@article {13834, title = {Does the Impact of Episodic Memory Declines on Future Changes in Perceived Control Vary Based on Individuals{\textquoteright} Experience With Cognitively Demanding Jobs?}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: This study proposes and evaluates a scenario wherein cognitive demands experienced at work can amplify the positive cross-lagged association of a shift in control beliefs following changes in episodic memory.

METHODS: From the Health and Retirement Study (2006-2018) for 9,998 participants aged 50 or above, we used repeated observations of memory and control beliefs, assessed with the Telephone Interview for Cognitive Status-modified (TICS-m) and self-mastery and perceived constraints questionnaires. A dual-Latent Change Score Model estimated the cross-lagged effects between memory and control beliefs, separately for individuals with prior high cognitive job demands and those without.

RESULTS: A decline in memory led to decreased control beliefs in terms of perceived constraints, only among those with experiences in cognitively demanding jobs.

DISCUSSION: High cognitive job demands may lead to a more cognitively oriented awareness of aging, thus amplifying the impact of memory decline on control constraints.

}, keywords = {Aging, Humans, Memory, Episodic, Occupational Stress, Retirement, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbae007}, author = {Oi, Katsuya} } @article {13831, title = {Dyadic profiles of couples{\textquoteright} self-perceptions of aging: Implications for mental health.}, journal = {Psychology and Aging}, volume = {39}, year = {2024}, pages = {153-165}, abstract = {

The way older adults perceive their own aging processes influences their mental health, but we know little about how this occurs in a dyadic context, where spouses{\textquoteright} perceptions and health are often intertwined. The present study sought to identify dyadic profiles of self-perceptions of aging (SPAs) in couples and examine how certain profiles are associated with each partner{\textquoteright}s mental health over time. A pooled sample of 3,850 heterosexual couples aged 50+ in the Health and Retirement Study (2012/2014) rated positive and negative SPAs and provided data on demographic characteristics, couple relationships, and health. We tracked these couples{\textquoteright} depressive symptoms over 2 years (2014/2016). Latent profile analysis revealed five profiles of couples{\textquoteright} SPAs: similarly positive (20\%), similarly negative (6\%), similarly average (38\%), husband negative (20\%), and wife negative (17\%). Physical health and marital quality consistently differentiated couples in profile membership. Couples with similarly positive and similarly average SPAs reported the smallest increases in depressive symptoms over time, and couples with similarly negative SPAs fared worst in mental health. We observed interesting gender differences across profiles; husbands in the husband negative profile reported significantly greater increases in depressive symptoms than those in the wife negative profile. Yet, wives in these two profiles did not differ in their depressive symptoms over time, and they reported worse mental health than wives in the similarly positive and similarly average profiles. This study adds to the emerging literature that advocates for an interpersonal approach to SPAs and reveals risk and resilience in couples as they age together. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

}, keywords = {Aged, Aging, Humans, Mental Health, Resilience, Psychological, Retirement, Self Concept}, issn = {1939-1498}, doi = {10.1037/pag0000801}, author = {Huo, Meng and Kim, Kyungmin} } @article {13699, title = {Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults.}, journal = {The Journal of Nutrition}, volume = {154}, year = {2024}, pages = {233-242}, abstract = {

BACKGROUND: Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE: This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS: We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS: Results showed that 17\% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION: Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

}, keywords = {Aged, Cognition, Cognitive Dysfunction, ethnicity, Food insecurity, Food Supply, Humans, Middle Aged, Minority Groups, Racial Groups, United States}, issn = {1541-6100}, doi = {10.1016/j.tjnut.2023.11.015}, author = {Wang, Haowei and El-Abbadi, Naglaa} } @article {13832, title = {Food Security and Health Outcomes following Gray Divorce.}, journal = {Nutrients}, volume = {16}, year = {2024}, abstract = {

The study evaluates the immediate and long-term consequences of gray divorce (i.e., marital dissolution after age 50) for the food security, depression, and disability of older Americans. Staggered Difference-in-Difference models were fitted to a nationally representative longitudinal sample of adults aged >= 50 years from the Health and Retirement Study, 1998-2018. Food insecurity and disability increase in the year of gray divorce and remain significantly elevated for up to six years or more following the event, consistent with the chronic strain model of gray divorce. Gray divorce has particularly adverse consequences for the food security of older women, while no gender differences were observed for disability. Increasing trends in gray divorce have important negative implications for food security and health of older Americans, particularly women, who appear to be less prepared to financially withstand a marital collapse in older age. Targeted policies to provide nutrition assistance and support in reemployment might be necessary to reduce the burden of food insecurity in the wake of gray divorce among women.

