@article {13881, title = {Hazardous Alcohol Use Among Community-Dwelling Older Adults With Persistent or Recurrent Pain: Findings From the Health and Retirement Study.}, journal = {The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences}, volume = {79}, year = {2024}, abstract = {

BACKGROUND: Although pain and alcohol use are highly prevalent and associated with deleterious health outcomes among older adults, a paucity of literature has examined hazardous drinking among older adults with pain. We aimed to examine the prevalence of hazardous drinking among a nationally representative sample of older adults with persistent or recurrent pain.

METHODS: We conducted cross-sectional analyses of data collected from the 2018 wave of the Health and Retirement Study. Participants included 1 ~549 community-dwelling adults aged >=65 with persistent or recurrent pain (ie, clinically significant pain present at 2 consecutive survey waves).

RESULTS: More than one-quarter of older adults with persistent or recurrent pain reported regular alcohol use (>=weekly), nearly half of whom reported hazardous patterns of drinking. Specifically, 32\% reported excessive drinking (ie, >2 drinks per day for older men; >1 drink per day for older women), and 22\% reported binge drinking (ie, >=4 drinks on one occasion). Exploratory analyses revealed a high prevalence of hazardous drinking among the subsample of older adults who used opioids (47\%).

CONCLUSIONS: Hazardous alcohol use-including both excessive and binge drinking-is common among older adults with persistent or recurrent pain, including those who take opioids. Given that hazardous drinking can complicate pain management and increase the risk for adverse opioid effects (eg, overdose), the current findings underscore the importance of assessing and addressing hazardous patterns of alcohol use among older adults with persistent or recurrent pain.

}, keywords = {Aged, Alcohol Drinking, Analgesics, Opioid, Binge drinking, Cross-Sectional Studies, Ethanol, Female, Humans, Independent Living, Male, pain, Prevalence, Retirement}, issn = {1758-535X}, doi = {10.1093/gerona/glad281}, author = {LaRowe, Lisa R and Miller, Angela and Shah, Sachin J and Ritchie, Christine S} } @article {13857, title = {A Longitudinal Dose-Response Curve Between Leisure-Time Physical Activity and the Prevalence of Diabetes Based on the Different Levels of Cognitive Function Among Older Adults.}, journal = {American Journal of Alzheimer{\textquoteright}s Disease and other Dementia}, volume = {39}, year = {2024}, pages = {15333175241241891}, abstract = {

This study investigated a dose-response relationship between Leisure-Time Physical Activity participation (LTPA) and the risk of diabetes and a comparison of the risk across different cognitive function groups among older adults. The Health and Retirement Study data were used from 2012 to 2020 (n = 18~746). This study conducted a Cox Proportional Hazard Regression to investigate the Dose-Response Curve between the prevalence of diabetes and the covariates following a level of LTPA participation. The result presented that the Odds Ratio continuously decreased as the level of LTPA participation increased. Among the three cognitive function groups, the high group (OR = .43, < .05) and the mid group (OR = .71, < .05) had a larger negative slope coefficient than the low group. This study found that LTPA participation reduces the risk of diabetes and gives evidence for the importance of cognitive function in reducing the prevalence of diabetes.

}, keywords = {Aged, Cognition, Diabetes Mellitus, Exercise, Humans, Leisure activities, Prevalence}, issn = {1938-2731}, doi = {10.1177/15333175241241891}, author = {Lee, Jungjoo and Kim, Junhyoung and Ju, Hyo Jin and An, Sang Joon and Woo, Bomi} } @article {13745, title = {The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy.}, journal = {Physical Therapy}, volume = {104}, year = {2024}, abstract = {

OBJECTIVE: The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice.

METHODS: This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) <=1{\texttimes}/week, and sleep disturbance frequency using multinomial logistic regression.

RESULTS: Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3\% (CIND:15.2\%, dementia:5.1\%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8\%, difficulty walking 1 block was 25.9\%, difficulty walking several blocks was 20.8\%, and no difficulty walking was 16.3\%. Additionally, prevalence of cognitive impairment among those with MVPA <=1{\texttimes}/week was 27.1\% and MVPA >1{\texttimes}/week was 14.1\%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance.

CONCLUSION: One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity.

IMPACT: Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient{\textquoteright}s ability to remember and process rehabilitation recommendations.

}, keywords = {Aged, Cognitive Dysfunction, Cross-Sectional Studies, Dementia, Female, Humans, Male, Medicare, Mobility Limitation, Outpatients, pain, Physical Therapy Modalities, Prevalence, United States}, issn = {1538-6724}, doi = {10.1093/ptj/pzad115}, author = {Miller, Matthew J and Cenzer, Irena and Barnes, Deborah E and Kelley, Amy S and Covinsky, Kenneth E} } @article {13076, title = {Estimating the Prevalence of Dementia in India Using a Semi-Supervised Machine Learning Approach.}, journal = {Neuroepidemiology}, volume = {57}, year = {2023}, pages = {43-50}, abstract = {

INTRODUCTION: Accurate estimation of dementia prevalence is essential for making effective public and social care policy to support individuals and families suffering from the disease. The purpose of this paper is to estimate the prevalence of dementia in India using a semi-supervised machine learning approach based on a large nationally representative sample.

METHODS: The sample of this study is adults 60 years or older in the wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI). A subsample in LASI received extensive cognitive assessment and clinical consensus ratings and therefore has diagnoses of dementia. A semi-supervised machine learning model was developed to predict the status of dementia for LASI participants without diagnoses. After obtaining the predictions, sampling weights and age standardization to the World Health Organization (WHO) standard population were applied to generate the estimate for prevalence of dementia in India.

RESULTS: The prevalence of dementia for those aged 60 years and older in India was 8.44\% (95\% CI: 7.89\%-9.01\%). The age-standardized prevalence was estimated to be 8.94\% (95\% CI: 8.36\%-9.55\%). The prevalence of dementia was greater for those who were older, were females, received no education, and lived in rural areas.

DISCUSSION: The prevalence of dementia in India may be higher than prior estimates derived from local studies. These prevalence estimates provide the information necessary for making long-term planning of public and social care policy. The semi-supervised machine learning approach adopted in this paper may also be useful for other large population aging studies that have a similar data structure.

}, keywords = {Aged, Aging, Dementia, Female, Humans, India, Male, Middle Aged, Prevalence, supervised machine learning}, issn = {1423-0208}, doi = {10.1159/000528904}, author = {Jin, Haomiao and Crimmins, Eileen and Kenneth M. Langa and Dey, A B and Lee, Jinkook} } @article {13642, title = {Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States.}, journal = {Journal of strength and conditioning research}, volume = {37}, year = {2023}, pages = {2484-2490}, abstract = {

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1\% (95\% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6\% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (>=65 years) Americans (64.2\%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2\%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5\%; CI: 53.1-55.9) than in men (50.4\%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

}, keywords = {Aged, Body Mass Index, Female, Hand Strength, Humans, Male, Middle Aged, Muscle Weakness, Prevalence, Retirement, United States}, issn = {1533-4287}, doi = {10.1519/JSC.0000000000004560}, author = {McGrath, Ryan and FitzSimmons, Samantha and Andrew, Sarah and Black, Kennedy} } @article {13641, title = {Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States.}, journal = {Journal of strength and conditioning research}, volume = {37}, year = {2023}, pages = {2484-2490}, abstract = {

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1\% (95\% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6\% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (>=65 years) Americans (64.2\%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2\%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5\%; CI: 53.1-55.9) than in men (50.4\%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

}, keywords = {Aged, Body Mass Index, Female, Hand Strength, Humans, Male, Middle Aged, Muscle Weakness, Prevalence, Retirement, United States}, issn = {1533-4287}, doi = {10.1519/JSC.0000000000004560}, author = {McGrath, Ryan and FitzSimmons, Samantha and Andrew, Sarah and Black, Kennedy and Bradley, Adam and Christensen, Bryan K and Collins, Kyle and Klawitter, Lukus and Kieser, Jacob and Langford, Matthew and Orr, Megan and Hackney, Kyle J} } @article {12880, title = {Trends in Obesity Prevalence among US Older Adults in the Last Two Years of Life, 1998-2018.}, journal = {Journal of Pain and Symptom Management}, volume = {65}, year = {2023}, pages = {81-86}, abstract = {

CONTEXT: The prevalence of obesity has grown in the US over the decades. The temporal trends of body mass index categories in the last two years of life are poorly understood.

OBJECTIVES: To describe the trends in body mass categories in the last two years of life over the past two decades controlling for other demographic changes.

METHODS: We performed a cross-sectional study of prospectively collected survey data from the nationally representative Health and Retirement Study (HRS) among decedents who died between 1998 and 2018. We categorized BMI into five categories and calculated the proportion of decedents with each BMI category during each four epochs (1998-2003, 2004-2008, 2009-2013, 2014-2018). We examined trends in regression models with survey wave groupings modeled as an orthogonal polynomial and adjusted for factors commonly associated with BMI: sex, age, race, ethnicity, education, and tobacco use.

RESULTS: The analytic cohort included 14,797 decedents. From 1998-2003 to 2014-2018 time periods, those categorized as having mild-to-moderate obesity in the last two years of life increased from 12.4\% to 14.8\% (linear trend P < 0.001), a 19\% increase. Severe obesity increased from 1.9\% to 4.3\%, a 126\% increase (linear trend P < 0.001). Underweight decreased from 9.9\% to 5.9\%, a 40\% decrease (linear trend P < 0.001), adjusted for demographic factors. Adjusted quadratic temporal trends for BMI category were nonsignificant, except for in mild-to-moderate obesity.

CONCLUSION: Severe obesity has increased greatly while underweight has decreased. As obesity increases in the final years of life, it is critical to assess how the existing and future palliative services and end of life care system address body size and weight.

}, keywords = {Body Mass Index, Morbid, Obesity, Prevalence, Thinness}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2022.11.004}, author = {Harris, John A and Kavalieratos, Dio and Thoonkuzhy, Matthew and Shieu, Bianca and Schenker, Yael} } @article {WANG202232, title = {Association between marital relationship and multimorbidity in middle-aged adults: A longitudinal study across the US, UK, Europe, and China}, journal = {Maturitas}, volume = {155}, year = {2022}, pages = {32-39}, abstract = {Background Marital relationship plays an important role in health and wellbeing. However, how marriage is associated with multimorbidity (the co-occurrence of two or more chronic conditions) has not been comprehensively investigated. We aimed to assess the association between marriage and multimorbidity in middle-aged adults. Methods We used nationally representative data on 23641 adults aged 50-60 years who participated in four longitudinal studies in the US, UK, Europe, and China (Health and Retirement Study, English Longitudinal Study on Ageing, Survey of Health, Ageing and Retirement in Europe, and China Health and Retirement Longitudinal Study). Respondents were followed up in 2010-11 (baseline), 2012-13, and 2014-15. We used generalized estimating equations to evaluate the associations between marital status (married/partnered or non-married [separated/devoiced/widowed/never married]), marriage duration and multimorbidity, adjusting for socioeconomic and lifestyle factors. Results Over 4-year follow-up, 24\% (n=5699) of respondents experienced separation, divorce, widowhood, or never-married status, and approximately 43\% (n=10228) of respondents reported multimorbidity. Those who were not married had a higher odds of multimorbidity (age-, sex- and region-adjusted odds ratio 1.19; 95\% confidence interval 1.14 to 1.25). Those who had been married for 21-30 years had a lower odds of experiencing multimorbidity than those married for less than 10 years. The associations remained robust after adjusting for socioeconomic and lifestyle factors. Conclusions Marital relationship (status and length) was associated with multimorbidity in middle-aged adults, highlighting the role of marital relationship in shaping the trajectory of health and wellbeing across the life course. These findings provide insight for the prevention and management of chronic disease and multimorbidity.}, keywords = {Marital Status, marriage duration, multimorbidity, Prevalence}, issn = {0378-5122}, doi = {https://doi.org/10.1016/j.maturitas.2021.09.011}, author = {Danyang Wang and Duanhui Li and Shiva Raj Mishra and Carmen Lim and Xiaochen Dai and Shu Chen and Xiaolin Xu} } @article {12969, title = {Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study.}, journal = {Frontiers in Public Health}, volume = {10}, year = {2022}, pages = {1038573}, abstract = {

BACKGROUND: Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs).

METHODS: To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants{\textquoteright} responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment.

RESULTS: A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5\%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95\% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95\% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95\% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95\% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking.

CONCLUSIONS: The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

}, keywords = {Aging, Cognitive Dysfunction, Educational Status, Prevalence, Research}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.1038573}, author = {Jin, Yuming and Zhou, Xianghong and Deng, Linghui and Xiong, Xingyu and Li, Yifan and Wei, Qiang and Dong, Birong and Qiu, Shi} } @article {12681, title = {Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {89}, year = {2022}, pages = {31-37}, abstract = {

We compared the prevalence of reporting difficulty with basic and instrumental activities of daily living without help received for persons with cognitive impairment living alone versus those living with others. We used data on 13,782 community-dwelling participants aged 55+ with cognitive impairment in the Health and Retirement Study (2000-2016). Models were stratified by gender and race/ethnicity. Among cognitively impaired older adults, those living alone were more likely to report difficulty without help received than those living with others. Results were similar by gender and race/ethnicity. Providers and policymakers might focus their efforts on ensuring the adequate provision of home and community-based services for older adults living alone with cognitive impairment.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, home environment, Independent Living, Prevalence}, issn = {1875-8908}, doi = {10.3233/JAD-220172}, author = {Yang, Yulin and Swinnerton, Kaitlin and Portacolone, Elena and Allen, Isabel Elaine and Torres, Jacqueline M and Duchowny, Kate} } @article {12700, title = {Serum Cystatin-C is linked to increased prevalence of diabetes and higher risk of mortality in diverse middle-aged and older adults.}, journal = {PLoS One}, volume = {17}, year = {2022}, pages = {e0270289}, abstract = {

OBJECTIVE: Type 2 Diabetes Mellitus (henceforth diabetes) affects roughly 35 million individuals in the US and is a major risk factor for cardiovascular and kidney disease. Serum Cystatin-C is used to monitor renal function and detect kidney damage. Recent research has focused on linking Cystatin-C to cardiovascular risk and disease, but most findings focus on small sample sizes and generalize poorly to diverse populations, thus limiting epidemiological inferences. The aim of this manuscript is to study the association between Cystatin-C, diabetes, and mortality and test for possible sex or racial/ethnic background modifications in these relationships.

