoking (12.0\% vs 14.8\%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2\% vs 44.6\%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004).

CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Chronic disease, Cohort Studies, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Mental Health, Middle Aged, Neoplasms, Survivors, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00507.x}, author = {Nancy L. Keating and Norredam, Marie and Landrum, Mary Beth and Haiden A. Huskamp and Meara, Ellen} } @article {7024, title = {Profiles of self-rated health in midlife adults with chronic illnesses.}, journal = {Nurs Res}, volume = {54}, year = {2005}, month = {2005 May-Jun}, pages = {167-77}, publisher = {54}, abstract = {

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time.

OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time.

METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time.

RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes.

DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

}, keywords = {Chronic disease, Comorbidity, Data collection, Educational Status, Exercise, Female, Health Behavior, Health Status, Humans, Male, Marital Status, Middle Aged, Nursing Research, Smoking}, issn = {0029-6562}, doi = {10.1097/00006199-200505000-00004}, author = {Finnegan, Lorna and Marion, Lucy and Cox, Cheryl} } @article {7039, title = {What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings.}, journal = {Med Care}, volume = {43}, year = {2005}, month = {2005 Oct}, pages = {1054-7}, publisher = {43}, abstract = {

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age.

METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration.

RESULTS: A total of 1015 subjects responded to the rating task (98\% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P{\textquoteright}s<0.075), whereas responses to the your-age scale did not (P=0.8).

CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Attitude to Health, Calibration, Female, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Male, Prospective Studies, Psychometrics, Self Concept}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000178193.38413.70}, author = {Peter A. Ubel and Jankovic, Aleksandra and Dylan M Smith and Kenneth M. Langa and Angela Fagerlin} } @article {7055, title = {When is baseline adjustment useful in analyses of change? An example with education and cognitive change.}, journal = {Am J Epidemiol}, volume = {162}, year = {2005}, month = {2005 Aug 01}, pages = {267-78}, publisher = {162}, abstract = {

In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased.

}, keywords = {Age Factors, Aged, Bias, Cognition Disorders, Educational Status, Epidemiologic Methods, Female, Health Status, Humans, Longitudinal Studies, Male, Models, Statistical, Neuropsychological tests, Regression Analysis, United States}, issn = {0002-9262}, doi = {10.1093/aje/kwi187}, author = {M. Maria Glymour and Weuve, Jennifer and Lisa F Berkman and Ichiro Kawachi and Robins, James M.} } @article {6963, title = {Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age.}, journal = {Am J Public Health}, volume = {94}, year = {2004}, month = {2004 Sep}, pages = {1567-73}, publisher = {94}, abstract = {

OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning.

METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression.

RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals.

CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.

}, keywords = {Attitude to Health, Body Mass Index, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Obesity, Quality of Life, Risk Assessment, Risk Factors, Risk Reduction Behavior, Self Care, United States}, issn = {0090-0036}, doi = {10.2105/ajph.94.9.1567}, author = {Xiaoxing He and David W. Baker} } @article {6984, title = {Brief communication: the relationship between having a living will and dying in place.}, journal = {Ann Intern Med}, volume = {141}, year = {2004}, month = {2004 Jul 20}, pages = {113-7}, publisher = {141}, abstract = {

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95\% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients{\textquoteright} preferences for location of death.

}, keywords = {Aged, Death, Health Status, Homes for the Aged, Hospices, Hospital Mortality, Housing, Humans, Living Wills, Nursing homes, Retrospective Studies}, issn = {1539-3704}, doi = {10.7326/0003-4819-141-2-200407200-00009}, author = {Howard B Degenholtz and Rhee, YongJoo and Robert M. Arnold} } @article {6924, title = {The effect of spousal mental and physical health on husbands{\textquoteright} and wives{\textquoteright} depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Jun}, pages = {398-425}, publisher = {16}, abstract = {

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms in a national sample of older married couples.

METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms.

RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses{\textquoteright} physical health was associated with a significant reduction in respondent depressive symptoms (p < .05).

DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

}, keywords = {Aged, Caregivers, depression, Female, Health Status, Humans, Male, Mental Health, Models, Theoretical, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264304264208}, author = {Michele J. Siegel and Elizabeth H Bradley and William T Gallo and Stanislav V Kasl} } @article {6983, title = {Elders who delay medication because of cost: health insurance, demographic, health, and financial correlates.}, journal = {Gerontologist}, volume = {44}, year = {2004}, month = {2004 Dec}, pages = {779-87}, publisher = {44}, abstract = {

PURPOSE: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost.

DESIGN AND METHODS: This was a cross-sectional study of a nationwide sample of 6,535 elders participating in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Participants reported if they had taken less medication than prescribed or if they had not filled prescriptions because of cost in the past 2 years. This response was then compared with the self-report of multiple variables, including demographic, health status, health insurance coverage, and financial variables.

RESULTS: Elders who were most vulnerable to medication delay as a result of cost included those with Medicare coverage only, low income, high out-of-pocket prescription costs, and poor health as well as African American elders and those aged 65-80 years.

IMPLICATIONS: This study provides important information about community-dwelling elders that reported a delay in medication use because of cost. As a Medicare prescription benefit has been passed, it will be important to monitor how these changes affect the elders identified at risk for medication delay.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Drug Therapy, Fees, Pharmaceutical, Female, Health Status, Humans, Insurance, Pharmaceutical Services, Logistic Models, Male, Medicare, Multivariate Analysis, Patient Compliance, Self Administration, Socioeconomic factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/44.6.779}, author = {Klein, Dawn and Carolyn L. Turvey and Robert B Wallace} } @article {6920, title = {The health effects of restricting prescription medication use because of cost.}, journal = {Med Care}, volume = {42}, year = {2004}, note = {Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485}, month = {2004 Jul}, pages = {626-34}, publisher = {42}, abstract = {

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.