}, keywords = {Adult, Aged, Divorce, Female, Food security, Food Supply, Humans, Marriage, Outcome Assessment, Health Care, Retirement, United States}, issn = {2072-6643}, doi = {10.3390/nu16050633}, author = {Zhao, Hang and Andreyeva, Tatiana and Sun, Xiaohan} } @article {13771, title = {The impact of informal caregiving on U.S. Veterans Health Administration utilization and expenditures.}, journal = {Social Science \& Medicine (1982)}, volume = {344}, year = {2024}, pages = {116625}, abstract = {

Few studies have examined the effect of informal care receipt on health care utilization and expenditures while accounting for the potentially endogenous relationship between informal and formal care, and none have examined these relationships for U.S. Veterans. With rapidly increasing investments in caregiver supports over the past decade, including stipends for caregivers, the U.S. Department of Veterans Affairs (VA) needs to better understand the costs and benefits of informal care provision. Using a unique data linkage between the 1998-2010 Health and Retirement Study and VA administrative data (n~=~2083 Veterans with 9511 person-wave observations), we applied instrumental variable techniques to understand the effect of care from an adult child on Veterans{\textquoteright} two-year VA utilization and expenditures. We found that informal care decreased overall utilization by 53 percentage points (p~<~0.001) and expenditures by $19,977 (p~<~0.01). These reductions can be explained by informal care decreasing the probability of inpatient utilization by 17 percentage points (p~<~0.001), outpatient utilization by 57 percentage points (p~<~0.001), and institutional long-term care by 3 percentage points (p~<~0.05). There were no changes in the probability of non-institutional long-term care use, though these expenditures decreased by $882 (p~<~0.05). Expenditure decreases were greatest amongst medically complex patients. Our results indicate relative alignment between VA{\textquoteright}s stipend payments, which are based on replacement cost methods, and the monetary benefits derived through VA cost avoidances due to informal care. For health systems considering similar caregiver stipend payments, our findings suggest that the cost of these programs may be offset by informal care substituting for formal care, particularly for higher need patients.

}, keywords = {Adult, Adult children, Health Expenditures, Humans, Inpatients, Investments, Veterans Health}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2024.116625}, author = {Jacobs, Josephine C and Lo, Jeanie and Van Houtven, Courtney H and Wagner, Todd H} } @article {13740, title = {The long and the short of it: Salivary telomere length as a candidate biomarker for hypertension and age-related changes in blood pressure.}, journal = {Physiological Reports}, volume = {12}, year = {2024}, pages = {e15910}, abstract = {

Hypertension becomes more prevalent with increasing age. Telomere length (TL) has been proposed as a candidate biomarker and can be accessibly extracted from saliva. However, clarity is needed to evaluate the suitability of using TL as a predictor in such instances. This study investigated salivary TL in a cohort of older adults from the 2008 Health and Retirement Study (n = 3329; F: 58\%, mean age: 69.4, SD: 10.3 years) to examine any associations with blood pressure (BP). A Bayesian robust regression model was fit using weakly informative priors to predict the effects of TL with age, sex, systolic BP (SBP), diastolic BP (DBP), and treatment status. There were small effects of treatment (β: -0.07, 95\% CrI [-0.33, 0.19], pd: 71.91\%) and sex (β: -0.10, 95\% CrI [-0.27, 0.07], pd: >86.78\%). Population effects showed a reduction of 0.01 log units in TL with each year of advancing age (95\% CrI [-0.01, -0.00]). Conditional posterior predictions suggest that females, and treated individuals, experience greater change in TL with increasing age. Bayes R was ~2\%. TL declines with increasing age, differs between sexes, and appears to be influenced by antihypertensive drugs. Overall, all effects were weak. The data do not currently support the suitability of salivary TL as a biomarker to predict or understand any age-related changes in BP.

}, keywords = {Aged, Bayes Theorem, Biomarkers, Blood pressure, Female, Humans, Hypertension, Telomere, Telomere Shortening}, issn = {2051-817X}, doi = {10.14814/phy2.15910}, author = {Speer, Hollie and McKune, Andrew J and Woodward, Andrew P} } @article {13732, title = {Longitudinal Associations of Neighborhood Social Cohesion With Self-Perceptions of Aging and Loneliness.}, journal = {The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: One{\textquoteright}s aging experience is structurally embedded in the social aspects of the residential environment. However, it is largely unknown how this upstream contextual factor may shape self-perceptions of aging (SPA) and loneliness, critical aspects of later-life psychological well-being with profound health implications. This study examines the longitudinal association of neighborhood social cohesion with SPA and -loneliness, as well as the potential bidirectional associations between outcomes.

METHODS: This study used 8-year data from the Health and Retirement Study, with an analytic sample of 9,299 U.S. adults aged 50 or older. Latent growth curve models were implemented to assess the associations of baseline neighborhood social cohesion with trajectories of SPA and loneliness. Path analysis was conducted to examine the longitudinal mediation mechanisms connecting neighborhood social cohesion with SPA and loneliness.