METHODS: We analyzed 8-years of biennial panel data from Health and Retirement Study participants 50-years and older who self-identified as White (unweighted N (uN) = 5,595), Black (uN = 867), or Latino (uN = 565) for a total of uN = 7,027 individuals. We modeled diabetes and death over 8-years as function of baseline Cystatin-C (log transformed) adjusting for covariates and tested modifications in associations by race/ethnic background and sex.

RESULTS: Mean log Cystatin-C at visit 1 was 0.03{\textpm}0.32 standard deviation. A 10\% increase in Cystatin-C levels was associated with 13\% increased relative risk of diabetes at baseline (11\% and 9\% by years 4 and 8). A 10\% increase in Cystatin-C was highly associated with increased relative risk of death (28\% and 31\% by years 4 and 8). These associations were present even after adjusting for possible confounders and were not modified by sex or racial/ethnic background.

CONCLUSION: Despite differential risks for diabetes and mortality by racial/ethnic groups, Cystatin-C was equally predictive of these outcomes across groups. Cystatin-C dysregulations could be used as a risk indicator for diabetes and as a warning sign for accelerated risk of mortality.

}, keywords = {Diabetes Mellitus, Hispanic or Latino, Kidney diseases, Prevalence, Risk Factors, Type 2}, issn = {1932-6203}, doi = {10.1371/journal.pone.0270289}, author = {Gonz{\'a}lez, Kevin A and Stickel, Ariana M and Kaur, Sonya S and Ramos, Alberto R and Gonz{\'a}lez, Hector M and Tarraf, Wassim} } @article {12938, title = {State-level metabolic comorbidity prevalence and control among adults age 50-plus with diabetes: estimates from electronic health records and survey data in five states.}, journal = {Population Health Metrics}, volume = {20}, year = {2022}, pages = {22}, abstract = {

BACKGROUND: Although treatment and control of diabetes can prevent complications and reduce morbidity, few data sources exist at the state level for surveillance of diabetes comorbidities and control. Surveys and electronic health records (EHRs) offer different strengths and weaknesses for surveillance of diabetes and major metabolic comorbidities. Data from self-report surveys suffer from cognitive and recall biases, and generally cannot be used for surveillance of undiagnosed cases. EHR data are becoming more readily available, but pose particular challenges for population estimation since patients are not randomly selected, not everyone has the relevant biomarker measurements, and those included tend to cluster geographically.

METHODS: We analyzed data from the National Health and Nutritional Examination Survey, the Health and Retirement Study, and EHR data from the DARTNet Institute to create state-level adjusted estimates of the prevalence and control of diabetes, and the prevalence and control of hypertension and high cholesterol in the diabetes population, age 50 and over for five states: Alabama, California, Florida, Louisiana, and Massachusetts.

RESULTS: The estimates from the two surveys generally aligned well. The EHR data were consistent with the surveys for many measures, but yielded consistently lower estimates of undiagnosed diabetes prevalence, and identified somewhat fewer comorbidities in most states.

CONCLUSIONS: Despite these limitations, EHRs may be a promising source for diabetes surveillance and assessment of control as the datasets are large and created during the routine delivery of health care.

TRIAL REGISTRATION: Not applicable.

}, keywords = {Comorbidity, Diabetes Mellitus, Electronic Health Records, Prevalence, Self Report}, issn = {1478-7954}, doi = {10.1186/s12963-022-00298-z}, author = {Mardon, Russell and Campione, Joanne and Nooney, Jennifer and Merrill, Lori and Johnson, Maurice and Marker, David and Jenkins, Frank and Saydah, Sharon and Rolka, Deborah and Zhang, Xuanping and Shrestha, Sundar and Gregg, Edward} } @article {12809, title = {Trends in inequalities in the prevalence of dementia in the United States.}, journal = {PNAS}, volume = {119}, year = {2022}, pages = {e2212205119}, abstract = {

This paper presents estimates of the prevalence of dementia in the United States from 2000 to 2016 by age, sex, race and ethnicity, education, and a measure of lifetime earnings, using data on 21,442 individuals aged 65 y and older and 97,629 person-year observations from a nationally representative survey, the Health and Retirement Study (HRS). The survey includes a range of cognitive tests, and a subsample underwent clinical assessment for dementia. We developed a longitudinal, latent-variable model of cognitive status, which we estimated using the Markov Chain Monte Carlo method. This model provides more accurate estimates of dementia prevalence in population subgroups than do previously used methods on the HRS. The age-adjusted prevalence of dementia decreased from 12.2\% in 2000 (95\% CI, 11.7 to 12.7\%) to 8.5\% in 2016 (7.9 to 9.1\%) in the 65+ population, a statistically significant decline of 3.7 percentage points or 30.1\%. Females are more likely to live with dementia, but the sex difference has narrowed. In the male subsample, we found a reduction in inequalities across education, earnings, and racial and ethnic groups; among females, those inequalities also declined, but less strongly. We observed a substantial increase in the level of education between 2000 and 2016 in the sample. This compositional change can explain, in a statistical sense, about 40\% of the reduction in dementia prevalence among men and 20\% among women, whereas compositional changes in the older population by age, race and ethnicity, and cardiovascular risk factors mattered less.

}, keywords = {Dementia, Educational Status, ethnicity, Prevalence, Retirement}, issn = {1091-6490}, doi = {10.1073/pnas.2212205119}, author = {Hudomiet, P{\'e}ter and Michael D Hurd and Rohwedder, Susann} } @article {13125, title = {Trends in prevalence, health disparities, and early detection of dementia: A 10-year nationally representative serial cross-sectional and cohort study.}, journal = {Front Public Health}, volume = {10}, year = {2022}, month = {2022}, pages = {1021010}, abstract = {

OBJECTIVE: To identify trends in the prevalence of mild cognitive impairment (MCI) and dementia, and to determine risk factors associated with the early detection of dementia among U.S. middle-aged and older adults.

METHODS: We used 10-year nationally representative longitudinal data from the Health and Retirement Study (HRS) (2006-2016). Adults aged 55 years or older were included to examine the trend. To identify the associated factors, adults aged 55 years or older in 2006 who developed MCI or dementia in subsequent waves until the 2016 wave were included. Early and late detection of dementia were identified using the Langa-Weir classification of cognitive function. Multivariate logistic regression models were used to identify factors associated with the early detection of dementia.

RESULTS: The sample size for the analysis of the prevalence of MCI and dementia ranged from 14,935 to 16,115 in the six survey years, and 3,729 individuals were identified to determine associated factors of the early detection of dementia. Among them, participants aged 65 years or older accounted for 77.9\%, and male participants accounted for 37.2\%. The 10-year prevalence of MCI and dementia was 14.5 and 6.6\%, respectively. We also found decreasing prevalence trends in MCI (from 14.9 to 13.6\%) and dementia (from 7.4 to 6.0\%) overall in the past decade. Using logistic regression controlling for the year, non-Hispanic black (MCI: OR = 2.83, < 0.001; dementia: OR = 2.53, < 0.001) and Hispanic (MCI: OR = 2.52, < 0.001; dementia: OR = 2.62, < 0.001) had a higher prevalence of both MCI and dementia than non-Hispanic white participants. In addition, men had a lower prevalence of MCI (OR = 0.94, = 0.035) and dementia (OR = 0.84, < 0.001) compared to women. Associated factors of the early detection of dementia include age, gender, race, educational attainment, stroke, arthritis diseases, heart problems, and pensions.

CONCLUSION: This study found a decreasing trend in the prevalence of MCI and dementia in the past decade and associated racial/ethnic and gender disparities among U.S. middle-aged and older adults. Healthcare policies and strategies may be needed to address health disparities in the prevalence and take the associated factors of the early detection of dementia into account in clinical settings.

}, keywords = {Aged, Cognitive Dysfunction, Cohort Studies, Cross-Sectional Studies, Dementia, Female, Humans, Male, Middle Aged, Prevalence}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.1021010}, author = {Lu, Kevin and Xiong, Xiaomo and Li, Minghui and Yuan, Jing and Luo, Ye and Friedman, Daniela B} } @mastersthesis {11689, title = {A Secondary Data Analysis of the Pr y Data Analysis of the Prevalence of Reported Dementia and Subjective Cognitive Decline Across U.S. National Surveys}, volume = {MA}, year = {2021}, school = {Washington University}, address = {St. Louis, MO}, abstract = {Within the United States, many large-scale, nationally representative studies exist with the goal of tracking and monitoring aspects of health. These studies are often used to establish the prevalence of dementia and subjective cognitive decline (SCD) in the population. The goal of the current study is to examine how different population-based studies probe respondents about conditions related to cognitive impairment, and to assess similarities and differences in point estimates. We reviewed eight studies and identified comparable items related to dementia and SCD. We calculated design-appropriate point prevalence estimates and compared weighted estimates across studies, finding a wide range and statistically significantly different estimates for dementia (estimates ranging from 2.7\% - 9.9\%) and for SCD (5.6\% - 46.6\%). Close analysis of item construction revealed meaningful differences in the use of terminologies and timeframes that could account for these differences. Moreover, subtle but consequential sampling differences were also discovered within study documentation that also could be responsible. Given the importance of prevalence estimates for research, practice, and policy, our findings highlight the need for harmonization across methodology in these large studies, even at their most basic level, to establish the true burden of these conditions.}, keywords = {Dementia, Prevalence, secondary data analysis, self-report, subjective cognitive decline}, url = {https://openscholarship.wustl.edu/cgi/viewcontent.cgi?article=3345\&context=art_sci_etds}, author = {Picchiello, Matthew C.} } @article {doi:10.1111/jgs.16380, title = {Motoric Cognitive Risk Syndrome in Polypharmacy}, journal = {Journal of the American Geriatrics Society}, year = {2020}, month = {02/2020}, type = {Report}, abstract = {Risk factors for motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait and cognitive complaints, have been identified, but few are reversible. Polypharmacy is a potentially reversible risk factor for cognitive decline, but the relationship between MCR and polypharmacy has not been examined. Our aim was to compare the epidemiology of MCR and polypharmacy. DESIGN Cross-sectional. SETTING Community-based Health and Retirement Study cohort. PARTICIPANTS A total of 1119 adults 65 years and older (mean age = 74.7 {\textpm} 7.0 y; 59\% female). MEASUREMENTS Polypharmacy is defined as the use of five or more regularly scheduled medications. MCR is defined as cognitive complaints and slow gait in an individual without dementia. RESULTS The prevalence of MCR among 417 participants with polypharmacy was 10\%; it was 6\% among 702 participants without polypharmacy. The odds of meeting MCR criteria in those with polypharmacy was 1.8 (confidence interval = 1.0-3.0; P = .035) compared with those without polypharmacy, even after adjusting for high-risk medication use. CONCLUSION Our results show the coexistence of MCR and polypharmacy in older adults, suggesting a potentially modifiable risk factor for dementia.}, keywords = {Motoric Cognitive Risk Syndrome, Polypharmacy, Prevalence}, doi = {10.1111/jgs.16380}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16380}, author = {George, Claudene J. and Joe Verghese} } @article {8706, title = {Early Origins of Adult Cancer Risk Among Men and Women: Influence of Childhood Misfortune?}, journal = {J Aging Health}, volume = {30}, year = {2018}, month = {2018 01}, pages = {140-163}, abstract = {

OBJECTIVE: To examine the effect of five childhood misfortune domains-parental behavior, socioeconomic status, infectious diseases, chronic diseases, and impairments-on all-site and selected site-specific cancer prevalence and all-site cancer incidence.

METHOD: Panel data from the Health and Retirement Study (2004-2012) were used to investigate cancer risk among adults above the age of 50.

RESULTS: Risky parental behavior and impairment in childhood were associated with higher odds of all-site cancer prevalence, and childhood chronic disease was associated with prostate cancer, even after adjusting for adult health and socioeconomic factors. Moreover, having one infectious disease in childhood lowered the odds of colon cancer. Cancer trends varied by race and ethnicity, most notably, higher prostate cancer prevalence among Black men and lower all-site cancer among Hispanic adults.

DISCUSSION: These findings underscore the importance of examining multiple domains of misfortune because the type and amount of misfortune influence cancer risk in different ways.

}, keywords = {African Americans, Aged, Child, Female, Hispanic Americans, Humans, Incidence, Male, Middle Aged, Neoplasms, Parents, Prevalence, Risk Assessment, Risk Factors, Social Class, Social Conditions, Socioeconomic factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264316670049}, author = {Blakelee R Kemp and Kenneth F Ferraro and Patricia M Morton and Sarah A Mustillo} } @article {11264, title = {State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data.}, journal = {Statistics in Medicine}, volume = {37}, year = {2018}, pages = {3975-3990}, abstract = {

Many statisticians and policy researchers are interested in using data generated through the normal delivery of health care services, rather than carefully designed and implemented population-representative surveys, to estimate disease prevalence. These larger databases allow for the estimation of smaller geographies, for example, states, at potentially lower expense. However, these health care records frequently do not cover all of the population of interest and may not collect some covariates that are important for accurate estimation. In a recent paper, the authors have described how to adjust for the incomplete coverage of administrative claims data and electronic health records at the state or local level. This article illustrates how to adjust and combine multiple data sets, namely, national surveys, state-level surveys, claims data, and electronic health record data, to improve estimates of diabetes and prediabetes prevalence, along with the estimates of the method{\textquoteright}s accuracy. We demonstrate and validate the method using data from three jurisdictions (Alabama, California, and New York City). This method can be applied more generally to other areas and other data sources.