}, keywords = {Aged, Chronic disease, Female, Financing, Personal, Health Services Accessibility, Health Status, Humans, Male, Middle Aged, Multivariate Analysis, Patient Compliance, Prospective Studies, Risk, United States}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000129352.36733.cc}, author = {Michele M Heisler and Kenneth M. Langa and Eby, Elizabeth L. and A. Mark Fendrick and Mohammed U Kabeto and John D Piette} } @article {6985, title = {Heart disease, comorbidity, and activity limitation in community-dwelling elderly.}, journal = {Eur J Cardiovasc Prev Rehabil}, volume = {11}, year = {2004}, month = {2004 Oct}, pages = {427-34}, publisher = {11}, abstract = {

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.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Female, Health Status, Heart Diseases, Humans, Male, Middle Aged, Motor Activity, Residence Characteristics, Self Concept, Socioeconomic factors}, issn = {1741-8267}, doi = {10.1097/01.hjr.0000140716.25015.b8}, author = {Oldrige, Neil B. and Timothy E. Stump} } @article {6934, title = {Life course transitions and depressive symptoms among women in midlife.}, journal = {Int J Aging Hum Dev}, volume = {58}, year = {2004}, month = {2004}, pages = {241-65}, publisher = {58}, abstract = {

This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature.

}, keywords = {Caregivers, depression, Female, Health Status, Humans, Interviews as Topic, Life Change Events, Longitudinal Studies, Marital Status, Middle Aged, Quality of Life}, issn = {0091-4150}, doi = {10.2190/4CUU-KDKC-2XAD-HY0W}, author = {M Jean Turner and Timothy S Killian and Rebekah Cain} } @article {6969, title = {Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms.}, journal = {Psychol Med}, volume = {34}, year = {2004}, month = {2004 May}, pages = {623-34}, publisher = {34}, abstract = {

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults.

METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6\%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline.

CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.

}, keywords = {Age Factors, Aged, Depressive Disorder, Major, Female, Follow-Up Studies, Health Status, Humans, Logistic Models, Male, Middle Aged, Prevalence, Residence Characteristics, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {0033-2917}, doi = {10.1017/S0033291703001764}, author = {Ramin Mojtabai and Mark Olfson} } @article {6970, title = {Race, gender, and the retirement decisions of people ages 60 to 80: prospects for age integration in employment.}, journal = {Int J Aging Hum Dev}, volume = {59}, year = {2004}, month = {2004}, pages = {255-86}, publisher = {59}, abstract = {

UNLABELLED: Demographic projections have prompted concerns about the potential economic burden of an aging population. This article, drawing on the 1998 Health and Retirement Study, explores ways in which race, gender, and age moderate the effects of various factors on labor force participation among people ages 60 to 80. Key findings center on health, education, and non-wage income. First, the effect of low non-wage income is weaker at older ages due to higher levels of functional disability. Second, the effect of low education is stronger for women, who perceive their chances of finding employment as low. Third, the effect of health is weaker for blacks, as they are less likely to find steady employment regardless of health.

POLICY IMPLICATIONS: Employer flexibility in number of hours worked might make sense for workers close to retirement age, while job search and training programs might be preferable for workers past the typical retirement age.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Black People, Educational Status, Employment, Female, Health Status, Humans, Income, Logistic Models, Male, Middle Aged, Retirement, Sex Distribution, White People}, issn = {0091-4150}, doi = {10.2190/GE24-03MX-U34P-AMNH}, author = {Tay K. McNamara and Williamson, John B.} } @article {6955, title = {Religion and functional health among the elderly: is there a relationship and is it constant?}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Jun}, pages = {355-74}, publisher = {16}, abstract = {

OBJECTIVES: Religion significantly influences a variety of health outcomes, especially among the elderly. Few studies have examined how the relationship may differ by age within this age group. It is possible that increasing levels of religiosity within the elderly, or other age-related differences, may strengthen the influence of religion on functional limitations.

METHOD: This study used the Assets and Health Dynamics Among the Oldest Old Survey, a nationally representative, longitudinal data set, to estimate the effects of religious attendance and salience on functional ability.

RESULTS: More frequent attendance is associated with fewer functional limitations, whereas higher levels of salience are associated with more limitations. No significant age interactions were found.

DISCUSSION: Attendance and salience predict the number of functional limitations in the elderly but in different directions. These effects tend to be stable within the elderly population, indicating that further age divisions may not be necessary when examining this relationship in future studies.

}, keywords = {Activities of Daily Living, Age Factors, Aging, Demography, Health Behavior, Health Status, Humans, Mental Health, Religion and Psychology, Socioeconomic factors, United States}, issn = {0898-2643}, doi = {10.1177/0898264304264204}, author = {Benjamins, Maureen Reindl} } @article {6945, title = {Religion and preventative health care utilization among the elderly.}, journal = {Soc Sci Med}, volume = {58}, year = {2004}, month = {2004 Jan}, pages = {109-18}, publisher = {58}, abstract = {

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Catholicism, Diagnostic Tests, Routine, Female, Health Services for the Aged, Health Status, Humans, Interviews as Topic, Jews, Logistic Models, Longitudinal Studies, Male, Patient Acceptance of Health Care, Preventive Health Services, Primary Health Care, Protestantism, Religion and Psychology, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/s0277-9536(03)00152-7}, author = {Benjamins, Maureen Reindl and Brown, Carolyn} } @article {6929, title = {Urinary incontinence and its association with death, nursing home admission, and functional decline.}, journal = {J Am Geriatr Soc}, volume = {52}, year = {2004}, month = {2004 May}, pages = {712-8}, publisher = {52}, abstract = {

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).