RESULTS: Respondents from cohesive neighborhoods at baseline started with and maintained more positive initial SPA over time, but their positive perceptions decreased faster over time. Cohesive neighborhoods were associated with lower levels of loneliness over an 8-year study period, but also with slower rates of decline in loneliness. Path analysis revealed that neighborhood social cohesion indirectly affected SPA and loneliness, via bidirectional mechanisms.

DISCUSSION: This study demonstrates the significant role of environmental factors beyond individual predictors and advocates for the potential of neighborhood environments as a target for interventions to foster positive aging perception and tackle loneliness. Furthermore, it indicates that loneliness and SPA could reciprocally influence each other in the context of neighborhood social cohesion, enriching our understanding of their dynamics.

}, keywords = {Aging, Humans, Loneliness, Residence Characteristics, Self Concept, social cohesion}, issn = {1758-5368}, doi = {10.1093/geronb/gbad148}, author = {Choi, Eun Young} } @article {13840, title = {Neighborhood Social Environment and Dementia: The Mediating Role of Social Isolation.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: Despite the potential importance of the neighborhood social environment for cognitive health, the connection between neighborhood characteristics and dementia remains unclear. This study investigated the association between the prospective risk of dementia and three distinct aspects of neighborhood social environment: socioeconomic deprivation, disorder, and social cohesion. We also examined whether objective and subjective aspects of individual-level social isolation may function as mediators.

METHODS: Leveraging data from the Health and Retirement Study (2006-2018; N = 9,251), we used Cox proportional hazards models to examine the association between time-to-dementia incidence and each neighborhood characteristic, adjusting for covariates and the propensity to self-select into disadvantaged neighborhoods. We used inverse odds weighting to decompose significant total effects of neighborhood characteristics into mediational effects of objective and subjective social isolation.

RESULTS: The risk of dementia was associated with deprivation and disorder but not low cohesion. In deprived neighborhoods, individuals had an 18\% increased risk of developing dementia (cause-specific hazard ratio [CHR] = 1.18, 95\% CI: 1.02 to 1.38), and those in disordered areas had a 27\% higher risk (CHR = 1.27, 95\% CI: 1.03 to 1.59). 20\% of the disorder{\textquoteright}s effects were mediated by subjective social isolation, while the mediational effects of objective isolation were nonsignificant. Deprivation{\textquoteright}s total effects were not partitioned into mediational effects given its nonsignificant associations with the mediators.

DISCUSSION: Neighborhood deprivation and disorder may increase middle to older adults{\textquoteright} risks of dementia. The disorder may adversely affect cognitive health through increasing loneliness. Our results suggest a clear need for dementia prevention targeting upstream neighborhood contexts, including the improvement of neighborhood conditions to foster social integration among residents.

}, keywords = {Aged, Dementia, Humans, Prospective Studies, Residence Characteristics, Social Environment, social isolation}, issn = {1758-5368}, doi = {10.1093/geronb/gbad199}, author = {Choi, Eun Young and Cho, Gawon and Chang, Virginia W} } @article {13743, title = {Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans.}, journal = {Frontiers in Public Health}, volume = {12}, year = {2024}, pages = {1258348}, abstract = {

INTRODUCTION: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.

METHODS: Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.

RESULTS: Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.

DISCUSSION: Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

}, keywords = {Adult, Aged, Diabetes Mellitus, Type 2, ethnicity, Hispanic or Latino, Humans, Middle Aged, United States, White, White People}, issn = {2296-2565}, doi = {10.3389/fpubh.2024.1258348}, author = {Yu, Min Ying and Velasquez, Alfredo J and Campos, Belinda and Robinette, Jennifer W} } @article {13782, title = {The Potential of Informal Care for Self-Perceptions of Aging Among Older Community-Dwelling Adults: Longitudinal Findings From the Health and Retirement Study.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: This is the first study to analyze, whether receipt of (informal) care with (instrumental) activities of daily living (IADL/ADL) is associated with (positive and negative) self-perceptions of aging among community-dwelling older adults; and whether chronological age moderates these associations, using a longitudinal design.

METHODS: Longitudinal data of the Health and Retirement Study in the United States was used. The sample was composed of up to 9,198 observations of community-dwelling adults aged >=50 years pooled over 6 waves (2008-2018). Receiving care at all and the amount of care received with (I)ADL were analyzed in association with positive and negative attitudes towards own aging (ATOA; 8-item modified Philadelphia Geriatric Center Morale Scale, positive and negative subscore). Adjusted fixed effects regression analyses with robust standard errors were calculated.

RESULTS: Transitioning into receipt of care with any (I)ADL was associated with lower positive ATOA but not with any change in negative ATOA. Chronological age moderated the association between receipt of informal care, primarily with IADL, and negative ATOA. More negative ATOA was found among care recipients between 50 and 64 years but less among care recipients aged >=80 years.