}, keywords = {Bias, California, Diabetes Mellitus, Electronic Health Records, Health Surveys, Humans, Insurance Claim Review, New York City, Nutrition Surveys, Prediabetic State, Prevalence, Statistics as Topic, United States}, issn = {1097-0258}, doi = {10.1002/sim.7848}, author = {David A Marker and Mardon, Russ and Jenkins, Frank and Campione, Joanne and Nooney, Jennifer and Li, Jane and Saydeh, Sharon and Zhang, Xuanping and Shrestha, Sundar and Deborah B. Rolka} } @article {8813, title = {A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012.}, journal = {JAMA Intern Med}, volume = {177}, year = {2017}, month = {2017 01 01}, pages = {51-58}, abstract = {

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95\% CI, 74.8-75.2 years) in 2000 and 74.8 years (95\% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4\% (95\% CI, 57.3\%-59.4\%) of the 2000 cohort was female compared with 56.3\% (95\% CI, 55.5\%-57.0\%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6\% (95\% CI, 10.7\%-12.7\%) in 2000 to 8.8\% (95\% CI, 8.2\%-9.4\%) (8.6\% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95\% CI, 11.6-11.9 years] to 12.7 years [95\% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

}, keywords = {Aged, Dementia, Female, Humans, Male, Prevalence, Risk Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2016.6807}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084}, author = {Kenneth M. Langa and Eric B Larson and Eileen M. Crimmins and Jessica Faul and Deborah A Levine and Mohammed U Kabeto and David R Weir} } @article {8809, title = {Home and community-based service and other senior service use: Prevalence and characteristics in a national sample.}, journal = {Home Health Care Serv Q}, volume = {36}, year = {2017}, month = {2017 Jan-Mar}, pages = {16-28}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Home Care Services, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Prevalence, Senior Centers, United States}, issn = {1545-0856}, doi = {10.1080/01621424.2016.1268552}, url = {https://www.tandfonline.com/doi/full/10.1080/01621424.2016.1268552}, author = {Amanda Sonnega and Kristen N Robinson and Helen G Levy} } @article {8350, title = {African Ancestry, Social Factors, and Hypertension Among Non-Hispanic Blacks in the Health and Retirement Study.}, journal = {Biodemography Soc Biol}, volume = {62}, year = {2016}, month = {2016}, pages = {19-35}, publisher = {62}, abstract = {

The biomedical literature contains much speculation about possible genetic explanations for the large and persistent black-white disparities in hypertension, but profound social inequalities are also hypothesized to contribute to this outcome. Our goal is to evaluate whether socioeconomic status (SES) differences provide a plausible mechanism for associations between African ancestry and hypertension in a U.S. cohort of older non-Hispanic blacks. We included only non-Hispanic black participants (N~=~998) from the Health and Retirement Study who provided genetic data. We estimated percent African ancestry based on 84,075 independent single nucleotide polymorphisms using ADMIXTURE V1.23, imposing K~=~4 ancestral populations, and categorized into quartiles. Hypertension status was self-reported in the year 2000. We used linear probability models (adjusted for age, sex, and southern birth) to predict prevalent hypertension with African ancestry quartile, before and after accounting for a small set of SES measures. Respondents with the highest quartile of African ancestry had 8 percentage points{\textquoteright} (RD~=~0.081; 95\% CI: -0.001, 0.164) higher prevalence of hypertension compared to the lowest quartile. Adjustment for childhood disadvantage, education, income, and wealth explained over one-third (RD~=~0.050; 95\% CI: -0.034, 0.135) of the disparity. Explanations for the residual disparity remain unspecified and may include other indicators of SES or diet, lifestyle, and psychosocial mechanisms.

}, keywords = {African Americans, Aged, Female, Health Status Disparities, Humans, Hypertension, Life Style, Male, Middle Aged, Prevalence, Risk Factors, Socioeconomic factors, United States}, issn = {1948-5573}, doi = {10.1080/19485565.2015.1108836}, url = {http://www.tandfonline.com/doi/full/10.1080/19485565.2015.1108836}, author = {Jessica R Marden and Stefan Walter and Jay S Kaufman and M. Maria Glymour} } @article {8333, title = {Antidepressant use and functional limitations in U.S. older adults.}, journal = {J Psychosom Res}, volume = {80}, year = {2016}, month = {2016 Jan}, pages = {31-6}, publisher = {80}, abstract = {

OBJECTIVE: The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults.

METHODS: Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum{\textquoteright}s Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics.

RESULTS: Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8\% (95\% confidence interval=4\%-12\%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8\% (3\%-13\%) among currently nondepressed participants but not currently depressed participants.

CONCLUSION: Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Antidepressive Agents, depression, Drug Utilization, Female, Health Surveys, Humans, Longitudinal Studies, Male, Mobility Limitation, Muscle, Skeletal, Prevalence, Risk Factors, Socioeconomic factors, United States}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2015.11.007}, url = {http://www.sciencedirect.com/science/article/pii/S0022399915300167}, author = {An, Ruopeng and Lu, Lingyun} } @article {8393, title = {Associations of childhood adversity and adulthood trauma with C-reactive protein: A cross-sectional population-based study.}, journal = {Brain Behav Immun}, volume = {53}, year = {2016}, month = {2016 Mar}, pages = {105-112}, publisher = {53}, abstract = {

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

}, keywords = {Aged, Biomarkers, C-reactive protein, Cross-Sectional Studies, Female, Humans, Inflammation, Longitudinal Studies, Male, Mental Disorders, Middle Aged, Prevalence, Risk Factors, Socioeconomic factors, Stress, Psychological, Trauma and Stressor Related Disorders, United States}, issn = {1090-2139}, doi = {10.1016/j.bbi.2015.11.015}, url = {http://www.sciencedirect.com/science/article/pii/S088915911530060X}, author = {Joy E. Lin and Thomas C Neylan and Elissa S Epel and O Donovan, Aoife} } @article {6514, title = {Changes in Visual Function in the Elderly Population in the United States: 1995-2010.}, journal = {Ophthalmic Epidemiol}, volume = {23}, year = {2016}, month = {2016 Jun}, pages = {137-44}, chapter = {1}, abstract = {

PURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).

METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).

RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.

CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Female, Humans, Male, Medicare Part B, Prevalence, Self Report, Socioeconomic factors, United States, Visual Acuity, Visually Impaired Persons}, issn = {1744-5086}, doi = {10.3109/09286586.2015.1057603}, url = {http://dx.doi.org/10.3109/09286586.2015.1057603}, author = {Chen, Yiqun and Hahn, Paul and Frank A Sloan} } @article {8479, title = {Comparison of hypertension healthcare outcomes among older people in the USA and England.}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Mar}, pages = {264-70}, abstract = {

BACKGROUND: The USA and England have very different health systems. Comparing hypertension care outcomes in each country enables an evaluation of the effectiveness of each system.

METHOD: The English Longitudinal Study of Ageing and the Health and Retirement Survey are used to compare the prevalence of controlled, uncontrolled and undiagnosed hypertension within the hypertensive population (diagnosed or measured within the survey data used) aged 50 years and above in the USA and in England.

RESULTS: Controlled hypertension is more prevalent within the hypertensive population in the USA (age 50-64: 0.53 (0.50 to 0.57) and age 65+: 0.51 (0.49 to 0.53)) than in England (age 50-64: 0.45 (0.42 to 0.48) and age 65+: 0.42 (0.40 to 0.45)). This difference is driven by lower undiagnosed hypertension in the USA (age 50-64: 0.18 (0.15-0.21) and age 65+: 0.13 (0.12 to 0.14)) relative to England (age 50-64: 0.26 (0.24 to 0.29) and age 65+: 0.22 (0.20 to 0.24)). The prevalence of uncontrolled hypertension within the hypertensive population is very similar in the USA (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.38)) and England (age 50-64: 0.29 (0.26 to 0.32) and age 65+: 0.36 (0.34 to 0.39)). Hypertension care outcomes are comparable across US insurance categories. In both countries, undiagnosed hypertension is positively correlated with wealth (ages 50-64). Uncontrolled hypertension declines with rising wealth in the USA.

CONCLUSIONS: Different diagnostic practices are likely to drive the cross-country differences in undiagnosed hypertension. US government health systems perform at least as well as private healthcare and are more equitable in the distribution of care outcomes. Higher undiagnosed hypertension among the affluent may reflect less frequent medical contact.

}, keywords = {Aged, Aging, Antihypertensive Agents, Blood pressure, Cross-Sectional Studies, Delivery of Health Care, England, Female, Health Surveys, Humans, Hypertension, Logistic Models, Longitudinal Studies, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prevalence, Quality of Life, Socioeconomic factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2014-205336}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26598759}, author = {Alan Marshall and James Nazroo and Feeney, Kevin and Jinkook Lee and Vanhoutte, Bram and Pendleton, Neil} } @article {8679, title = {Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 10}, pages = {2035-2041}, abstract = {

OBJECTIVES: To determine the prevalence and outcomes of breathlessness in older Americans.

SETTING: Community-dwelling older adults.

PARTICIPANTS: Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).

MEASUREMENTS: Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.

RESULTS: Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63\%), multimorbidity (>=2 chronic conditions) (45\%), current smokers (38\%), heart disease (36\%), obesity (body mass index >=30.0 kg/m ) (33\%), and education less than high school (32\%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95\% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95\% CI = 1.32-2.02).

CONCLUSION: One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40\% greater risk of worsened function and 60\% greater risk of death over the next 5 years.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Anxiety, Chronic disease, Comorbidity, depression, Dyspnea, Female, Geriatric Assessment, Hospitalization, Humans, Male, Prevalence, Proportional Hazards Models, Risk Assessment, Risk Factors, Symptom Assessment, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14313}, author = {David C. Currow and Amy P Abernethy and Miriam J Johnson and Yinghui Miao and W John Boscardin and Christine S Ritchie} } @article {8506, title = {Self-Reported Hearing in the Last 2 Years of Life in Older Adults.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 07}, pages = {1486-91}, abstract = {

OBJECTIVES: To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN: Observational cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS: Older adults (N = 5,895, mean age at death 78, 53\% female, 20\% nonwhite).

MEASUREMENTS: The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS: Thirty-two percent (95\% confidence interval (CI) = 31-34\%) of all participants and 60\% (95\% CI = 57-64\%) of the 7\% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29\% 19-24 months before death, 36\% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22\%; 60-69, 21\%; 70-79, 26\%; 80-89, 38\%; >=90, 50\%), sex (men 35\%, women 30\%), race and ethnicity (Hispanic 42\%, white 33\%), wealth (lowest quartile 38\%, highest quartile 27\%), history of heart disease (yes 38\%, no 27\%), activity of daily living dependence (yes 42\%, no 26\%), difficulty taking medications (yes 46\%, no 29\%), and probable dementia (yes 44\%, no 24\%).

CONCLUSION: Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, California, Demography, Female, Hearing aids, Hearing loss, Humans, Longitudinal Studies, Male, Middle Aged, Prevalence, Quality of Life, Risk Factors, Self Report, Vulnerable Populations}, issn = {1532-5415}, doi = {10.1111/jgs.14145}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27341383}, author = {Christine S Ritchie and Yinghui Miao and W John Boscardin and Margaret Wallhagen} } @article {8546, title = {Ten-Year Prevalence and Incidence of Urinary Incontinence in Older Women: A Longitudinal Analysis of the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 06}, pages = {1274-80}, abstract = {

OBJECTIVES: To measure the incidence of urinary incontinence (UI) over 10~years in older women who did not report UI at baseline in 1998, to estimate the prevalence of female UI according to severity and type, and to explore potential risk factors for development of UI.

DESIGN: Secondary analysis of a prospective cohort.

SETTING: Health and Retirement Study.

PARTICIPANTS: Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline (1998).

MEASUREMENTS: UI was defined as an answer of "yes" to the question, "During the last 12~months, have you lost any amount of urine beyond your control?" UI was characterized according to severity (according to the Sandvik Severity Index) and type (according to International Continence Society definitions) at each biennial follow-up between 1998 and 2008.

RESULTS: In 1998, 5,552 women aged 51 to 74 reported no UI. The cumulative incidence of UI in older women was 37.2\% (95\% confidence interval (CI)=36.0-38.5\%). The most common incontinence type at the first report of leakage was mixed UI (49.1\%, 95\% CI=46.5-51.7\%), and women commonly reported their symptoms at first leakage as moderate to severe (46.4\%, 95\% CI=43.8-49.0\%).

CONCLUSION: Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms.

}, keywords = {Aged, Female, Humans, Incidence, Longitudinal Studies, Prevalence, Prospective Studies, Surveys and Questionnaires, United States, Urinary incontinence}, issn = {1532-5415}, doi = {10.1111/jgs.14088}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27321606}, author = {Erekson, Elisabeth A and Cong, Xiangyu and Mary K Townsend and Ciarleglio, Maria M} } @article {8174, title = {Cross-National Differences in Disability Among Elders: Transitions in Disability in Mexico and the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {759-68}, publisher = {70}, abstract = {

OBJECTIVES: Little is known about how exposure to a combination of infectious and chronic conditions throughout the lifecourse could impact disability in old age. This paper compares 2 cohorts of adults who have aged under very different country contexts by contrasting disability transitions among elders in Mexico with elders in the United States.