DESIGN: A population-based prospective cohort study from 1993 to 1995.

SETTING: Community-dwelling within the United States.

PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.

MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.

RESULTS: The prevalence of UI was 14.8\% (18.5\% in women; 8.5\% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9\% vs 8.7\%; unadjusted odds ratio (OR)=1.29, 95\% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4\% vs 2.6\%, OR=1.77; 95\% CI=1.18-2.63), and to have declined in ADL function (13.6\% vs 8.1\%; OR=1.78, 95\% CI=1.36-2.33) and IADL function (21.2\% vs 13.8\%; OR 1.69, 95\% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95\% CI=0.67-1.21), nursing home admission (AOR=1.33, 95\% CI=0.86-2.04), or ADL decline (AOR=1.24, 95\% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95\% CI=1.05-1.63), although adjustment markedly reduced the strength of this association.

CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Mass Index, Female, Follow-Up Studies, Frail Elderly, Health Status, Humans, Male, Nursing homes, Outcome Assessment, Health Care, Risk Factors, Smoking, Socioeconomic factors, Time Factors, Urinary incontinence}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2004.52207.x}, author = {Holroyd-Leduc, Jayna M. and Kala M. Mehta and Kenneth E Covinsky} } @article {6898, title = {Cognitive function and acute care utilization.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 Jan}, pages = {S38-49}, publisher = {58B}, abstract = {

OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS: Sixteen percent, 64\%, and 20\% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

}, keywords = {Aged, Cognition Disorders, Female, Geriatric Assessment, Health Behavior, Health Status, Hospitalization, Hospitals, Humans, Length of Stay, Male, Neuropsychological tests, Outpatient Clinics, Hospital, Severity of Illness Index, United States}, issn = {1079-5014}, doi = {10.1093/geronb/58.1.s38}, author = {Walsh, Edith G. and Bei Wu and Mitchell, Janet B. and Lisa F Berkman} } @article {6891, title = {Determinants of self-perceived changes in health status among pre- and early-retirement populations.}, journal = {Int J Aging Hum Dev}, volume = {56}, year = {2003}, month = {2003}, pages = {197-222}, publisher = {56}, abstract = {

Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects{\textquoteright} selective optimization and resiliency.

}, keywords = {Activities of Daily Living, Age Factors, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Retirement, Self Concept, United States}, issn = {0091-4150}, doi = {10.2190/T8JD-1P30-6MFT-8WHA}, author = {Namkee G Choi} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6850, title = {Racial disparities in joint replacement use among older adults.}, journal = {Med Care}, volume = {41}, year = {2003}, month = {2003 Feb}, pages = {288-98}, publisher = {41}, abstract = {

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98\%; Hispanic: 0.97\%, annually) less frequently compared with white persons (1.48\% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95\% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95\% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95\% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

}, keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Black or African American, Cohort Studies, Data Interpretation, Statistical, Health Services Accessibility, Health Services Needs and Demand, Health Status, Health Surveys, Hispanic or Latino, Humans, Interviews as Topic, Osteoarthritis, Sampling Studies, United States, White People}, issn = {0025-7079}, doi = {10.1097/01.MLR.0000044908.25275.E1}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6873, title = {Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys.}, journal = {Gerontology}, volume = {49}, year = {2003}, month = {2003 Jul-Aug}, pages = {265-71}, publisher = {49}, abstract = {

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality.

OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics.

METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9\% (n = 185) of the men died and 5\% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2\% (n = 99) of the women died in the 3 years of follow-up.

RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model.

CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

}, keywords = {Aged, Female, Health Status, Health Surveys, Humans, Life Expectancy, Male, Mortality, Prognosis, Proportional Hazards Models, Self Concept, Sex Distribution, Survival Analysis}, issn = {0304-324X}, doi = {10.1159/000070409}, author = {Michele J. Siegel and Elizabeth H Bradley and Stanislav V Kasl} } @article {6855, title = {Sickness and preventive medical behavior.}, journal = {J Health Econ}, volume = {22}, year = {2003}, month = {2003 Jul}, pages = {675-89}, publisher = {22}, abstract = {

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

}, keywords = {Aged, Anxiety, Breast Self-Examination, Cholesterol, Female, Health Behavior, Health Expenditures, Health Status, Humans, Influenza Vaccines, Male, Mammography, Mass Screening, Middle Aged, Papanicolaou Test, Patient Acceptance of Health Care, Preventive Health Services, Primary Prevention, Prostatic Neoplasms, Retirement, Risk Factors, Vaginal Smears}, issn = {0167-6296}, doi = {10.1016/S0167-6296(03)00042-0}, author = {Stephen Wu} } @article {6827, title = {Body-mass index and 4-year change in health-related quality of life.}, journal = {J Aging Health}, volume = {14}, year = {2002}, month = {2002 May}, pages = {195-210}, publisher = {14}, abstract = {

OBJECTIVE: To determine the effect of body-mass index (BMI) categories (a proxy for adiposity) on 4-year changes in health-related quality of life (HRQL) independent of baseline disease severity.

DESIGN: Secondary analyses of a prospective, longitudinal study.

PARTICIPANTS: Data on 7,895 adults ages 51 to 61 years who responded to the Health and Retirement Surveys in 1992, 1994, and 1996 were included.

RESULTS: Estimates of the effect of BMI on changes in HRQL were adjusted by disease severity. Each BMI category was associated with an increasing risk of decline in perceived health, with the highest risk in the higher categories. A BMI of between 30 and 35 was associated with a risk of decline in mobility.

CONCLUSIONS: The findings suggest a significant impact of BMI on changes in HRQL that is independent of disease severity and baseline HRQL.