DISCUSSION: Receiving any form of informal care was associated with an increase in internalized ageism, in particular among adults aged 50 to 64 years, but a decrease among those aged >=80 years. Psycho-educative measures are recommended for adults with care needs to prevent a loss of positive self-perceptions of aging, and reduce the danger to their healthy aging, with the receipt of care.

}, keywords = {Activities of Daily Living, Aged, Humans, Independent Living, Longitudinal Studies, Patient Care, Retirement, Self Concept, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbad189}, author = {Zwar, Larissa and K{\"o}nig, Hans-Helmut and Hajek, Andr{\'e}} } @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 {13730, title = {Purposeful and purposeless aging: Structural issues for sense of purpose and their implications for predicting life outcomes.}, journal = {Developmental Psychology}, volume = {60}, year = {2024}, pages = {75-93}, abstract = {

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: = 14,481; Midlife in the United States: = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

}, keywords = {Aged, Aging, Humans, Longevity, Retirement, United States}, issn = {1939-0599}, doi = {10.1037/dev0001633}, author = {Pfund, Gabrielle N and Olaru, Gabriel and Allemand, Mathias and Hill, Patrick L} } @article {13729, title = {Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States.}, journal = {Environmental Research}, volume = {243}, year = {2024}, pages = {117844}, abstract = {

BACKGROUND AND AIM: Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate.

METHODS: We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1~km buffer. Reflecting clinical criteria, a score of >=5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using K{\"o}ppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace.

RESULTS: The 21,611 eligible participants were 65~{\textpm}~10 years old on average, 55\% female, 81\% White, 12\% Black, 10\% Hispanic/Latino, and 31\% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8\%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95\% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95\% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95\% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95\% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95\% CI, 0.86 to 1.11) climates.

CONCLUSIONS: Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.

}, keywords = {Aged, depression, Depressive Disorder, Major, Environmental Exposure, Female, Humans, Male, Mental Health, Middle Aged, Parks, Recreational, United States}, issn = {1096-0953}, doi = {10.1016/j.envres.2023.117844}, author = {Fossa, Alan J and D{\textquoteright}Souza, Jennifer and Bergmans, Rachel and Zivin, Kara and Adar, Sara D} } @article {13781, title = {Return Migration and Disability by Life Course Stage of Return: Evidence Against the Salmon Bias.}, journal = {The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: Life course theory points to unique characteristics among older immigrants that may differentiate older age return migration from return at younger ages in terms of health. To investigate how the health of returnees may differ by age-at-return, this analysis compares disability between 3 groups of Mexican adults with a history of migration to the United States: those who return to Mexico before age 50, those who return at 50 and older, and those who remain in the United States at age 50 and older.

METHODS: Data from two nationally representative data sets, the U.S. Health and Retirement Study and the Mexican Health and Aging Study, are combined to create a data set representing Mexicans 50 and older with a history of migration to the United States. Adopting a life course perspective, activity of daily living (ADL) difficulty is compared by return status and age-at-return to account for differential selection into return by life stage.

RESULTS: Mexican immigrants who remain in the United States past age 50 have a higher probability of at least 1 ADL compared to those who return to Mexico, regardless of life course timing of return. The immigrant disadvantage persists after adjusting for differences in demographic, childhood, and adult characteristics between groups.

DISCUSSION: These findings are noteworthy because they stand in opposition to hypotheses based on life course and health-selective return migration theories and because they mean that Mexican immigrants remaining in the United States into midlife and older adulthood may be vulnerable to heightened prevalence of disability.

}, keywords = {Disabled Persons, Emigrants and Immigrants, Emigration and Immigration, Humans, Life Change Events, Mexican Americans, Mexico, Middle Aged, North American People, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbad171}, author = {Sheftel, Mara Getz} } @article {13775, title = {Structural Racism and Health Stratification: Connecting Theory to Measurement.}, journal = {Journal of Health and Social Behavior}, volume = {65}, year = {2024}, pages = {141-160}, abstract = {

Less than 1\% of studies on racialized health inequities have empirically examined their root cause: structural racism. Moreover, there has been a disconnect between the conceptualization and measurement of structural racism. This study advances the field by (1) distilling central tenets of theories of structural racism to inform measurement approaches, (2) conceptualizing U.S. states as racializing institutional actors shaping health, (3) developing a novel latent measure of structural racism in states, (4) using multilevel models to quantify the association between structural racism and five individual-level health outcomes among respondents from the Health and Retirement Study (N = 9,020) and the Behavioral Risk Factor Surveillance System (N = 308,029), and (5) making our measure of structural racism publicly available to catalyze research. Results show that structural racism is consistently associated with worse health for Black people but not White people. We conclude by highlighting this study{\textquoteright}s contributions (theoretical, methodological, and substantive) and important avenues for future research on the topic.