METHODS: Data comes from the Mexican Health and Aging Study (MHAS) and the U.S. Health and Retirement Study (HRS). Estimated probabilities of 2-year transitions among disability states and mortality are presented for adults aged 50 and older.

RESULTS: The levels of disability prevalence and 2 year transitions are consistent with a higher rate of disability for the United States compared to Mexico. In 2-year transitions, the U.S. sample was more likely to transition to a disabled state or increase the number of disabilities than the Mexican counterparts, while Mexicans are more likely to move out of disability or reduce the number of disabilities reported.

DISCUSSION: The findings suggest that the current rate of disability in old age is lower for a less developed country compared with a developed society. We discuss implications, possible explanations, and likely future scenarios.

}, keywords = {Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Disabled Persons, Female, Humans, Male, Mexico, Middle Aged, Mortality, Prevalence, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu185}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/28/geronb.gbu185.abstract}, author = {Kerstin Gerst and Rebeca Wong and Alejandra Michaels-Obregon and Alberto Palloni} } @article {8668, title = {Disease incidence and mortality among older Americans and Europeans.}, journal = {Demography}, volume = {52}, year = {2015}, month = {2015 Apr}, pages = {593-611}, abstract = {

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

}, keywords = {Age Distribution, Aged, Chronic disease, Europe, Health Behavior, Humans, Incidence, Middle Aged, Neoplasms, Prevalence, Risk Factors, Sex Distribution, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1007/s13524-015-0372-7}, author = {Sole-Auro, Aida and Pierre-Carl Michaud and Michael D Hurd and Eileen M. Crimmins} } @article {8228, title = {Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Oct}, pages = {1528-49}, publisher = {50}, abstract = {

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Chronic disease, Disabled Persons, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Mobility Limitation, Obesity, Prevalence, Sex Distribution, Smoking, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12284}, author = {Chen, Yiqun and Frank A Sloan} } @article {8229, title = {Increase in Disability Prevalence Before Hip Fracture.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Oct}, pages = {2029-35}, publisher = {63}, abstract = {

OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture.

DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.

SETTING: The HRS is a nationally representative longitudinal study (1992-2010).

PARTICIPANTS: HRS participants aged >=65 with hip fracture (mean age at fracture 84, 77\% female).

RESULTS: The adjusted prevalence of disability was 20\% (95\% confidence interval (CI) = 14-25\%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44\% (95\% CI = 33-55\%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53\%) and for those with dementia (60\%).

CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Dementia, Disability Evaluation, Disabled Persons, Educational Status, Female, Health Surveys, Hip Fractures, Humans, Income, Male, Mobility Limitation, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/jgs.13658}, author = {Irena Cenzer and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Kenneth E Covinsky} } @article {8216, title = {Prostate Cancer Screening Among American Indians and Alaska Natives: The Health and Retirement Survey, 1996-2008.}, journal = {Prev Chronic Dis}, volume = {12}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Aug 06}, pages = {E123}, publisher = {12}, abstract = {

INTRODUCTION: Among US men, prostate cancer is the leading malignancy diagnosed and the second leading cause of cancer death. Disparities in cancer screening rates exist between American Indians/Alaska Natives and other racial/ethnic groups. Our study objectives were to examine prostate screening at 5 time points over a 12-year period among American Indian/Alaska Native men aged 50 to 75 years, and to compare their screening rates to African American men and white men in the same age group.

METHODS: We analyzed Health and Retirement Study data for 1996, 1998, 2000, 2004, and 2008. Prostate screening was measured by self-report of receipt of a prostate examination within the previous 2 years. Age-adjusted prevalence was estimated for each year. We used regression with generalized estimating equations to compare prostate screening prevalence by year and race.

RESULTS: Our analytic sample included 119 American Indian/Alaska Native men (n = 333 observations), 1,359 African American men (n = 3,704 observations), and 8,226 white men (n = 24,292 observations). From 1996 to 2008, prostate screening rates changed for each group: from 57.0\% to 55.7\% among American Indians/Alaska Natives, from 62.0\% to 71.2\% among African Americans, and from 68.6\% to 71.3\% among whites. Although the disparity between whites and African Americans shrank over time, it was virtually unchanged between whites and American Indians/Alaska Natives.

CONCLUSION: As of 2008, American Indians/Alaska Natives were less likely than African Americans and whites to report a prostate examination within the previous 2 years. Prevalence trends indicated a modest increase in prostate cancer screening among African Americans and whites, while rates remained substantially lower for American Indians/Alaska Natives.

}, keywords = {Aged, Alaska, Analysis of Variance, Black or African American, Health Behavior, Health Surveys, Healthcare Disparities, Humans, Indians, North American, Male, Mass Screening, Middle Aged, Prevalence, Prostatic Neoplasms, Regression Analysis, Retirement, Self Report, Surveys and Questionnaires, United States, White People}, issn = {1545-1151}, doi = {10.5888/pcd12.150088}, author = {R. Turner Goins and Marc B Schure and Carolyn Noonan and Dedra S. Buchwald} } @article {8056, title = {Identifying diabetics in Medicare claims and survey data: implications for health services research.}, journal = {BMC Health Serv Res}, volume = {14}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Apr 03}, pages = {150}, publisher = {14}, abstract = {

BACKGROUND: Diabetes health services research often utilizes secondary data sources, including survey self-report and Medicare claims, to identify and study the diabetic population, but disagreement exists between these two data sources. We assessed agreement between the Chronic Condition Warehouse diabetes algorithm for Medicare claims and self-report measures of diabetes. Differences in healthcare utilization outcomes under each diabetes definition were also explored.

METHODS: Claims data from the Medicare Beneficiary Annual Summary File were linked to survey and blood data collected from the 2006 Health and Retirement Study. A Hemoglobin A1c reading, collected on 2,028 respondents, was used to reconcile discrepancies between the self-report and Medicare claims measures of diabetes. T-tests were used to assess differences in healthcare utilization outcomes for each diabetes measure.

RESULTS: The Chronic Condition Warehouse (CCW) algorithm yielded a higher rate of diabetes than respondent self-reports (27.3 vs. 21.2, p < 0.05). A1c levels of discordant claims-based diabetics suggest that these patients are not diabetic, however, they have high rates of healthcare spending and utilization similar to diabetics.

CONCLUSIONS: Concordance between A1c and self-reports was higher than for A1c and the CCW algorithm. Accuracy of self-reports was superior to the CCW algorithm. False positives in the claims data have similar utilization profiles to diabetics, suggesting minimal bias in some types of claims-based analyses, though researchers should consider sensitivity analysis across definitions for health services research.

}, keywords = {Aged, Aged, 80 and over, Algorithms, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Research, Humans, Insurance Claim Review, Male, Medicare, Prevalence, United States}, issn = {1472-6963}, doi = {10.1186/1472-6963-14-150}, author = {Joseph W Sakshaug and David R Weir and Lauren Hersch Nicholas} } @article {7881, title = {Combining direct and proxy assessments to reduce attrition bias in a longitudinal study.}, journal = {Alzheimer Dis Assoc Disord}, volume = {27}, year = {2013}, note = {Times Cited: 0}, month = {2013 Jul-Sep}, pages = {207-12}, publisher = {27}, abstract = {

Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject{\textquoteright}s memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3\% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.

}, keywords = {Aged, Bias, Caregivers, Dementia, Female, Humans, Longitudinal Studies, Male, Neuropsychological tests, Prevalence, Proxy}, issn = {1546-4156}, doi = {10.1097/WAD.0b013e31826cfe90}, author = {Bei Wu and Tchetgen Tchetgen, Eric J and Theresa L Osypuk and White, Kellee and Mujahid, Mahasin and M. Maria Glymour} } @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 {7787, title = {Race differences in the relationship between formal volunteering and hypertension.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Mar}, pages = {310-9}, publisher = {68}, abstract = {

OBJECTIVES: This study investigated race differences in the relationship between formal volunteering and hypertension prevalence among middle-aged and older adults.

METHOD: Using data from the 2004 and 2006 Health and Retirement Study (N = 5,666; 677 African Americans and 4,989 whites), we examined regression models stratified by race to estimate relationships among hypertension prevalence, systolic and diastolic blood pressure, and volunteer status and hours spent volunteering among persons aged 51 years old and older.

RESULTS: White volunteers had a lower risk of hypertension than white nonvolunteers. A threshold effect was also present; compared with nonvolunteers, volunteering a moderate number of hours was associated with lowest risk of hypertension for whites. Results for hypertension were consistent with results from alternative models of systolic and diastolic blood pressure. We found no statistically significant relationship between volunteering activity and hypertension/blood pressure for African Americans.

DISCUSSION: There may be unmeasured cultural differences related to the meaning of volunteering and contextual differences in volunteering that account for the race differences we observed. Research is needed to determine the pathways through which volunteering is related to hypertension risk and that may help explain race differences identified here.

}, keywords = {Black or African American, Blood pressure, Female, Humans, Hypertension, Logistic Models, Male, Middle Aged, Prevalence, Risk Factors, United States, Volunteers, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbs162}, author = {Jane Tavares and Jeffrey A Burr and Jan E Mutchler} } @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 {7713, title = {Antigenic challenge in the etiology of autoimmune disease in women.}, journal = {J Autoimmun}, volume = {38}, year = {2012}, note = {Rogers, Mary A M Levine, Deborah A Blumberg, Neil Fisher, Gwenith G Kabeto, Mohammed Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ HL078603/HL/NHLBI NIH HHS/ HL095467/HL/NHLBI NIH HHS/ HL100051/HL/NHLBI NIH HHS/ R21 HL093129-01A1/HL/NHLBI NIH HHS/ R21 HL093129-02/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ England J Autoimmun. 2012 May;38(2-3):J97-J102. Epub 2011 Aug 30.}, month = {2012 May}, pages = {J97-J102}, publisher = {38}, abstract = {

Infection has long been implicated as a trigger for autoimmune disease. Other antigenic challenges include receipt of allogeneic tissue or blood resulting in immunomodulation. We investigated antigenic challenges as possible risk factors for autoimmune disease in women using the Health and Retirement Study, a nationally representative longitudinal study, linked to Medicare files, years 1991-2007. The prevalence of autoimmune disease (rheumatoid arthritis, Hashimoto{\textquoteright}s disease, Graves{\textquoteright} disease, systemic lupus erythematosus, celiac disease, systemic sclerosis, Sj{\"o}gren syndrome and multiple sclerosis) was 1.4\% in older women (95\% CI: 1.3\%, 1.5\%) with significant variation across regions of the United States. The risk of autoimmune disease increased by 41\% (95\% CI of incidence rate ratio (IRR): 1.10, 1.81) with a prior infection-related medical visit. The risk of autoimmune disease increased by 90\% (95\% CI of IRR: 1.36, 2.66) with a prior transfusion without infection. Parity was not associated with autoimmune disease. Women less than 65 years of age and Jewish women had significantly elevated risk of developing autoimmune disease, as did individuals with a history of heart disease or end-stage renal disease. Antigenic challenges, such as infection and allogeneic blood transfusion, are significant risk factors for the development of autoimmune disease in older women.

}, keywords = {Aged, Aged, 80 and over, Antigens, Autoimmune Diseases, Female, Humans, Incidence, Middle Aged, Prevalence, Risk Factors, United States}, issn = {1095-9157}, doi = {10.1016/j.jaut.2011.08.001}, author = {Mary A M Rogers and Deborah A Levine and Neil Blumberg and Gwenith G Fisher and Mohammed U Kabeto and Kenneth M. Langa} } @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 {7771, title = {Depressive symptoms and psychosocial stress at work among older employees in three continents.}, journal = {Global Health}, volume = {8}, year = {2012}, month = {2012 Jul 20}, pages = {27}, publisher = {8}, abstract = {

BACKGROUND: To assess whether an association of psychosocial stress at work with depressive symptoms among older employees is evident in a set of comparable empirical studies from Europe, North America and Asia.

METHODS: Cross-sectional and longitudinal multivariate regression analyses of data from 4 cohort studies with elder workers (2004 and 2006) testing associations of psychosocial stress at work ({\textquoteright}effort-reward imbalance{\textquoteright}; {\textquoteright}low control{\textquoteright}) with depressive symptoms.

RESULTS: Cross-sectional analyses from 17 countries with 14.236 participants reveal elevated odds ratios of depressive symptoms among people experiencing high work stress compared to those with low or no work stress. Adjusted odds ratios vary from 1.64 (95\% CI 1.02-2.63) in Japan to 1.97 (95\% CI 1.75-2.23) in Europe and 2.28 (95\% CI 1.59-3.28) in the USA. Odds ratios from additional longitudinal analyses (in 13 countries) controlling for baseline depression are smaller, but remain in part significant.

CONCLUSION: Findings indicate that psychosocial stress at work might be a relevant risk factor for depressive symptoms among older employees across countries and continents. This observation may call for global policy efforts to improve quality of work in view of a rapidly aging workforce, in particular in times of economic globalization.

}, keywords = {Asia, Cross-Sectional Studies, Data collection, depression, Europe, Female, Humans, Longitudinal Studies, Male, Middle Aged, North America, Prevalence, Regression Analysis, Risk Factors, Stress, Psychological, Work}, issn = {1744-8603}, doi = {10.1186/1744-8603-8-27}, author = {Johannes Siegrist and Lunau, T. and Morten Wahrendorf and Dragano, N.} } @article {7681, title = {Effect of obesity on falls, injury, and disability.}, journal = {J Am Geriatr Soc}, volume = {60}, year = {2012}, note = {Himes, Christine L Reynolds, Sandra L United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2012 Jan;60(1):124-9. doi: 10.1111/j.1532-5415.2011.03767.x. Epub 2011 Dec 8.}, month = {2012 Jan}, pages = {124-9}, publisher = {60}, abstract = {

OBJECTIVES: To examine the effect of obesity on the propensity of older adults to fall, sustain a fall-related injury, and develop disability in activities of daily living (ADLs) after a fall.