}, keywords = {Body Mass Index, Disabled Persons, Female, Health Status, Humans, Male, Middle Aged, Obesity, Quality of Life, United States}, issn = {0898-2643}, doi = {10.1177/089826430201400202}, url = {http://reviews.bmn.com/medline/search/record?uid=MDLN.21990701andrefer=scirus}, author = {Damush, T.M. and Timothy E. Stump and Daniel O. Clark} } @article {6832, title = {Breast cancer and women{\textquoteright}s labor supply.}, journal = {Health Serv Res}, volume = {37}, year = {2002}, month = {2002 Oct}, pages = {1309-28}, publisher = {37}, abstract = {

OBJECTIVE: To investigate the effect of breast cancer on women{\textquoteright}s labor supply. DATE SOURCE/STUDY SETTING: Using the 1992 Health and Retirement Study, we estimate the probability of working using probit regression and then, for women who are employed, we estimate regressions for average weekly hours worked using ordinary least squares (OLS). We control for health status by using responses to perceived health status and comorbidities. For a sample of married women, we control for spouses{\textquoteright} employer-based health insurance. We also perform additional analyses to detect selection bias in our sample.

PRINCIPAL FINDINGS: We find that the probability of breast cancer survivors working is 10 percentage points less than that for women without breast cancer. Among women who work, breast cancer survivors work approximately three more hours per week than women who do not have cancer. Results of similar magnitude persist after health status is controlled in the analysis, and although we could not definitively rule out selection bias, we could not find evidence that our results are attributable to selection bias.

CONCLUSIONS: For some women, breast cancer may impose an economic hardship because it causes them to leave theirjobs. However, for women who survive and remain working, this study failed to show a negative effect on hours worked associated with breast cancer. Perhaps the morbidity associated with certain types and stages of breast cancer and its treatment does not interfere with work.

}, keywords = {Breast Neoplasms, Comorbidity, Cost of Illness, Decision making, Employment, Family Characteristics, Female, Health Benefit Plans, Employee, Health Status, Humans, Marital Status, Middle Aged, Probability, Selection Bias, Survivors, United States, Women, Working}, issn = {0017-9124}, doi = {10.1111/1475-6773.01041}, author = {Cathy J. Bradley and Bednarek, Heather and David Neumark} } @article {6803, title = {Individual consequences of volunteer and paid work in old age: health and mortality.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, month = {2002 Dec}, pages = {490-509}, publisher = {43}, abstract = {

The impacts of the productive social activities of volunteer and paid work on health have rarely been investigated among the oldest Americans despite a recent claim for their beneficial effect (Rowe and Kahn 1998). This paper used data from Waves 3 and 4 of the Asset and Health Dynamics among the Oldest Old (AHEAD) Study to (1) investigate the impact of these activities on health measured as self-reported health and activities of daily living (ADL) functioning limitations and to (2) explore possible causal mechanisms. Using multinomial logistic regression analysis, amounts of volunteer and paid work over a minimum of 100 annual hours self-reported at Wave 3 were related to poor health and death as competing risks measured at Wave 4, controlling for health measured at Wave 2 and for other predictors of poor health and death. Findings suggest that performing more than 100 annual hours of volunteer work and of paid work have independent and significant protective effects against subsequent poor health and death. Additional analyses suggest that the quantity of volunteer and paid work beyond 100 annual hours is not related to health outcomes and that physical exercise and mental health measured as cognitive functioning and depressive symptoms explain not entirely overlapping parts of the relationship between productive activities and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Employment, Female, Health Status, Humans, Male, Mortality, Multivariate Analysis, Prospective Studies, United States, Volunteers}, issn = {0022-1465}, doi = {10.2307/3090239}, author = {Luoh, M. and A. Regula Herzog} } @article {6825, title = {Linking clinical variables to health-related quality of life in Parkinson{\textquoteright}s disease.}, journal = {Parkinsonism Relat Disord}, volume = {8}, year = {2002}, month = {2002 Jan}, pages = {199-209}, publisher = {8}, abstract = {

OBJECTIVE: Identify the point-in-time relationship between Parkinson{\textquoteright}s disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).

BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.

DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.

RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.

CONCLUSION: PD patients{\textquoteright} well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.

}, keywords = {Aged, Cross-Sectional Studies, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Parkinson Disease, Quality of Life}, issn = {1353-8020}, doi = {10.1016/s1353-8020(01)00044-x}, author = {Elizabeth A Chrischilles and Linda M. Rubenstein and Voelker, Margaret D. and Robert B Wallace and Rodnitzky, Robert L.} } @article {6807, title = {A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey.}, journal = {Prev Med}, volume = {34}, year = {2002}, month = {2002 Mar}, pages = {334-45}, publisher = {34}, abstract = {

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Attitude to Health, Chi-Square Distribution, Exercise, Female, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Longitudinal Studies, Male, Middle Aged, Risk Assessment, Risk Factors, Sex Distribution, Smoking, Socioeconomic factors, Survival Rate, United States}, issn = {0091-7435}, doi = {10.1006/pmed.2001.0991}, author = {Truls Ostbye and Donald H. Taylor Jr. and Sang-Hyuk Jung} } @article {6828, title = {Loss of health insurance and the risk for a decline in self-reported health and physical functioning.}, journal = {Med Care}, volume = {40}, year = {2002}, month = {2002 Nov}, pages = {1126-31}, publisher = {40}, abstract = {

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0\%) people continued to have private insurance, 229 (3.8\%) reported having lost all insurance, and 75 (1.2\%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6\% for those who lost all insurance versus 7.2\% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95\% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5\% vs. 20.4\%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95\% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

}, keywords = {Female, Health Services Accessibility, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Regression Analysis, Risk, Self Efficacy}, issn = {0025-7079}, doi = {10.1097/00005650-200211000-00013}, author = {David W. Baker and Joseph J Sudano and Jeffrey M. Albert and Elaine A Borawski and Avi Dor} } @article {6733, title = {Life events and alcohol consumption among mature adults: a longitudinal analysis.}, journal = {J Stud Alcohol}, volume = {62}, year = {2001}, month = {2001 Jul}, pages = {501-8}, publisher = {62}, abstract = {

OBJECTIVE: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events.