}, keywords = {Black or African American, Health Status Disparities, Humans, systemic racism, White}, issn = {2150-6000}, doi = {10.1177/00221465231222924}, author = {Brown, Tyson H and Homan, Patricia} } @article {13798, title = {Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.}, journal = {Journals of Gerontology. Series A Biological Sciences and Medical Sciences}, volume = {79}, year = {2024}, abstract = {

BACKGROUND: Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient{\textquoteright}s home. Nearly one-third (31\%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD).

METHODS: We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1~940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors.

RESULTS: PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4\% vs 32.1\%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002).

CONCLUSIONS: Findings highlight HHC{\textquoteright}s importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

}, keywords = {Aged, Delivery of Health Care, Dementia, Home Care Services, Hospitalization, Humans, Medicare, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glad270}, author = {Burgdorf, Julia G and Ornstein, Katherine A and Liu, Bian and Leff, Bruce and Brody, Abraham A and McDonough, Catherine and Ritchie, Christine S} } @article {13082, title = {15 years of GWAS discovery: Realizing the promise.}, journal = {Am J Hum Genet}, volume = {110}, year = {2023}, pages = {179-194}, abstract = {

It has been 15 years since the advent of the genome-wide association study (GWAS) era. Here, we review how this experimental design has realized its promise by facilitating an impressive range of discoveries with remarkable impact on multiple fields, including population genetics, complex trait genetics, epidemiology, social science, and medicine. We predict that the emergence of large-scale biobanks will continue to expand to more diverse populations and capture more of the allele frequency spectrum through whole-genome sequencing, which will further improve our ability to investigate the causes and consequences of human genetic variation for complex traits and diseases.

}, keywords = {Gene Frequency, Genetics, Population, Genome-Wide Association Study, Humans, Multifactorial Inheritance, Polymorphism, Single Nucleotide}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2022.12.011}, author = {Abdellaoui, Abdel and Yengo, Loic and Verweij, Karin J H and Visscher, Peter M} } @article {13058, title = {ADHD genetic burden associates with older epigenetic age: mediating roles of education, behavioral and sociodemographic factors among older adults.}, journal = {Clin Epigenetics}, volume = {15}, year = {2023}, pages = {67}, abstract = {

BACKGROUND: Shortened lifespans are associated with having Attention Deficit Hyperactivity Disorder (ADHD), which is likely mediated by related behavioral and sociodemographic factors that are also associated with accelerated physiological aging. Such factors include exhibiting more depressive symptoms, more cigarette smoking, higher body mass index, lower educational attainment, lower income in adulthood, and more challenges with cognitive processes compared to the general population. A higher polygenic score for ADHD (ADHD-PGS) is associated with having more characteristic features of ADHD. The degree to which (1) the ADHD-PGS associates with an epigenetic biomarker developed to predict accelerated aging and earlier mortality is unknown, as are whether (2) an association would be mediated by behavioral and sociodemographic correlates of ADHD, or (3) an association would be mediated first by educational attainment, then by behavioral and sociodemographic correlates. We evaluated these relationships in a population-based sample from the US Health and Retirement Study, among N = 2311 adults age 50 and older, of European-ancestry, with blood-based epigenetic and genetic data. The ADHD-PGS was calculated from a prior genomewide meta-analysis. Epigenome-wide DNA methylation levels that index biological aging and earlier age of mortality were quantified by a blood-based biomarker called GrimAge. We used a structural equation modeling approach to test associations with single and multi-mediation effects of behavioral and contextual indicators on GrimAge, adjusted for covariates.

RESULTS: The ADHD-PGS was significantly and directly associated with GrimAge when adjusting for covariates. In single mediation models, the effect of the ADHD-PGS on GrimAge was partially mediated via smoking, depressive symptoms, and education. In multi-mediation models, the effect of the ADHD-PGS on GrimAge was mediated first through education, then smoking, depressive symptoms, BMI, and income.

CONCLUSIONS: Findings have implications for geroscience research in elucidating lifecourse pathways through which ADHD genetic burden and symptoms can alter risks for accelerated aging and shortened lifespans, when indexed by an epigenetic biomarker. More education appears to play a central role in attenuating negative effects on epigenetic aging from behavioral and sociodemographic risk factors related to ADHD. We discuss implications for the potential behavioral and sociodemographic mediators that may attenuate negative biological system effects.