DESIGN: Longitudinal population-based survey.

SETTING: Five waves of the Health and Retirement Study (HRS), 1998-2006.

PARTICIPANTS: Ten thousand seven hundred fifty-five respondents aged 65 and older in 31,602 person-intervals.

MEASUREMENTS: Falls within any 2-year interval (9,621 falls). Injuries requiring medical attention (3,130 injuries). Increased ADL disability after a fall within any 2-year interval (2,162 events). Underweight and three classes of obesity (body mass index (BMI) 30.0-34.9~kg/m(2) , Class 1) 35.0-39.9~kg/m(2) , Class 2; >=40.0~kg/m(2) , Class 3), calculated from self-reported height and weight. Self-reported presence of lower body limitation, pain, dizziness, or vision problems. Self-reported doctor{\textquoteright}s diagnosis of diabetes mellitus, stroke, or arthritis.

RESULTS: Compared with normal-weight respondents, the odds ratios (OR) for risk of falling were 1.12 (95\% confidence interval (CI)~=~1.01-1.24) for obesity Class 1, 1.26 (95\% CI~=~1.05-1.51) for obesity Class 2, and 1.50 (95\% CI~=~1.21-1.86) for obesity Class 3. Conditional on falling, only obesity Class 3 was related to a lower propensity for a fall-related injury (OR~=~0.62, 95\% CI~=~0.44-0.87). Obesity Classes 1 and 2 were associated with a higher risk of greater ADL disability after a fall than normal-weight respondents (OR~=~1.17, 95\% CI~=~1.02-1.34; OR~=~1.39, 95\% CI~=~1.10-1.75, respectively). Being underweight was not related to risk of falling or to reported injury or greater ADL limitation after a fall. The presence of measured health problems and chronic conditions was associated with greater risk of falling and, of those who fell, greater ADL limitation but not serious injury.

CONCLUSION: Obesity appears to be associated with greater risk of falling in older adults, as well as a higher risk of greater ADL disability after a fall. Obesity (BMI~>=~40~kg/m(2) ) may reduce the risk of injury from a fall. Further investigation of the mechanisms of obesity on falls and related health outcomes is warranted.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Body Mass Index, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Humans, Incidence, Male, Obesity, Odds Ratio, Prevalence, Retrospective Studies, Risk Factors, United States, Wounds and Injuries}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03767.x}, author = {Christine L Himes and Sandra L Reynolds} } @article {7690, title = {Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans.}, journal = {J Behav Med}, volume = {35}, year = {2012}, month = {2012 Apr}, pages = {211-20}, publisher = {35}, abstract = {

Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N~=~18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27\%) and Hispanics (33\%) than whites/others (18\%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR~=~1.53; 95\% CI: 1.36-1.73) and among blacks (HR~=~1.31; 95\% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR~=~1.33; 95\% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3\% for whites/others, 7.8\% for blacks, and 10.3\% for Hispanics.

}, keywords = {Age Factors, Aged, Black or African American, depression, Female, Health Surveys, Hispanic or Latino, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Prevalence, Risk Factors, Stroke, United States, White People}, issn = {1573-3521}, doi = {10.1007/s10865-011-9356-2}, author = {M. Maria Glymour and Jessica J. Yen and Anna Kosheleva and J Robin Moon and Benjamin D Capistrant and Kristen K Patton} } @article {7721, title = {An examination of healthy aging across a conceptual continuum: prevalence estimates, demographic patterns, and validity.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Jun}, pages = {783-9}, publisher = {67}, abstract = {

BACKGROUND: Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity.

METHODS: Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death.

RESULTS: Across definitions, the prevalence of healthy aging ranged from 3.3\% to 35.5\%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as "healthy" were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions.

CONCLUSIONS: Moving across the conceptual continuum--from a more to less rigid definition of healthy aging--markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, health, Humans, Male, Odds Ratio, Prevalence, Reproducibility of Results}, issn = {1758-535X}, doi = {10.1093/gerona/glr234}, author = {Sara J McLaughlin and Alan M Jette and Cathleen M. Connell} } @article {7761, title = {Prevalence of cognitive impairment in older adults with heart failure.}, journal = {J Am Geriatr Soc}, volume = {60}, year = {2012}, month = {2012 Sep}, pages = {1724-9}, publisher = {60}, abstract = {

OBJECTIVES: To determine the prevalence of cognitive impairment in older adults with heart failure (HF).

DESIGN: Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002 to 2004 Medicare administrative claims.

SETTING: United States, community.

PARTICIPANTS: Six thousand one hundred eighty-nine individuals aged 67 and older.

MEASUREMENTS: An algorithm was developed using a combination of self- and proxy report of a heart problem and the presence of one or more Medicare claims in administrative files using standard HF diagnostic codes. On the basis of the algorithm, three categories were created to characterize the likelihood of a HF diagnosis: high or moderate probability of HF, low probability of HF, and no HF. Cognitive function was assessed using a screening measure of cognitive function or according to proxy rating. Age-adjusted prevalence estimates of cognitive impairment were calculated for the three groups.

RESULTS: The prevalence of cognitive impairment consistent with dementia in older adults with HF was 15\%, and the prevalence of mild cognitive impairment was 24\%. The odds of dementia in those with HF were significantly higher, even after adjustment for age, education level, net worth, and prior stroke (odds ratio = 1.52, 95\% confidence interval = 1.14-2.02).

CONCLUSION: Cognitive impairment is common in older adults with HF and is independently associated with risk of dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.

}, keywords = {Aged, Aged, 80 and over, Algorithms, Chi-Square Distribution, Cognition Disorders, Cross-Sectional Studies, Demography, Female, Heart Failure, Humans, Logistic Models, Male, Medicare, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2012.04097.x}, author = {Tanya R Gure and Caroline S Blaum and Bruno J Giordani and Todd M Koelling and Andrzej T Galecki and Susan J Pressler and Scott L Hummel and Kenneth M. Langa} } @article {7676, title = {Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study.}, journal = {BMC Geriatr}, volume = {12}, year = {2012}, month = {2012 Jul 26}, pages = {39}, publisher = {12}, abstract = {

BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders.

METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation.

RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6\%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95\% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95\% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46).

CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cross-Sectional Studies, Disabled Persons, Female, Humans, Male, Middle Aged, Prevalence, Restless Legs Syndrome, Risk Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-12-39}, author = {Dominic J Cirillo and Robert B Wallace} } @article {7631, title = {Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66 Suppl 1}, year = {2011}, note = {Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i162-71.}, month = {2011 Jul}, pages = {i162-71}, publisher = {66 Suppl 1}, abstract = {

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74\% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86\% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84\% and 93\%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Dementia, Educational Status, Female, Humans, Interviews as Topic, Logistic Models, Longitudinal Studies, Male, Multivariate Analysis, Neuropsychological tests, Odds Ratio, Prevalence, Sex Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr048}, author = {Eileen M. Crimmins and Jung K Kim and Kenneth M. Langa and David R Weir} } @article {7510, title = {Can Food Stamps help to reduce Medicare spending on diabetes?}, journal = {Econ Hum Biol}, volume = {9}, year = {2011}, month = {2011 Jan}, pages = {1-13}, publisher = {9}, abstract = {

Diabetes is rapidly escalating amongst low-income, older adults at great cost to the Medicare program. We use longitudinal survey data from the Health and Retirement Study linked to administrative Medicare records and biomarker data to assess the relationship between Food Stamp receipt and diabetes health outcomes. We find no significant difference in Medicare spending, outpatient utilization, diabetes hospitalizations and blood sugar (HbA1c) levels between recipients and income-eligible non-recipients after controlling for a detailed set of covariates including individual fixed effects and measures of diabetes treatment compliance. As one-third of elderly Food Stamp recipients are currently diabetic, greater coordination between the Food Stamp, Medicare, and Medicaid programs may improve health outcomes for this group.

}, keywords = {Aged, Aged, 80 and over, Biomarkers, Confidence Intervals, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Care Costs, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Odds Ratio, Outpatients, Poverty, Prevalence, Public Assistance, Regression Analysis, Social Welfare, Treatment Outcome, United States}, issn = {1873-6130}, doi = {10.1016/j.ehb.2010.10.003}, author = {Lauren Hersch Nicholas} } @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 {7667, title = {Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study.}, journal = {Eur J Epidemiol}, volume = {26}, year = {2011}, month = {2011 May}, pages = {395-403}, publisher = {26}, abstract = {

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cognition Disorders, Educational Status, Female, Health Surveys, Humans, Incidence, Life Expectancy, Life Tables, Male, Middle Aged, Prevalence, Proportional Hazards Models, Retirement, Sex Factors, Smoking, Time Factors, United States}, issn = {1573-7284}, doi = {10.1007/s10654-011-9553-x}, author = {Mieke Reuser and Frans J Willekens and Luc G Bonneux} } @article {7564, title = {National estimates of the prevalence of Alzheimer{\textquoteright}s disease in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {61-73}, publisher = {7}, abstract = {

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer{\textquoteright}s disease and dementia. ADAMS obtained direct estimates by relying on probability sampling nationwide. EBSHP relied on projection of localized prevalence estimates to the national population. The sampling techniques of ADAMS and EBSHP were rather similar, whereas their disease definitions were not. By contrast, EBSPH and CHAP have similar disease definitions internally, but use different calculation techniques, and yet arrive at similar prevalence estimates, which are considerably greater than those obtained by either Brookmeyer or ADAMS. Choice of disease definition may play the larger role in explaining differences in observed prevalence between these studies.

}, keywords = {Age Factors, Alzheimer disease, Community Health Planning, Data collection, Humans, Incidence, Models, Statistical, Prevalence, Sampling Studies, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.007}, author = {Brookmeyer, Ron and Denis A Evans and Liesi Hebert and Kenneth M. Langa and Steven G Heeringa and Brenda L Plassman and Walter Kukull} } @article {7563, title = {Operationalizing diagnostic criteria for Alzheimer{\textquoteright}s disease and other age-related cognitive impairment-Part 2.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {35-52}, publisher = {7}, abstract = {

This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer{\textquoteright}s disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.

}, keywords = {Age Factors, Aging, Alzheimer disease, Cognition Disorders, Community Health Planning, Humans, Incidence, Longitudinal Studies, Neuropsychological tests, Prevalence, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.12.002}, author = {Seshadri, Sudha and Alexa S. Beiser and Au, Rhoda and Philip A Wolf and Robert S Wilson and Ronald C Petersen and David S Knopman and Walter A Rocca and Claudia H Kawas and Maria M Corrada and Brenda L Plassman and Kenneth M. Langa and Helena C Chui} } @article {7639, title = {The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults.}, journal = {Aging Ment Health}, volume = {15}, year = {2011}, note = {Ayalon, Liat Gum, Amber M U01AG009740/AG/NIA NIH HHS/United States Evaluation Studies Research Support, N.I.H., Extramural England Aging and mental health Aging Ment Health. 2011 Jul 1;15(5):587-94.}, month = {2011 Jul 01}, pages = {587-94}, publisher = {15}, abstract = {

OBJECTIVES: To evaluate the relationships between perceived exposure to major lifetime discrimination, everyday discrimination, and mental health in three racial/ethnic groups of older adults.

DESIGN: The Health and Retirement Study is a nationally representative sample of individuals 50 years and older living in the United States. A total of 6455 Whites, 716 Latinos, and 1214 Blacks were eligible to complete a self-report psychosocial questionnaire in the year 2006.

RESULTS: Whereas 30\% of the general population reported at least one type of major lifetime discrimination, almost 45\% of Black older adults reported such discrimination. Relative to the other two racial/ethnic groups (82\% Whites, 82.6\% Blacks), Latinos were significantly less likely to report any everyday discrimination (64.2\%), whereas Blacks reported the greatest frequency of everyday discrimination. Whites reported the highest levels of life satisfaction and the lowest levels of depressive symptoms. Relative to major lifetime discrimination, everyday discrimination had a somewhat stronger correlation with mental health indicators. The relationships between discrimination and mental health outcomes were stronger for White compared to Black older adults, although everyday discrimination was still significantly associated with outcomes for Black older adults.

CONCLUSIONS: Black older adults experience the greatest number of discriminative events, but weaker associated mental health outcomes. This could be because they have become accustomed to these experiences, benefit from social or cultural resources that serve as buffers, or selective survival, with the present sample capturing only the most resilient older adults who have learned to cope with the deleterious effects of discrimination.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Asian, Black or African American, Cross-Cultural Comparison, depression, Discrimination, Psychological, ethnicity, Hispanic or Latino, Humans, Longitudinal Studies, Mental Health, Middle Aged, Personal Satisfaction, Prejudice, Prevalence, Social Perception, Socioeconomic factors, Surveys and Questionnaires, United States, White People}, issn = {1364-6915}, doi = {10.1080/13607863.2010.543664}, author = {Liat Ayalon and Amber M Gum} } @article {7565, title = {Sources of variability in estimates of the prevalence of Alzheimer{\textquoteright}s disease in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {74-9}, publisher = {7}, abstract = {

BACKGROUND: The prevalence of Alzheimer{\textquoteright}s disease (AD) in the United States was estimated at 2.3 million in 2002 by the Aging, Demographics, and Memory Study (ADAMS), which is almost 50\% less than the estimate of 4.5 million in 2000 derived from the Chicago Health and Aging Project.