METHOD: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated.

RESULTS: Most persons (68\%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking influenced the association between certain life events (e.g., divorce and retirement) and changes in drinking. Gender modified the association between losing a spouse and changes in drinking.

CONCLUSIONS: Even after controlling for problem drinking history, social support and coping skills, changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age. The magnitude of these relationships, however, varied by gender and problem drinking history.

}, keywords = {Adaptation, Psychological, Aged, Alcohol Drinking, Employment, Family, Health Status, Humans, Life Change Events, Longitudinal Studies, Middle Aged, Social Support, Stress, Psychological}, issn = {0096-882X}, doi = {10.15288/jsa.2001.62.501}, author = {Perreira, Krista M. and Frank A Sloan} } @article {6737, title = {Predictors of transitions in disease and disability in pre- and early-retirement populations.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Aug}, pages = {379-409}, publisher = {13}, abstract = {

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period.

METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses.

RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes.

DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Chronic disease, Disabled Persons, Female, Health Status, Hispanic or Latino, Humans, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/089826430101300304}, author = {Namkee G Choi and Schlichting-Ray, L.} } @article {6729, title = {Proportional treatment effects for count response panel data: effects of binary exercise on health care demand.}, journal = {Health Econ}, volume = {10}, year = {2001}, note = {ProCite field 3 : Sungkyunkwan U; Mitsubishi Trust and Banking Corp, Tokyo}, month = {2001 Jul}, pages = {411-28}, publisher = {10}, abstract = {

We define conditional and marginal treatment effects appropriate for count data, and then conduct an empirical analysis for the effects of exercise on health care demand using panel data from the Health Retirement Study. The response variables are office visits to doctors and hospitalization days, and the treatments of interest are light and vigorous exercises. We found that short-run light exercise increases health care demand by 3-5\%, whereas long-run light exercise decreases it by 3-6\%. We also found that short-run vigorous exercise decreases health care demand by 1-2\%, whereas long-run vigorous exercise decreases it by 1-3\%. However, many of these numbers are not statistically significantly different from zero. These findings suggest that it will be difficult to reduce health care cost much by encouraging people to do more exercise--at least in the short-run.

}, keywords = {Adult, Aged, Aged, 80 and over, Bias, Cost Control, Cross-Sectional Studies, Data Interpretation, Statistical, Effect Modifier, Epidemiologic, Exercise Therapy, Female, Health Promotion, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Needs Assessment, Regression Analysis, Research Design, Treatment Outcome, United States}, issn = {1057-9230}, doi = {10.1002/hec.626}, author = {Lee, Myoung Jae and Satoru Kobayashi} } @article {6746, title = {Socioeconomic status and the prevalence of health problems among married couples in late midlife.}, journal = {Am J Public Health}, volume = {91}, year = {2001}, month = {2001 Jan}, pages = {131-5}, publisher = {91}, abstract = {

OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

}, keywords = {Activities of Daily Living, Cohort Studies, Female, Health Status, Humans, Male, Marital Status, Middle Aged, Odds Ratio, Risk Factors, Socioeconomic factors, Spouses, United States}, issn = {0090-0036}, doi = {10.2105/ajph.91.1.131}, author = {Sven E. Wilson} } @article {6680, title = {The effect of smoking on health using a sequential self-selection model.}, journal = {Health Econ}, volume = {9}, year = {2000}, note = {ProCite field 3 : SUNY, Albany; SUNY, Albany}, month = {2000 Sep}, pages = {491-511}, publisher = {9}, abstract = {

We estimate a structural model of individual smoking behaviour emphasizing the role of individual risk belief on smoking choices. Our model consists of five equations: two selection equations for initiation and cessation decisions, and three switching outcome regressions for nonsmokers, ex-smokers, and current smokers. The presence of significant self-selectivity implies that the health effects of smoking based on sample proportions do not correctly indicate the true risk of cigarette smoking. Further, our evidence suggests that the self-selection in the cessation decision, but not in the initiation decision, is consistent with economic rationality. We estimate the model by full information maximum likelihood (FIML) with starting values from heteroskedasticity corrected Heckman-Lee two-step method using newly released Health and Retirement Study (HRS) data.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Decision making, Health Behavior, Health Status, Health Surveys, Humans, Middle Aged, Models, Econometric, Predictive Value of Tests, Reproducibility of Results, Risk Factors, Risk-Taking, Selection Bias, Smoking, Smoking cessation, Surveys and Questionnaires, United States}, issn = {1057-9230}, doi = {10.1002/1099-1050(200009)9:6<491::aid-hec541>3.0.co;2-$\#$}, author = {Kajal Chatterji Lahiri and Song, Jae G.} } @article {6723, title = {Expectations among the elderly about nursing home entry.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {1181-202}, publisher = {35}, abstract = {

OBJECTIVE: To assess whether the covariates that explain expectations of nursing home entry are consistent with the characteristics of those who enter nursing homes.

DATA SOURCES: Waves 1 and 2 of the Assets and Health Dynamics Among the Oldest Old (AHEAD) survey.

STUDY DESIGN: We model expectations about nursing home entry as a function of expectations about leaving a bequest, living at least ten years, health condition, and other observed characteristics. We use an instrumental variables and generalized least squares (IV-GLS) method based on Hausman and Taylor (1981) to obtain more efficient estimates than fixed effects, without the restrictive assumptions of random effects.