}, keywords = {Aged, Aging, Attention Deficit Disorder with Hyperactivity, Biomarkers, DNA Methylation, Educational Status, Epigenesis, Genetic, Humans, Middle Aged, sociodemographic factors}, issn = {1868-7083}, doi = {10.1186/s13148-023-01484-y}, author = {Arpawong, Thalida E and Klopack, Eric T and Jung K Kim and Crimmins, Eileen M} } @article {13455, title = {Adverse Childhood Experiences, Social Isolation, Job Strain, and Cardiovascular Disease Mortality in U.S. Older Employees.}, journal = {Medicina (Kaunas)}, volume = {59}, year = {2023}, abstract = {

Stress is a key driver of cardiovascular disease (CVD), yet the contribution of psychosocial stressors to the development of CVD has not been systematically examined in United States (U.S.) populations. The objective of this study was to assess prospective associations of adverse childhood experiences (ACEs), social isolation, and job strain with CVD mortality. Data were from the large, nationally representative, population-based Health and Retirement Study (HRS). ACEs, social isolation and job strain were assessed using validated survey instruments at baseline between 2006-2008, and death information was followed up through 2018. Cox proportional hazards regression models were used to examine prospective associations of ACEs, social isolation, and job strain with CVD mortality among 4046 older employees free from CVD at baseline. During 42,149 person-years of follow-up time, 59 death cases of CVD were reported. After adjustment for covariates, ACEs and job strain were significantly associated with increased risk of CVD mortality (aHR and 95\% CI = 3.67 [1.59, 8.48] and 2.24 [1.21, 4.11], respectively), whereas social isolation demonstrated an inflated but nonsignificant association (aHR and 95\% CI = 1.62 [0.72, 3.66]). These findings highlight the role of psychosocial exposures as novel and clinically relevant risk factors for CVD.

}, keywords = {Adverse Childhood Experiences, Cardiovascular Diseases, Humans, Risk Factors, social isolation, Surveys and Questionnaires, United States}, issn = {1648-9144}, doi = {10.3390/medicina59071304}, author = {Matthews, Timothy A and Li, Jian} } @article {13410, title = {[Analysis of healthy life expectancy and related socioeconomic influencing factors among the middle-aged and elderly in China, the United States, and the European Union].}, journal = {Zhonghua Liu Xing Bing Xue Za Zhi}, volume = {44}, year = {2023}, month = {2023 Jun 10}, pages = {1006-1012}, abstract = {

To calculate and compare the healthy life expectancy (HLE) of the middle-aged and elderly in China, the United States, and developing and developed countries in the European Union(EU) and analyze the impact of socioeconomic factors on HLE in different countries or regions. Four surveys from 2010 to 2019 were brought into the research. The data were collected from the China Health and Retirement Longitudinal Study, Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. Developed and developing countries in the EU were divided into two groups for calculation. Education level, total family wealth, and work retirement status were selected to measure socioeconomic status, and activities of daily living were used as health status indicators. We used the multi-state life cycle table method to calculate the transition probability between different health states and estimate life expectancy and HLE. A total of 69 544 samples were included in the study. In terms of age, the middle-aged and elderly in the United States and developed countries of the EU have higher HLE in all age groups. In terms of gender, only Chinese women have lower HLE than men. Regarding socioeconomic factors, the middle-aged and elderly with higher education levels and total family wealth level have higher HLE. In China, working seniors have higher HLE, while for USA women and developed countries of the EU, retired or unemployed seniors have higher HLE. Demographic and socioeconomic factors impact HLE in different countries or regions. China should pay more attention to the health of women and the middle-aged and elderly retired with lower education and less total family wealth.

}, keywords = {Activities of Daily Living, Aged, China, European Union, Female, Healthy life expectancy, Humans, Longitudinal Studies, Male, Middle Aged, Socioeconomic factors, United States}, issn = {0254-6450}, doi = {10.3760/cma.j.cn112338-20221031-00924}, author = {Hou, X D and Luo, Y N and Jin, Y Z and Zheng, Z J} } @article {13350, title = {Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations.}, journal = {Alzheimers Dement}, volume = {19}, year = {2023}, pages = {602-610}, abstract = {

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer{\textquoteright}s disease. However, the strength of this risk factor is not well established across diverse Hispanic populations.

METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample.

RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8\%-25.4\%), but was substantially higher in AAs (33.6\%; P~<~0.001). APOE ε4 carriers had higher dementia prevalence across all groups.

DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

}, keywords = {Aged, Alleles, Alzheimer disease, Apolipoprotein E4, Apolipoproteins E, Caribbean Region, Female, Genotype, Hispanic or Latino, Humans, Male}, issn = {1552-5279}, doi = {10.1002/alz.12699}, author = {Llibre-Guerra, Jorge J and Li, Jing and Qian, Yuting and Llibre-Rodriguez, Juan de Jes{\'u}s and Jim{\'e}nez-Vel{\'a}zquez, Ivonne Z and Acosta, Daisy and Salas, Aquiles and Llibre-Guerra, Juan Carlos and Valvuerdi, Adolfo and Harrati, Amal and Weiss, Jordan and Liu, Mao-Mei and Dow, William H} } @article {13683, title = {Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study.}, journal = {BMC Geriatrics}, volume = {23}, year = {2023}, pages = {773}, abstract = {

BACKGROUND: The association between body mass index (BMI) and dementia risk differs depending on follow-up time and age at BMI measurement. The relationship between BMI trajectories in late-middle age (50-65~years old) and the risk of dementia in older age (> 65~years old) has not been revealed.