METHODS: We considered how differences in diagnostic criteria may have contributed to these differences in AD prevalence.

RESULTS: We identified several important differences in diagnostic criteria that may have contributed to the differing estimates of AD prevalence. Two factors were especially noteworthy. First, the Diagnostic and Statistical Manual of Mental Disorders III-R and IV criteria of functional limitation documented by an informant used in ADAMS effectively concentrated the diagnosis of dementia toward a relatively higher level of cognitive impairment. ADAMS separately identified a category of cognitive impairment not dementia and within that group there were a substantial number of cases with "prodromal" AD (a maximum of 1.95 million with upweighting). Second, a substantial proportion of dementia in ADAMS was attributed to either vascular disease (representing a maximum of 0.59 million with upweighting) or undetermined etiology (a maximum of 0.34 million), whereas most dementia, including mixed dementia, was attributed to AD in the Chicago Health and Aging Project.

CONCLUSION: The diagnosis of AD in population studies is a complex process. When a diagnosis of AD excludes persons meeting criteria for vascular dementia, when not all persons with dementia are assigned an etiology, and when a diagnosis of dementia requires an informant report of functional limitations, the prevalence is substantially lower and the diagnosed cases most likely have a relatively higher level of impairment.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Community Health Planning, Comorbidity, Dementia, Diagnosis, Differential, Female, Humans, Incidence, Male, Prevalence, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.006}, author = {Robert S Wilson and David R Weir and Sue E Leurgans and Denis A Evans and Liesi Hebert and Kenneth M. Langa and Brenda L Plassman and Brent J. Small and David A Bennett} } @article {7654, title = {Subsidized housing not subsidized health: health status and fatigue among elders in public housing and other community settings.}, journal = {Ethn Dis}, volume = {21}, year = {2011}, note = {Parsons, Pamela L Mezuk, Briana Ratliff, Scott Lapane, Kate L K12 HD055881/HD/NICHD NIH HHS/United States UL1 RR031990-01/RR/NCRR NIH HHS/United States UL1RR031990/RR/NCRR NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States Ethnicity and disease Nihms287854 Ethn Dis. 2011 Winter;21(1):85-90.}, month = {2011 Winter}, pages = {85-90}, publisher = {21}, abstract = {

OBJECTIVES: To estimate trends in the prevalence of fatigue among elders living in public housing or in the community; to compare health status of elders living in public housing to their community-dwelling counterparts.

DESIGN: Cross-sectional study.

SETTING: Community-dwelling elders who reported ever residing in public housing were compared to those living in other community settings.

PARTICIPANTS: Participants of the Health and Retirement Study (seven waves of interviews conducted from 1995 through 2006) interviewed in 2006 with complete data on housing status, self-report measures of health status and measures of functioning (n = 16,191).

MEASUREMENTS: Self-reported fatigue, functioning, and other health conditions. We also evaluated four functional indices: overall mobility, large muscle functioning, gross motor functioning, and fine motor functioning.

RESULTS: Those reporting having lived in public housing were twice as likely to rate their health as fair or poor relative to those with no public housing experience (57.3\% vs 26.9\%, respectively). Cardiac conditions, stroke, hypertension, diabetes, arthritis and psychiatric problems were all more prevalent in those living in public housing relative to community-dwelling elders not living in public housing. Fatigue was more prevalent in persons residing in public housing (26.7\%) as compared to other community-dwelling elders (17.8\%).

CONCLUSION: The health status of persons residing in public housing is poor. Fatigue and comorbid conditions are highly prevalent and more common in those living in public housing. Developing care models that meet the needs of this oft-neglected population is warranted.

}, keywords = {Aged, Chronic disease, Comorbidity, Cross-Sectional Studies, Fatigue, Female, Health Status Disparities, Humans, Male, Poverty, Prevalence, Public Housing, United States}, issn = {1049-510X}, url = {https://pubmed.ncbi.nlm.nih.gov/21462736/}, author = {Parsons, Pamela L and Briana Mezuk and Scott M Ratliff and Kate L Lapane} } @article {7567, title = {Trends in the incidence and prevalence of Alzheimer{\textquoteright}s disease, dementia, and cognitive impairment in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {80-93}, publisher = {7}, abstract = {

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified.

}, keywords = {Age Factors, Alzheimer disease, Cognition Disorders, Cohort Studies, Community Health Planning, Dementia, Humans, Incidence, Prevalence, Residence Characteristics, Retrospective Studies, Time Factors, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.002}, author = {Walter A Rocca and Ronald C Petersen and David S Knopman and Liesi Hebert and Denis A Evans and Kathleen S Hall and Gao, Sujuan and Frederick W Unverzagt and Kenneth M. Langa and Eric B Larson and Lon R White} } @article {7674, title = {Who pays for obesity?}, journal = {J Econ Perspect}, volume = {25}, year = {2011}, month = {2011 Winter}, pages = {139-58}, publisher = {25}, abstract = {

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population{\textemdash}a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

}, keywords = {Adult, Cost of Illness, Financing, Personal, Health Benefit Plans, Employee, Health Care Costs, health policy, Humans, Income, Insurance Coverage, Insurance Pools, Insurance, Health, Life Expectancy, Models, Econometric, Obesity, Prevalence, Private Sector, Public Sector, Risk Adjustment, Social Control Policies, United States}, issn = {0895-3309}, doi = {10.1257/jep.25.1.139}, author = {Bhattacharya, Jay and Sood, Neeraj} } @article {7439, title = {Coronary heart disease from a life-course approach: findings from the health and retirement study, 1998-2004.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Mar}, pages = {219-41}, publisher = {22}, abstract = {

OBJECTIVE: Guided by a life-course approach to chronic disease, this study examined the ways in which childhood deprivation (low parental education and father{\textquoteright}s manual occupation) may be associated with coronary heart disease (CHD).

METHOD: Multilevel modeling techniques and a nationally representative sample of Americans above age 50 from the Health and Retirement Study (HRS; N = 18,465) were used to examine childhood and CHD relationships over the course of 6 years (1998-2004).

RESULTS: Having a father with

DISCUSSION: Policies and programs aimed at improving the conditions of poor children and their families may effectively reduce the prevalence of CHD in later life.

}, keywords = {Age Factors, Aged, Aging, Coronary Artery Disease, Educational Status, Female, Health Status Disparities, Health Surveys, Humans, Income, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Poverty, Prevalence, Retirement, Risk Assessment, Risk Factors, Self Report, Social Class, Socioeconomic factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264309355981}, author = {Mary E Bowen} } @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 {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 {7501, title = {The epidemiology of pain during the last 2 years of life.}, journal = {Ann Intern Med}, volume = {153}, year = {2010}, month = {2010 Nov 02}, pages = {563-9}, publisher = {153}, abstract = {

BACKGROUND: The epidemiology of pain during the last years of life has not been well described.

OBJECTIVE: To describe the prevalence and correlates of pain during the last 2 years of life.

DESIGN: Observational study. Data from participants who died while enrolled in the Health and Retirement Study were analyzed. The survey interview closest to death was used. Each participant or proxy was interviewed once in the last 24 months of life and was classified into 1 of 24 cohorts on the basis of the number of months between the interview and death. The relationship between time before death and pain was modeled and was adjusted for age, sex, race or ethnicity, education level, net worth, income, terminal diagnosis category, presence of arthritis, and proxy status.

SETTING: The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006).

PARTICIPANTS: Older adult decedents.

MEASUREMENTS: Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity.

RESULTS: The sample included 4703 decedents. Mean age (SD) of participants was 75.7 years (SD, 10.8); 83.1\% were white, 10.7\% were black, 4.7\% were Hispanic; and 52.3\% were men. The adjusted prevalence of pain 24 months before death was 26\% (95\% CI, 23\% to 30\%). The prevalence remained flat until 4 months before death (28\% [CI, 25\% to 32\%]), then it increased, reaching 46\% (CI, 38\% to 55\%) in the last month of life. The prevalence of pain in the last month of life was 60\% among patients with arthritis versus 26\% among patients without arthritis (P < 0.001) and did not differ by terminal diagnosis category (cancer [45\%], heart disease [48\%], frailty [50\%], sudden death [42\%], or other causes [47\%]; P = 0.195).

LIMITATION: Data are cross-sectional; 19\% of responses were from proxies; and information about cause, location, and treatment of pain was not available.

CONCLUSION: Although the prevalence of pain increases in the last 4 months of life, pain is present in more than one quarter of elderly persons during the last 2 years of life. Arthritis is strongly associated with pain at the end of life.

PRIMARY FUNDING SOURCE: National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.

}, keywords = {Aged, Aged, 80 and over, Arthritis, Chronic disease, Cross-Sectional Studies, Death, Female, Humans, Male, pain, Palliative care, Prevalence, Quality of Life, Socioeconomic factors, Terminally Ill, Time Factors}, issn = {1539-3704}, doi = {10.7326/0003-4819-153-9-201011020-00005}, author = {Alexander K Smith and Irena Cenzer and Sara J Knight and Kathleen A Puntillo and Eric W Widera and Brie A Williams and W John Boscardin and Kenneth E Covinsky} } @article {7544, title = {Modifiable risk factors for incidence of pain in older adults.}, journal = {Pain}, volume = {151}, year = {2010}, month = {2010 Nov}, pages = {366-371}, publisher = {151}, abstract = {

Pain symptoms in aging populations have significant public health impact. The aim of this study was to determine risk factors for the incidence of pain in older adults, focusing on those factors that can be modified. Secondary analyses were performed of survey data from the nationally representative Health and Retirement Study of US adults older than 50 years. Generalized estimating equations logistic regressions were used to evaluate the effect of selected variables on the incidence of pain using biennial (1992 through 2006) data, determining the relationship between the incidence of pain and the potential risk factors. Of the 18,439 survey respondents in 2006, 34.1\% (95\% CI: 33.2\%, 35.0\%) reported that they were often troubled by pain; 24.3\% reported having moderate to severe pain; and 22.3\% reported that their daily life was affected by pain. Between 1992 and 2006, 7967 individuals reported new onset of pain in 169,762 person-years of follow-up, an incidence of 4.69 (4.59, 4.80) per 100 person-years. Depression and being overweight were independent predictors associated with an increased likelihood of incident pain. Current smoking increased the likelihood of incident pain only in those subjects who also reported depression. In conclusion, pain is a common symptom in older adults. Depression, smoking, and overweight are potentially modifiable risk factors and could be considered in the prevention and management of pain in older adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Demography, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Overweight, pain, Prevalence, Retrospective Studies, Risk Assessment, Risk Factors, Smoking, United States}, issn = {1872-6623}, doi = {10.1016/j.pain.2010.07.021}, author = {Yu Shi and Hooten, W Michael and Rosebud O. Roberts and David O. Warner} } @article {7509, title = {Prevalence and predictors of fatigue in middle-aged and older adults: evidence from the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Oct}, pages = {2033-4}, publisher = {58}, keywords = {Aged, Aged, 80 and over, Fatigue, Female, Health Surveys, Humans, Male, Middle Aged, Prevalence, Retirement, Retrospective Studies, Survival Rate, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03088.x}, author = {Meng, Hongdao and Hale, Lauren and Friedberg, Fred} } @article {7441, title = {Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: the aging, demographics, and memory study.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Feb}, pages = {330-7}, publisher = {58}, abstract = {

OBJECTIVES: To estimate the prevalence of neuropsychiatric symptoms and examine their association with functional limitations.

DESIGN: Cross-sectional analysis.

SETTING: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: A sample of adults aged 71 and older (N=856) drawn from Health and Retirement Study (HRS), a nationally representative cohort of U.S. adults aged 51 and older.

MEASUREMENTS: The presence of neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) was identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned a cognitive category (normal cognition; cognitive impairment, no dementia (CIND); mild, moderate, or severe dementia). Functional limitations, chronic medical conditions, and sociodemographic information were obtained from the HRS and ADAMS.

RESULTS: Forty-three percent of individuals with CIND and 58\% of those with dementia exhibited at least one neuropsychiatric symptom. Depression was the most common individual symptom in those with normal cognition (12\%), CIND (30\%), and mild dementia (25\%), whereas apathy (42\%) and agitation (41\%) were most common in those with severe dementia. Individuals with three or more symptoms and one or more clinically significant symptoms had significantly higher odds of having functional limitations. Those with clinically significant depression had higher odds of activity of daily living limitations, and those with clinically significant depression, anxiety, or aberrant motor behaviors had significantly higher odds of instrumental activity of daily living limitations.