PRINCIPAL FINDINGS: Expectations about nursing home entry are reasonably close to the actual probability of nursing home entry. Most of the variables that affect actual entry also have significant effects on expectations about entry. Medicaid subsidies for nursing home care may have little effect on expectations about nursing home entry; individuals in the lowest asset quartile, who are most likely to receive these subsidies, report probabilities not significantly different from those in other quartiles. Application of the IV-GLS approach is supported by a series of specification tests.

CONCLUSIONS: We find that expectations about future nursing home entry are consistent with the characteristics of actual entrants. Underestimation of risk of nursing home entry as a reason for low levels of long-term care insurance is not supported by this analysis.

}, keywords = {Activities of Daily Living, Aged, Attitude to Health, Data Interpretation, Statistical, Effect Modifier, Epidemiologic, Female, Geriatric Assessment, Health Care Surveys, Health Services Research, Health Status, Homes for the Aged, Humans, Least-Squares Analysis, Longevity, Male, Medicaid, Nursing homes, Patient Admission, Probability, Risk Factors, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard C Lindrooth and Hoerger, Thomas J. and Edward C Norton} } @article {6705, title = {Health effects of involuntary job loss among older workers: findings from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 May}, pages = {S131-40}, publisher = {55B}, abstract = {

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.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aging, Female, Geriatric Assessment, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Unemployment, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.3.s131}, author = {William T Gallo and Elizabeth H Bradley and Michele J. Siegel and Stanislav V Kasl} } @article {6703, title = {Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Sep}, pages = {S288-97}, publisher = {55B}, abstract = {

OBJECTIVES: This study explores the analytic implications of using questions about difficulty with daily activities that do not specify whether to consider assistance.

METHODS: For 1,054 Asset and Health Dynamics of the Oldest Old Study Wave 2 respondents, we compared responses to questions about difficulty without reference to assistance (ambiguous difficulty) to those about difficulty without help or equipment (underlying difficulty) and difficulty with help or equipment, if used (residual difficulty). We modelled predictors of discordance by means of logistic regression.

RESULTS: Discordance exists for 15\% of respondents between summary variables indicating underlying and ambiguous difficulty with one or more activities. Discrepancies are evenly split between respondents reporting (a) underlying but no ambiguous difficulty and (b) ambiguous but no underlying difficulty. Discordance also exists for 15\% of respondents between summary variables indicating residual and ambiguous difficulty with one or more activities: most of these discrepancies involve reports of ambiguous but no residual difficulty. Most respondent characteristics investigated are not significant predictors of discrepancies.

DISCUSSION: Analysts should be aware that (a) ambiguously worded questions appear to be a better proxy for underlying than for residual difficulty, (b) discrepancies seem to be lower for separate activities than for summary variables indicating difficulty with one or more activities, and (c) being Hispanic and receiving help may affect reporting discrepancies.

}, keywords = {Activities of Daily Living, Aged, Cognition, Female, Health Status, Humans, Male, Prospective Studies, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/55.5.s288}, author = {Vicki A Freedman} } @article {6684, title = {Nativity and older women{\textquoteright}s health: constructed reliance in the health and retirement study.}, journal = {J Women Aging}, volume = {12}, year = {2000}, month = {2000}, pages = {21-37}, publisher = {12}, abstract = {

Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women{\textquoteright}s physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.

}, keywords = {Aged, Emigration and Immigration, ethnicity, Female, Florida, Health Status, Humans, Middle Aged, Retirement, Social Support, Socioeconomic factors, Women{\textquoteright}s Health}, issn = {0895-2841}, doi = {10.1300/J074v12n03_03}, author = {Cynthia J. Buckley and Jacqueline L. Angel and Donahue, Dennis} } @article {6724, title = {Older adults and financial bequests.}, journal = {Int J Aging Hum Dev}, volume = {50}, year = {2000}, month = {2000}, pages = {227-44}, publisher = {50}, abstract = {

Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult{\textquoteright}s assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Attitude, Female, Health Care Costs, Health Status, Humans, Male, Mental Health, Michigan, Models, Economic, Sampling Studies, Sex Factors, Socioeconomic factors, Spouses, Surveys and Questionnaires, Wills}, issn = {0091-4150}, doi = {10.2190/AJJ3-AVG7-QKMW-R21R}, author = {Goetting, Marsha A. and Peter Martin and Johnson, Christine} } @article {6693, title = {Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: results from a national study.}, journal = {Gerontologist}, volume = {40}, year = {2000}, month = {2000 Aug}, pages = {449-57}, publisher = {40}, abstract = {

This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school- and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Black or African American, Choice Behavior, Communication, Educational Status, Family, Female, Health education, Health Status, Humans, Logistic Models, Male, Needs Assessment, Surveys and Questionnaires, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/40.4.449}, author = {Faith P. Hopp} } @article {6715, title = {The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions.}, journal = {Arthritis Care Res}, volume = {13}, year = {2000}, month = {2000 Jun}, pages = {168-76}, publisher = {13}, abstract = {

OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later.

METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression.

RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2\%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one{\textquoteright}s job (12.1\%), scheduling more breaks during the work day (9.5\%), changing the time that the work day started and stopped (6.3\%), having a shorter work day (5.6\%), getting special equipment (5.3\%), and changing the work tasks (5.3\%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one{\textquoteright}s job--was associated with a higher rate of employment in 1994.

CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.