METHODS: In the present study, participants from the Health and Retirement Study were included. BMI trajectories were constructed by combining BMI trend and variation information. The association between BMI trajectories at the age of 50-65~years and dementia risk after the age of 65~years was investigated. Participants with European ancestry and information on polygenic scores for cognitive performance were pooled to examine whether genetic predisposition could modify the association.

RESULTS: A total of 10,847 participants were included in the main analyses. A declining BMI trend and high variation in late-middle age were associated with the highest subsequent dementia risk in older age compared with an ascending BMI trend and low variation (RR = 1.76, 95\% CI = 1.45-2.13). Specifically, in stratified analyses on BMI trajectories and dementia risk based on each individual{\textquoteright}s mean BMI, the strongest association between a declining BMI trend with high variation and elevated dementia risk was observed in normal BMI group (RR = 2.66, 95\% CI = 1.72-4.1). Similar associations were found when participants were stratified by their genetic performance for cognition function without interaction.

CONCLUSIONS: A declining BMI trend and high variation in late-middle age were associated with a higher risk of dementia. Early monitoring of these individuals is needed to prevent dementia in older individuals.

}, keywords = {Aged, Body Mass Index, Cognition, Cohort Studies, Dementia, Humans, Risk Factors}, issn = {1471-2318}, doi = {10.1186/s12877-023-04483-z}, author = {Qin, Zijian and Liu, Zheran and Li, Ruidan and Luo, Yaxin and Wei, Zhigong and He, Ling and Pei, Yiyan and Su, Yonglin and Hu, Xiaolin and Peng, Xingchen} } @article {13320, title = {Association Between Serum Cystatin C and Cognitive Decline Independently from Creatinine: Evidence from Two Nationally Representative Aging Cohorts.}, journal = {J Alzheimers Dis}, volume = {93}, year = {2023}, pages = {459-469}, abstract = {

BACKGROUND: Studies on the association between cystatin C based estimated glomerular filtration rate (eGFRcys) and cognitive outcomes yielded inconsistent results.

OBJECTIVE: The present study aimed to examine the potential association of eGFRcys with subsequent cognitive decline rate.

METHODS: A total of 11,503 community-based participants were involved in our analyses, including 5,837 (aged 72.9{\textpm}6.3; 58.6\% women) in the Health and Retirement Study (HRS) from the US and 5,666 (aged 58.1{\textpm}9.2; 49.0\% women) in the China Health and Retirement Longitudinal Study (CHARLS). The association of eGFRcys with subsequent cognitive decline rate was evaluated by linear mixed models.

RESULTS: During 85,266 person-years of follow-up, both baseline elevated serum cystatin C (-0.048 standard deviation [SD]/year per mg/L; 95\% confidence interval [CI], -0.060 to -0.036; p < 0.001) and decreased eGFRcys (0.026 SD/year per 30 mL/min/1.73m2; 95\% CI, 0.020 to 0.032; p < 0.001) were associated with faster cognitive decline rate after full adjustment. Compared with those had eGFRcys >=90 mL/min/1.73m2, participants with eGFRcys between 60 to 90 mL/min/1.73m2 (-0.012 SD/year; 95\% CI, -0.020 to -0.004; p = 0.004) and those with eGFRcys <60 mL/min/1.73m2 (-0.048 SD/year; 95\% CI, -0.058 to -0.039; p < 0.001) experienced statistically significantly faster cognitive decline after adjustment. The associations were independent from serum creatinine/eGFRcre (eGFR that was calculated from serum creatinine).

CONCLUSION: Decreased eGFRcys are significantly associated with faster cognitive decline after full adjustment, independently from serum creatinine/eGFRcre. Serum cystatin C might be a risk factor or a prodromal biomarker of cognitive decline.

}, keywords = {Aging, Cognitive Dysfunction, Creatinine, Cystatin C, Female, Glomerular Filtration Rate, Humans, kidney, Longitudinal Studies, Male}, issn = {1875-8908}, doi = {10.3233/JAD-221162}, author = {Ma, Yanjun and Li, Chenglong and Hua, Rong and Yang, Chao and Xie, Wuxiang and Zhang, Luxia} } @article {13211, title = {The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter?}, journal = {Arch Gerontol Geriatr}, volume = {111}, year = {2023}, pages = {104992}, abstract = {

OBJECTIVES: We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships.

METHODS: Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD.

RESULTS: SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD.

CONCLUSION: Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.