CONCLUSION: Neuropsychiatric symptoms are highly prevalent in older adults with CIND and dementia. Of those with cognitive impairment, a greater number of total neuropsychiatric symptoms and some specific individual symptoms are strongly associated with functional limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Behavioral Symptoms, Cognition Disorders, Cross-Sectional Studies, Dementia, Female, Humans, Male, Mental Disorders, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02680.x}, author = {Okura, Toru and Brenda L Plassman and David C Steffens and David J Llewellyn and Guy G Potter and Kenneth M. Langa} } @article {7442, title = {Self-reported versus measured height and weight in the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Feb}, pages = {412-3}, publisher = {58}, keywords = {Aged, Body Height, Body Weight, Female, Humans, Male, Middle Aged, Obesity, Population Surveillance, Prevalence, Reproducibility of Results, Sensitivity and Specificity, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02713.x}, author = {Meng, Hongdao and Xiaoxing He and Dixon, Denise} } @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 {7403, title = {The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited.}, journal = {J Alzheimers Dis}, volume = {17}, year = {2009}, month = {2009}, pages = {807-15}, publisher = {17}, abstract = {

Our study estimates the sensitivity and specificity of Medicare claims to identify clinically-diagnosed dementia, and documents how errors in dementia assessment affect dementia cost estimates. We compared Medicare claims from 1993-2005 to clinical dementia assessments carried out in 2001-2003 for the Aging Demographics and Memory Study (ADAMS) cohort (n = 758) of the Health and Retirement Study. The sensitivity and specificity of Medicare claims was 0.85 and 0.89 for dementia (0.64 and 0.95 for AD). Persons with dementia cost the Medicare program (in 2003) $7,135 more than controls (P < 0.001) when using claims to identify dementia, compared to $5,684 more when using ADAMS (P < 0.001). Using Medicare claims to identify dementia results in a 110\% increase in costs for those with dementia as compared to a 68\% increase when using ADAMS to identify disease, net of other variables. Persons with false positive Medicare claims notations of dementia were the most expensive group of subjects ($11,294 versus $4,065, for true negatives P < 0.001). Medicare claims overcount the true prevalence of dementia, but there are both false positive and negative assessments of disease. The use of Medicare claims to identify dementia results in an overstatement of the increase in Medicare costs that are due to dementia.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cohort Studies, Dementia, Female, Health Care Costs, Humans, Insurance Claim Reporting, Male, Medicare, Prevalence, Sensitivity and Specificity, United States}, issn = {1875-8908}, doi = {10.3233/JAD-2009-1099}, author = {Donald H. Taylor Jr. and {\O}stbye, Truls and Kenneth M. Langa and David R Weir and Brenda L Plassman} } @article {7413, title = {Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Nov}, pages = {445-53}, publisher = {5}, abstract = {

BACKGROUND: The diagnosis of cognitive impairment and dementia must reflect an increasingly diverse and aging United States population. This study compared direct testing and informant reports of cognition with clinical diagnoses of cognitive impairment and dementia between African Americans and whites.

METHODS: Participants in the Aging, Demographics, and Memory Study completed in-person dementia evaluations, and were assigned clinical diagnoses (by a consensus panel of dementia experts) of normal; cognitive impairment, not demented (CIND); and dementia. The Consortium to Establish a Registry for Alzheimer{\textquoteright}s Disease (CERAD) total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive performance and reported cognitive decline.

RESULTS: A higher CERAD total score was associated with lower odds of CIND and dementia, at comparable ratios between African Americans and whites. Higher IQCODE scores were associated with increased odds of dementia in both African Americans and whites. Higher IQCODE scores were associated with increased odds of CIND among whites, but not among African Americans.

CONCLUSIONS: Cultural differences may influence informant reports of prevalent CIND and dementia. Our findings also highlight the need for more comparative research to establish the cultural validity of measures used to diagnose these conditions.

}, keywords = {Activities of Daily Living, Age of Onset, Aged, Aged, 80 and over, Black or African American, Caregivers, Cognition Disorders, Cohort Studies, Culture, Dementia, Disability Evaluation, Female, Geriatric Assessment, Health Surveys, Humans, Male, Neuropsychological tests, Observer Variation, Population Surveillance, Predictive Value of Tests, Prevalence, Psychiatric Status Rating Scales, Psychometrics, Registries, Sensitivity and Specificity, Surveys and Questionnaires, White People}, issn = {1552-5279}, doi = {10.1016/j.jalz.2009.04.1234}, author = {Guy G Potter and Brenda L Plassman and James R Burke and Mohammed U Kabeto and Kenneth M. Langa and David J Llewellyn and Mary A M Rogers and David C Steffens} } @article {7409, title = {Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Mar}, pages = {540-8}, publisher = {99}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Chronic disease, Confidence Intervals, Disabled Persons, Europe, Female, Health Status Disparities, Heart Diseases, Humans, Male, Middle Aged, Odds Ratio, Poverty, Prevalence, Risk Factors, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.139469}, author = {Mauricio Avendano and M. Maria Glymour and James Banks and Johan P Mackenbach} } @article {7422, title = {Incidence and remission of urinary incontinence in a community-based population of women >= 50 years.}, journal = {Int Urogynecol J Pelvic Floor Dysfunct}, volume = {20}, year = {2009}, note = {Times Cited: 1 Komesu, Yuko M. Rogers, Rebecca G. Schrader, Ronald M. Lewis, Cindi M.}, month = {2009 May}, pages = {581-9}, publisher = {20}, abstract = {

INTRODUCTION AND HYPOTHESIS: The objective of the study was to determine incidence, remission, and predictors of change in urinary incontinence in women >= 50 in a racially diverse population.

METHODS: Subjects were women >= 50 with 4-year follow-up incontinence information in the Health and Retirement Study. Women with Any UI (AUI) and Severe UI (SVUI) were evaluated. Repeated measures logistic regression determined predictors of progression to and improvement of SVUI.

RESULTS: Women (11,591) were evaluated. AUI 4-year cumulative incidence was 12.7-33.8\% (fifth vs. ninth decades). SVUI incidence was lower but also increased with age. Among the predictors of improvement in SVUI were age (ninth vs. fifth decade odds ratios (OR) = 6.06) and ethnicity (Black vs. White OR = 0.57). Improvement of SVUI (45.8\% overall) decreased with age (ninth vs. fifth decade OR = 0.12).

CONCLUSIONS: SVUI incidence increased and remission decreased with age. Ethnicity and age predicted SVUI progression while age predicted improvement. Rates of the latter were high, particularly in younger patients.

}, keywords = {Age Factors, Black People, disease progression, Female, Hispanic or Latino, Humans, Incidence, Logistic Models, Longitudinal Studies, Middle Aged, Odds Ratio, Prevalence, Remission, Spontaneous, Severity of Illness Index, United States, Urinary incontinence, White People}, doi = {10.1007/s00192-009-0838-5}, author = {Yuko M Komesu and Rebecca G Rogers and Ronald M Schrader and Cynthia M. Lewis} } @article {7316, title = {Parental education and late-life dementia in the United States.}, journal = {J Geriatr Psychiatry Neurol}, volume = {22}, year = {2009}, month = {2009 Mar}, pages = {71-80}, publisher = {22}, abstract = {

We investigated the relation between parental education and dementia in the United States. Participants in the Aging, Demographics, and Memory Study were included, with information regarding parental education obtained from the Health and Retirement Study. The odds of dementia in elderly Americans whose mothers had less then 8 years of schooling were twice (95\% CI, 1.1-3.8) that of individuals with higher maternal education, when adjusted for paternal education. Of elderly Americans with less educated mothers, 45.4\% (95\% CI, 37.4-53.4\%) were diagnosed with dementia or ;;cognitive impairment, no dementia{\textquoteright}{\textquoteright} compared to 31.2\% (95\% CI, 25.0-37.4\%) of elderly Americans whose mothers had at least an 8th grade education. The population attributable risk of dementia due to low maternal education was 18.8\% (95\% CI, 9.4-28.2\%). The education of girls in a population may be protective of dementia in the next generation.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Apolipoproteins E, Biomarkers, Cognition Disorders, Dementia, Educational Status, Fathers, Female, Genetic Predisposition to Disease, Humans, Longitudinal Studies, Male, Mothers, Odds Ratio, Parents, Prevalence, Prospective Studies, Racial Groups, Risk Factors, Sex Distribution, United States}, issn = {0891-9887}, doi = {10.1177/0891988708328220}, author = {Mary A M Rogers and Brenda L Plassman and Mohammed U Kabeto and Gwenith G Fisher and John J McArdle and David J Llewellyn and Guy G Potter and Kenneth M. Langa} } @article {7365, title = {Patterns of food insecurity and participation in food assistance programmes over time in the elderly.}, journal = {Public Health Nutr}, volume = {12}, year = {2009}, month = {2009 Nov}, pages = {2113-9}, publisher = {12}, abstract = {

OBJECTIVE: The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

DESIGN: Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996-2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995-2002).

SETTING: USA.

SUBJECTS: There were 7623 participants for HRS and 3378 for AHEAD.

RESULTS: The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0.001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0.001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

CONCLUSIONS: The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.

}, keywords = {Aged, diet, Food Supply, Humans, Longitudinal Studies, Malnutrition, National Health Programs, Patient Acceptance of Health Care, Prevalence, Public Assistance, United States}, issn = {1475-2727}, doi = {10.1017/S1368980009005357}, author = {Kim, Kirang and Edward A Frongillo} } @article {7323, title = {Physician outpatient contacts and hospitalizations among cognitively impaired elderly.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Jan}, pages = {30-42}, publisher = {5}, abstract = {

BACKGROUND: This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community-residing older adults.

METHODS: Analysis of the 1998 wave of the Health and Retirement Survey (HRS) was conducted to create three levels of cognitive function among 6,991 older adults by using direct measures for self-respondents and proxy evaluations. Ordinary least square regression analyses were used to estimate the probability of physician outpatient contacts, number of hospitalizations, and nights hospitalized during the last 2 years.

RESULTS: Lower cognitive function level was found to be associated with decreasing levels of physician contacts and increasing levels of hospitalizations as well as nights hospitalized. In addition, lower cognitive function levels were consistently related to a variety of comorbidities. Moreover, many older adults with low cognitive function levels reported or were reported by their proxies as not having a diagnosis of a memory-related disease (MRD). Finally, having a diagnosis of an MRD was found to be associated with more physician contacts but fewer hospital nights compared with those who had never received such a diagnosis.

CONCLUSIONS: The findings suggest the need for increased outreach targeted at identification of community-dwelling older adults with decline in cognitive function who are in need of care but are underdiagnosed, underutilize physician care, and are overhospitalized.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Ambulatory Care, Cognition Disorders, Community-Institutional Relations, Comorbidity, Female, Hospitalization, Housing for the Elderly, Humans, Male, Memory Disorders, Physicians, Prevalence, Severity of Illness Index}, issn = {1552-5279}, doi = {10.1016/j.jalz.2008.05.2493}, author = {Caspi, Eilon and Nina M Silverstein and Frank Porell and Kwan, Ngai} } @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 {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 {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 {7201, title = {Prevalence of cognitive impairment without dementia in the United States.}, journal = {Ann Intern Med}, volume = {148}, year = {2008}, month = {2008 Mar 18}, pages = {427-34}, publisher = {148}, abstract = {

BACKGROUND: Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.

OBJECTIVE: To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.

DESIGN: Longitudinal study from July 2001 to March 2005.

SETTING: In-home assessment for cognitive impairment.

PARTICIPANTS: Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.

MEASUREMENTS: Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.

RESULTS: In 2002, an estimated 5.4 million people (22.2\%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2\%) and cerebrovascular disease (5.7\%). Among participants who completed follow-up assessments, 11.7\% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17\% to 20\%. The annual death rate was 8\% among those with cognitive impairment without dementia and almost 15\% among those with cognitive impairment due to medical conditions.

LIMITATIONS: Only 56\% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.

CONCLUSION: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Dementia, disease progression, Humans, Longitudinal Studies, Prevalence, United States}, issn = {1539-3704}, doi = {10.7326/0003-4819-148-6-200803180-00005}, author = {Brenda L Plassman and Kenneth M. Langa and Gwenith G Fisher and Steven G Heeringa and David R Weir and Mary Beth Ofstedal and James R Burke and Michael D Hurd and Guy G Potter and Willard L Rodgers and David C Steffens and John J McArdle and Robert J. Willis and Robert B Wallace} } @article {7272, title = {Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity?}, journal = {Alzheimers Dement}, volume = {4}, year = {2008}, month = {2008 Mar}, pages = {134-44}, publisher = {4}, abstract = {

BACKGROUND: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004.

METHODS: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. CI was determined by using a 35-point cognitive scale for self-respondents and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained with HRS data verified by the National Death Index.

RESULTS: In 1993, 12.2\% of those aged 70 or older had CI compared with 8.7\% in 2002 (P < .001). CI was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate/severe CI was greater in 2002 compared with 1993 (unadjusted hazard ratio, 4.12 in 2002 vs 3.36 in 1993; P = .08; age- and sex-adjusted hazard ratio, 3.11 in 2002 vs 2.53 in 1993; P = .09). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality.

CONCLUSIONS: These findings support the hypothesis of a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood and continued cognitive stimulation during work and leisure in adulthood might help limit the burden of dementia among the growing number of older adults worldwide.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Humans, Male, Neurology, Prevalence, Quality of Life, Socioeconomic factors, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2008.01.001}, author = {Kenneth M. Langa and Eric B Larson and Jason H. Karlawish and David M Cutler and Mohammed U Kabeto and Scott Y H Kim and Allison B Rosen} } @article {7212, title = {Within-group differences in depression among older Hispanics living in the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Jan}, pages = {P27-32}, publisher = {63B}, abstract = {

Using the Health and Retirement Study, we examine the prevalence of depression in different groups of Hispanic older adults. Respondents (n = 759) were aged 59 and older and identified themselves as Mexican American (56\%), Cuban American (13\%), Puerto Rican (8\%), other (8\%), or not specified (15\%). We used a modified version of the Center for Epidemiologic Studies-Depression scale and the Composite International Diagnostic Interview to assess depressive symptoms and the presence of major depression. Relative to Puerto Ricans, each Hispanic group had significantly lower levels of depressive symptoms, except for Cuban Americans; and each Hispanic group had lower prevalence rates for major depression, except for other Hispanics, even after we adjusted for sociodemographic, cultural factors, socioeconomic, functional limitations, and chronic health conditions.