}, keywords = {Disabled Persons, Employment, Supported, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Personnel Turnover, Program Evaluation, Surveys and Questionnaires, United States, Workload, Workplace}, issn = {0893-7524}, doi = {10.1002/1529-0131(200006)13:3<168::aid-anr6>3.0.co;2-r}, author = {Yelin, Edward and Sonneborn, Dean and Laura S. Trupin} } @article {6698, title = {Uninsured status and out-of-pocket costs at midlife.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {911-32}, publisher = {35}, abstract = {

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

}, keywords = {Age Factors, Female, Financing, Personal, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Models, Econometric, Multivariate Analysis, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6639, title = {The associations between self-rated vision and hearing and functional status in middle age.}, journal = {Ophthalmology}, volume = {106}, year = {1999}, month = {1999 Feb}, pages = {401-5}, publisher = {106}, abstract = {

OBJECTIVES: To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans.

DESIGN: Cross-sectional.

PARTICIPANTS: A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated.

METHODS: Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed.

MAIN OUTCOME MEASURE: A global index of functional status based on self-reported limitations in 17 activities was measured.

RESULTS: Approximately 3\% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

}, keywords = {Cross-Sectional Studies, Female, health, Health Status, Health Surveys, Hearing Disorders, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Quality of Life, Self Disclosure, Vision Disorders}, issn = {0161-6420}, doi = {10.1016/S0161-6420(99)90082-9}, url = {http://www.ncbi.nlm.nih.gov/pubmed/9951498?dopt=Abstract}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {6672, title = {A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 Sep}, pages = {S291-301}, publisher = {54B}, abstract = {

OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States.

METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning.

RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments.

DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cognition, Cross-Cultural Comparison, depression, Educational Status, Female, Geriatric Assessment, Health Status, Humans, Male, Multivariate Analysis, Regression Analysis, Sex Factors, Socioeconomic factors, Surveys and Questionnaires, Taiwan, United States}, issn = {1079-5014}, doi = {10.1093/geronb/54b.5.s291}, author = {Mary Beth Ofstedal and Zachary Zimmer and Hui-Sheng Lin} } @article {6634, title = {Healthy bodies and thick wallets: the dual relation between health and economic status.}, journal = {J Econ Perspect}, volume = {13}, year = {1999}, note = {ProCite field 3 : RAND}, month = {1999 Spring}, pages = {144-66}, publisher = {13}, abstract = {

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.

}, keywords = {Financing, Personal, Health Expenditures, Health Status, Humans, Socioeconomic factors, United States}, issn = {0895-3309}, url = {http://www.aeaweb.org/jep/}, author = {James P Smith} } @article {6640, title = {Racial differences in education, obesity, and health in later life.}, journal = {Ann N Y Acad Sci}, volume = {896}, year = {1999}, month = {1999}, pages = {370-2}, publisher = {896}, keywords = {Age Distribution, Aged, Arthritis, Black or African American, Diabetes Mellitus, Educational Status, Female, Health Status, Health Surveys, Humans, Logistic Models, Male, Obesity, Prevalence, Social Class, United States, White People}, issn = {0077-8923}, doi = {10.1111/j.1749-6632.1999.tb08144.x}, author = {Christine L Himes} } @article {6673, title = {The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older.}, journal = {Am J Ophthalmol}, volume = {127}, year = {1999}, month = {1999 Apr}, pages = {447-52}, publisher = {127}, abstract = {

PURPOSE: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.

METHODS: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.

RESULTS: Of the respondents, 27\% rated their vision as fair or poor, whereas 25\% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, hearing, Hearing Disorders, Humans, Male, Multivariate Analysis, Quality of Life, Self Disclosure, Surveys and Questionnaires, Vision Disorders, Vision, Ocular, Visual Acuity}, issn = {0002-9394}, doi = {10.1016/s0002-9394(98)00418-8}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {6610, title = {Do medical conditions affect cognition in older adults?}, journal = {Health Psychol}, volume = {17}, year = {1998}, month = {1998 Nov}, pages = {504-12}, publisher = {17}, abstract = {

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

}, keywords = {Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, Cognition, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Hypertension, Male, Mental Health}, issn = {0278-6133}, doi = {10.1037//0278-6133.17.6.504}, url = {https://pubmed.ncbi.nlm.nih.gov/9848800/}, author = {Elizabeth Zelinski and Eileen M. Crimmins and Sandra L Reynolds and Teresa Seeman} } @article {6576, title = {Asset and Health Dynamics Among the Oldest Old (AHEAD): initial results from the longitudinal study. Introduction.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {v-viii}, publisher = {52B}, keywords = {Aged, Aged, 80 and over, Data collection, Health Status, Humans, Income, Longitudinal Studies, Research Design}, issn = {1079-5014}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215353}, author = {Myers, George C. and Juster, F. Thomas and Richard M. Suzman} } @article {6583, title = {A comparative analysis of ADL questions in surveys of older people.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {21-36}, publisher = {52B}, abstract = {

This article describes questions designed to assess limitations with respect to activities of daily living (ADLs) that were asked on the first wave of the AHEAD study, and it assesses their cross-sectional measurement properties. It also provides comparisons between those questions and parallel questions that have been asked on two other surveys of the elderly population in the United States: the 1984 Supplement on Aging (SOA) to the National Health Interview Survey and the screener for the 1982 National Long Term Care Survey (NLTCS). It also compares a single item from the 1990 Census. It then compares the ways in which the same individuals answer these different versions of ADL questions, using data from subsamples of the AHEAD respondents who were also asked the SOA, NLTCS, or Census questions. The analysis shows that there is a substantial amount of measurement error in the answers to ADL questions, and it suggests that this is a major contributor to apparent improvements and declines in functional health observed in longitudinal data.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Geriatric Assessment, Health Services, Health Status, Health Surveys, Humans, Regression Analysis, Reproducibility of Results, United States}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.21}, author = {Willard L Rodgers and Baila Miller} } @article {6566, title = {Demographic and economic correlates of health in old age.}, journal = {Demography}, volume = {34}, year = {1997}, note = {ProCite field 3 : RAND; UCLA and RAND}, month = {1997 Feb}, pages = {159-70}, publisher = {34}, abstract = {