}, keywords = {Aged, Culture, Depressive Disorder, Major, Female, Hispanic or Latino, Humans, Insurance, Health, Male, Middle Aged, Prevalence, Severity of Illness Index, Socioeconomic factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.1.p27}, author = {Frances Margaret Yang and Cazorla-Lancaster, Yamileth and Richard N Jones} } @article {7150, title = {Do panel surveys really make people sick? A commentary on Wilson and Howell (60:11, 2005, 2623-2627).}, journal = {Soc Sci Med}, volume = {65}, year = {2007}, month = {2007 Sep}, pages = {1071-7; discussion 1078-81}, publisher = {65}, abstract = {

In a recent article in this journal, Wilson and Howell [2005. Do panel surveys make people sick? US arthritis trends in the Health and Retirement Survey. Social Science \& Medicine, 60(11), 2623-2627.] argue that the sharp trend of rising age-specific arthritis prevalence from 1992 to 2000 in the USA among those in their 50s based on the original Health and Retirement Study (HRS) cohort of respondents is "almost surely spurious." Their reasons are that no such trend is found in the National Health Interview Study (NHIS) over this same time period, and that an introduction of a new birth cohort into HRS in 1998 also indicates no trend. They also claim that there may be an inherent bias in panel surveys leading respondents to report greater levels of disease as the duration of their participation in the panel increases. This bias, which they call "panel conditioning," suggests a tendency for participants in a longitudinal survey to seek out medical care and diagnosis of symptoms asked about in previous waves. In this paper, we show that the evidence presented and the conclusions reached by Wilson and Howell are incorrect. Properly analyzed, three national health surveys--the NHIS, National Health and Nutrition Examination Survey (NHANES), and HRS--all show increases in age-specific arthritis prevalence during the 1990s. Since the new HRS sample cohort introduced in 1998 represents only a part of that birth cohort, we also demonstrate that Wilson and Howell{\textquoteright}s evidence in favor of panel conditioning was flawed. We find little indication of panel conditioning among existing participants in a panel survey.

}, keywords = {Arthritis, Female, Health Surveys, Humans, Male, Middle Aged, Prevalence, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.04.019}, author = {David R Weir and James P Smith} } @article {7169, title = {Early childbearing, marital status, and women{\textquoteright}s health and mortality after age 50.}, journal = {J Health Soc Behav}, volume = {48}, year = {2007}, month = {2007 Sep}, pages = {254-66}, publisher = {48}, abstract = {

This article examines the relationship between a woman{\textquoteright}s childbearing history and her later health and mortality, with primary focus on whether the association between them is due to early and later socioeconomic status. Data are drawn from the Health and Retirement Study birth cohort of 1931-1941. Results indicate that, conditional on reaching midlife and controlling for early and later socioeconomic status, a first birth before age 20 is associated with a higher hazard of dying. In addition, having an early birth is associated with a higher prevalence of reported heart disease, lung disease, and cancer in 1994. Being unmarried at the time of the first birth is associated with earlier mortality, but this association disappears when midlife socioeconomic status is controlled. The number of children ever born does not significantly affect mortality but is associated with prevalence of diabetes.

}, keywords = {Adolescent, Cohort Studies, Female, Humans, Marital Status, Maternal Age, Middle Aged, Mortality, Parity, Pregnancy, Pregnancy in Adolescence, Prevalence, Proportional Hazards Models, Social Class, United States, Women{\textquoteright}s Health}, issn = {0022-1465}, doi = {10.1177/002214650704800304}, author = {John C Henretta} } @article {7158, title = {Geriatric conditions and disability: the Health and Retirement Study.}, journal = {Ann Intern Med}, volume = {147}, year = {2007}, month = {2007 Aug 07}, pages = {156-64}, publisher = {147}, abstract = {

BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

DESIGN: Cross-sectional analysis.

SETTING: Health and Retirement Study survey administered in 2000.

PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

RESULTS: Of adults age 65 years or older, 49.9\% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95\% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions).

LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Dizziness, Female, Geriatric Assessment, Geriatrics, Hearing Disorders, Humans, Male, Prevalence, Retirement, Urinary incontinence, Vision Disorders}, issn = {1539-3704}, doi = {10.7326/0003-4819-147-3-200708070-00004}, author = {Christine T Cigolle and Kenneth M. Langa and Mohammed U Kabeto and Zhiyi Tian and Caroline S Blaum} } @article {7164, title = {Prevalence of dementia in the United States: the aging, demographics, and memory study.}, journal = {Neuroepidemiology}, volume = {29}, year = {2007}, month = {2007}, pages = {125-32}, publisher = {29}, abstract = {

AIM: To estimate the prevalence of Alzheimer{\textquoteright}s disease (AD) and other dementias in the USA using a nationally representative sample.

METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender.

RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9\%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7\% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0\% of those aged 71-79 years to 37.4\% of those aged 90 and older.

CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Cohort Studies, Dementia, Female, Geriatric Assessment, Health Surveys, Humans, Logistic Models, Male, Prevalence, Sex Distribution, United States}, issn = {1423-0208}, doi = {10.1159/000109998}, author = {Brenda L Plassman and Kenneth M. Langa and Gwenith G Fisher and Steven G Heeringa and David R Weir and Mary Beth Ofstedal and James R Burke and Michael D Hurd and Guy G Potter and Willard L Rodgers and David C Steffens and Robert J. Willis and Robert B Wallace} } @article {7175, title = {Racial/ethnic differences in the development of disability among older adults.}, journal = {Am J Public Health}, volume = {97}, year = {2007}, month = {2007 Dec}, pages = {2209-15}, publisher = {97}, abstract = {

OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95\% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95\% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95\% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Disabled Persons, Female, Health Behavior, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Prevalence, Proportional Hazards Models, Prospective Studies, Risk, Socioeconomic factors, Survival Analysis, United States, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2006.106047}, author = {Dorothy D Dunlop and Song, Jing and Larry M Manheim and Daviglus, Martha L. and Rowland W Chang} } @article {7106, title = {Social status, risky health behaviors, and diabetes in middle-aged and older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Nov}, pages = {S290-8}, publisher = {61B}, abstract = {

OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age.

METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses.

RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors.

DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.

}, keywords = {Aged, Body Mass Index, Diabetes Mellitus, Female, Follow-Up Studies, Health Behavior, Humans, Incidence, Male, Middle Aged, Prevalence, Risk-Taking, Social Behavior, Social Class, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/61.6.s290}, author = {Linda A. Wray and Duane F. Alwin and Ryan J McCammon and Manning, Timothy and Best, Latrica E.} } @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 {6942, title = {Nonmetro residence and impaired vision among elderly Americans.}, journal = {J Rural Health}, volume = {20}, year = {2004}, month = {2004 Spring}, pages = {142-50}, publisher = {20}, abstract = {

PURPOSE: Nonmetro and metro elderly people are contrasted in their risk of having (relative to lacking) an impairment in distance vision and in near vision.

METHODS: Using the 1995-1996 panel (Wave 2) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey, the prevalence of 5 eye-threatening conditions (cardiovascular disease, cataract, diabetes, glaucoma, and hypertension), a variety of medical treatments for these conditions, the number of talks/visits with doctors in the 2 years before Wave 2, and several relevant demographic characteristics of the 6,817 respondents were controlled.

FINDINGS: Nonmetro and metro elders have the same risk of impairment in distance vision. After controlling for other factors, nonmetro elders have a higher risk than their metro peers of an uncorrected impairment in near vision (probably presbyopia).

CONCLUSIONS: Nonmetro elders may confront more impediments to updating their corrective lenses for presbyopia. Implications for public health policy are discussed.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Cataract, Chronic disease, Comorbidity, Diabetes Mellitus, Humans, Hypertension, Prevalence, Risk Assessment, Rural Health, United States, Urban Health, Vision Disorders}, issn = {0890-765X}, doi = {10.1111/j.1748-0361.2004.tb00021.x}, author = {Nan E. Johnson} } @article {6883, title = {Medication costs, adherence, and health outcomes among Medicare beneficiaries.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 Jul-Aug}, pages = {220-9}, publisher = {22}, abstract = {

In a two-year period more than two million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost. This poor adherence tended to be more common among beneficiaries with no or partial medication coverage and was associated with poorer health and higher rates of hospitalization. The risk for cost-related poor adherence was especially pronounced among lower-income beneficiaries with high out-of-pocket drug spending. We argue that this pattern of cost-related poor medication adherence should inform the design of Medicare prescription drug benefit legislation.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Continuity of Patient Care, Family Characteristics, Female, Financing, Personal, Health Services Research, Humans, Income, Insurance, Pharmaceutical Services, Longitudinal Studies, Male, Medicare, Patient Compliance, Prevalence, Probability, Self Administration, Treatment Outcome, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.4.220}, author = {Ramin Mojtabai and Mark Olfson} } @article {6835, title = {Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure.}, journal = {J Am Geriatr Soc}, volume = {50}, year = {2002}, month = {2002 Dec}, pages = {2003-8}, publisher = {50}, abstract = {

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older.

DESIGN: Cross-sectional.

SETTING: Community-based epidemiological study of older people from the continental United States.

PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier.

MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070).

RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8\% of people with other heart conditions and 3.2\% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses.

CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

}, keywords = {Aged, depression, Female, Heart Failure, Humans, Longitudinal Studies, Male, Prevalence, United States}, issn = {0002-8614}, doi = {10.1046/j.1532-5415.2002.50612.x}, author = {Carolyn L. Turvey and Schultz, K. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @article {6749, title = {Arthritis prevalence and activity limitations in older adults.}, journal = {Arthritis Rheum}, volume = {44}, year = {2001}, month = {2001 Jan}, pages = {212-21}, publisher = {44}, abstract = {

OBJECTIVE: To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics.

METHODS: Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture was ascertained by self-report.

RESULTS: The prevalence of arthritis in older adults ranged from 25\% in non-Hispanic whites to 40\% in non-Hispanic blacks to 44\% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29\%, 30\%, and 37\%, respectively, and increased to 48\%, 57\%, and 56\%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex.

CONCLUSION: Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Arthritis, Data collection, Humans, Prevalence, Racial Groups, Socioeconomic factors, Surveys and Questionnaires}, issn = {0004-3591}, doi = {10.1002/1529-0131(200101)44:1<212::AID-ANR28>3.0.CO;2-Q}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {8742, title = {Prevalence and outcomes of comorbid metabolic and cardiovascular conditions in middle- and older-age adults.}, journal = {J Clin Epidemiol}, volume = {54}, year = {2001}, month = {2001 Sep}, pages = {928-34}, abstract = {

UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease.

DESIGN: Nationally representative prospective cohort study.

SETTING: PARTICIPANTS{\textquoteright} homes.

PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993.

MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease.

RESULTS: Those with one condition represented 80\% and 70\% of the middle- and older-age groups, respectively, while just 1-2\% of each age group reported all three metabolic conditions. Thirteen percent and 32\%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26).

CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Cardiovascular Diseases, Cohort Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Services for the Aged, Humans, Hypertension, Male, Middle Aged, Obesity, Odds Ratio, Outcome Assessment, Health Care, Prevalence, Prospective Studies, Quality of Life, United States}, issn = {0895-4356}, doi = {10.1016/s0895-4356(01)00350-x}, author = {Oldrige, Neil B. and Timothy E. Stump and Nothwehr, F. and Daniel O. Clark} } @article {6649, title = {Prevalence and severity of urinary incontinence in older African American and Caucasian women.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {54}, year = {1999}, month = {1999 Jun}, pages = {M299-303}, publisher = {54A}, abstract = {

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services.

METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups.

RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02\% of the Caucasian women reported incontinence, compared with 16.17\% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women.

CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Female, Humans, Prevalence, Risk Factors, United States, Urinary incontinence, White People}, issn = {1079-5006}, doi = {10.1093/gerona/54.6.m299}, author = {Fultz, Nancy H. and A. Regula Herzog and Trivellore E. Raghunathan and Robert B Wallace and Diokno, A.C.} } @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 {6666, title = {Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994.}, journal = {Arthritis Rheum}, volume = {42}, year = {1999}, month = {1999 Apr}, pages = {769-79}, publisher = {42}, abstract = {

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time.

METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994.

RESULTS: In 1992, 62.4\% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5\% by 1994. More than 40\% of persons with musculoskeletal conditions reported disability, which was almost 90\% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences.

CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10\% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

}, keywords = {Chronic disease, Disability Evaluation, Disabled Persons, Employment, Female, Humans, Incidence, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Prevalence, Retirement, United States}, issn = {0004-3591}, doi = {10.1002/1529-0131(199904)42:4<769::AID-ANR22>3.0.CO;2-M}, author = {Yelin, Edward and Laura S. Trupin and Sebesta, D.S.} } @article {6592, title = {Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women.}, journal = {Am J Epidemiol}, volume = {145}, year = {1997}, month = {1997 May 15}, pages = {865-75}, publisher = {145}, abstract = {

A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20\%), 25-29 (38\%), 30-34 (24\%), and 35 or over (18\%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.

}, keywords = {Activities of Daily Living, Black People, Body Mass Index, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Health Behavior, Humans, Michigan, Middle Aged, Obesity, Prevalence, Regression Analysis, Severity of Illness Index, Socioeconomic factors}, issn = {0002-9262}, doi = {10.1093/oxfordjournals.aje.a009046}, author = {Daniel O. Clark and Mungai, S.M.} } @article {6569, title = {Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {52}, year = {1997}, month = {1997 Mar}, pages = {M97-105}, publisher = {52A}, abstract = {

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites.

METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups.

RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group.

CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Chronic disease, Cohort Studies, Disabled Persons, Disease, Female, Health Behavior, Humans, Male, Memory Disorders, Mexican Americans, Middle Aged, Prevalence, Risk Factors, Socioeconomic factors, White People}, issn = {1079-5006}, doi = {10.1093/gerona/52a.2.m97}, url = {http://biomed.gerontologyjournals.org/contents-by-date.0.shtml}, author = {Daniel O. Clark and Mungai, S.M. and Timothy E. Stump and Frederic D Wolinsky} }