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Demography, Disabled Persons, ethnicity, Female, Health Status, Humans, Income, Male, Models, Econometric, Racial Groups, Socioeconomic factors, United States}, issn = {0070-3370}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9074837}, author = {James P Smith and Raynard Kington} } @article {6584, title = {Measures of cognitive functioning in the AHEAD Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {37-48}, publisher = {52B}, abstract = {

Decline in cognitive functioning and onset of cognitive impairment are potentially important predictors of elderly persons needing informal assistance and formal health care. This article describes the measures of cognitive functioning that were developed for the Asset and Health Dynamics Among the Oldest Old (AHEAD) study of some 6,500 Americans aged 70 years and older. The study was designed to investigate the impact of health on disbursement of family and economic resources. Evaluation of the cognitive measures in terms of psychometric properties and missing data, telephone administration, and formation of an aggregate index is encouraging. Their construct validity is evidenced by their correlations with sociodemographic characteristics and health indicators that replicate existing findings as well as by their prediction of IADL and ADL functioning that are consistent with theory.

}, keywords = {Aged, Aged, 80 and over, Cognition, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Memory, Mental Status Schedule, Psychological Tests, Socioeconomic factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.37}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215356}, author = {A. Regula Herzog and Robert B Wallace} } @article {6549, title = {The health-wealth connection: racial differences.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {342-9}, publisher = {36}, abstract = {

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.

}, keywords = {Black or African American, Cross-Sectional Studies, Female, Health Status, Humans, Income, Male, Middle Aged, Models, Theoretical, Regression Analysis, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.342}, author = {Dennis G. Shea and Toni Miles and Mark D Hayward} } @article {6548, title = {Minority perspectives from the Health and Retirement Study. Introduction: health and retirement among ethnic and racial minority groups.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {282-4}, publisher = {36}, keywords = {Aged, Health Status, Humans, Minority Groups, Prospective Studies, Quality of Life, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.282}, author = {James S Jackson and Lockery, Shirley A. and Juster, F. Thomas} } @article {6543, title = {Physical function among retirement-aged African American men and women.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {322-31}, publisher = {36}, abstract = {

Prior attempts to identify factors associated with physical function (here, major lower body movements) among African Americans have been constrained by a narrow range of measures, small sample sizes, or both. The 1992 Health and Retirement Study (HRS) contains a substantial over-sample of African Americans (649 men and 957 women self-respondents aged 51 to 61 years), and detailed measures of high-risk behaviors, disease prevalence and severity, impairment, and physical function. We extend the natural history of disease to the natural history of functional status and model sociodemographic characteristics, high-risk behaviors, disease prevalence and severity, and impairments as direct and indirect influences on physical function in this African American sample. This natural history of functional status model fits the data well for both men (ROC = .88) and women (ROC = .83), although there are gender differences. Slightly over one-half of the women report some difficulty in physical function, compared with one-third of the men. Women also have a higher mean body-mass and report a greater prevalence and severity in 6 of 9 chronic diseases and more pain, but are less likely to smoke or abuse alcohol than men. Importantly, many of the factors with the largest direct and indirect associations with difficulty in physical function among these African American men (alcohol abuse, smoking, body mass, diabetes, heart disease, cerebrovascular disease, arthritis, and pain) and women (alcohol abuse, body mass, arthritis, and respiratory illness) are all potentially preventable or manageable.

}, keywords = {Black or African American, Female, Health Behavior, Health Status, Humans, Male, Middle Aged, Models, Theoretical, Odds Ratio, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.322}, author = {Daniel O. Clark and Christopher M. Callahan and Mungai, S.M. and Frederic D Wolinsky} } @article {6552, title = {Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.}, journal = {Am J Public Health}, volume = {86}, year = {1996}, month = {1996 Sep}, pages = {1306-9}, publisher = {86}, abstract = {

OBJECTIVES: This study examined risk factors for occupational injury among older workers.

METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers{\textquoteright} impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

}, keywords = {Accidents, Occupational, Cross-Sectional Studies, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Occupational Diseases, Regression Analysis, Retirement, Risk Factors, Sex Factors, United States, Wounds and Injuries}, issn = {0090-0036}, doi = {10.2105/ajph.86.9.1306}, author = {Zwerling, Craig and Nancy L. Sprince and Robert B Wallace and Charles S. Davis and Paul S. Whitten and Steven G Heeringa} } @article {6544, title = {Who takes early Social Security benefits? The economic and health characteristics of early beneficiaries.}, journal = {Gerontologist}, volume = {36}, year = {1996}, note = {RDA}, month = {1996 Dec}, pages = {789-99}, publisher = {36}, abstract = {

Using the 1992 and 1994 Waves of the Health and Retirement Survey, we compare individuals who first take Social Security benefits at age 62 with those who don{\textquoteright}t and find that the income and net assets of these two groups are similar in the years just prior to eligibility. However, there is great diversity within the groups, so that poor health appears to be more closely related to lower economic well-being than is early Social Security acceptance status. Our results suggest that raising the Social Security retirement age is not likely to dramatically lower the economic well-being of the typical person aged 62 since only 3\% of men aged 62 are receiving Social Security retirement benefits, are in poor health, and have Social Security retirement benefits as their only source of pension income.

}, keywords = {Aged, Eligibility Determination, Female, Health Status, Health Surveys, Humans, Income, Male, Middle Aged, Pensions, Retirement, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.6.789}, author = {R.V. Burkhauser and Kenneth A. Couch and John W R Phillips} }