}, keywords = {Cognition, Cognitive Dysfunction, Humans, Interpersonal Relations, Memory, Episodic, Neuropsychological tests}, issn = {1872-6976}, doi = {10.1016/j.archger.2023.104992}, author = {Pai, Manacy and Lu, Wentian and Chen, Miaoqi and Xue, Baowen} } @article {13242, title = {Association of Joint Genetic and Social Environmental Risks With Incident Myocardial Infarction: Results From the Health and Retirement Study.}, journal = {J Am Heart Assoc}, volume = {12}, year = {2023}, pages = {e028200}, abstract = {

Background Myocardial infarction (MI) is a significant clinical and public health problem worldwide. However, little research has assessed the interplay between genetic susceptibility and social environment in the development of MI. Methods and Results Data were from the HRS~(Health and Retirement Study). The polygenic risk score and polysocial score for MI were classified as low, intermediate, and high. Using Cox regression models, we assessed the race-specific association of polygenic score and polysocial score with MI and examined the association between polysocial score and MI in each polygenic risk score category. We also examined the joint effect of genetic (low, intermediate, and high) and social environmental risks (low/intermediate, high) on MI. A total of 612 Black and 4795 White adults aged >=65 years initially free of MI were included. We found a risk gradient of MI across the polygenic risk score and polysocial score among White participants; no significant risk gradient across the polygenic risk score was found among Black participants. A disadvantaged social environment was associated with a higher risk of incident MI among older White adults with intermediate and high genetic risk but not those with low genetic risk. We revealed the joint effect of genetics and social environment in the development of MI among White participants. Conclusions Living in a favorable social environment is particularly important for people with intermediate and high genetic risk for MI. It is critical to developing tailored interventions to improve social environment for disease prevention, especially among adults with a relatively high genetic risk.

}, keywords = {Adult, Genetic Predisposition to Disease, Humans, Myocardial Infarction, Proportional Hazards Models, Retirement, Risk Factors}, issn = {2047-9980}, doi = {10.1161/JAHA.122.028200}, author = {Tang, Junhan and Sheng, Chen and Wu, Yan Yan and Yan, Lijing L and Wu, Chenkai} } @article {13689, title = {Associations Between Longitudinal Loneliness, DNA Methylation Age Acceleration, and Cognitive Functioning.}, journal = {The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences}, volume = {78}, year = {2023}, pages = {2045-2059}, abstract = {

OBJECTIVES: Loneliness may influence aging biomarkers related to cognitive functioning, for example, through accelerated DNA methylation (DNAm) aging.

METHODS: In the present study, we tested whether six common DNAm age acceleration measures mediated the effects of baseline loneliness and five different longitudinal loneliness trajectories on general cognitive ability, immediate memory recall, delayed memory recall, and processing speed in 1,814 older adults in the Health and Retirement Study.

RESULTS: We found that baseline loneliness and individuals who belong to the highest loneliness trajectories had poorer general cognitive ability and memory scores. Only DNAm age acceleration measures that index physiological comorbidities, unhealthy lifestyle factors (e.g., smoking), and mortality risk-mediated effects of baseline loneliness on general cognitive ability and memory functioning but not processing speed. These same DNAm measures mediated effects of the moderate-but-declining loneliness trajectory on cognitive functioning. Additionally, immediate and delayed memory scores were mediated by GrimAge Accel in the lowest and two highest loneliness trajectory groups. Total and mediated effects of loneliness on cognitive functioning outcomes were mainly accounted for by demographic, social, psychological, and physiological covariates, most notably self-rated health, depressive symptomatology, objective social isolation, and body mass index.

DISCUSSION: Current findings suggest that DNAm biomarkers of aging, particularly GrimAge Accel, have promise for explaining the prospective association between loneliness and cognitive functioning outcomes.

}, keywords = {Aged, Aging, Biomarkers, Cognition, DNA Methylation, Humans, Loneliness, Longitudinal Studies}, issn = {1758-5368}, doi = {10.1093/geronb/gbad128}, author = {Lynch, Morgan and Em Arpawong, Thalida and Beam, Christopher R} } @article {13416, title = {Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, pages = {e2321474}, abstract = {

IMPORTANCE: Food insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.

OBJECTIVE: To examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older-aged adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.

MAIN OUTCOMES AND MEASURES: In each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.

RESULTS: The analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60\%] women, 10 277 [81.51\%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, -0.045; 95\% CI, -0.046 to -0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity {\texttimes} time, -0.0030; 95\% CI, -0.0062 to -0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle to older-aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

}, keywords = {Adult, Aged, Cohort Studies, Cross-Sectional Studies, Female, Food insecurity, Food Supply, Humans, Male, Memory Disorders, Middle Aged, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.21474}, author = {Lu, Peiyi and Kezios, Katrina and Jawadekar, Neal and Swift, Samuel and Vable, Anusha and Zeki Al Hazzouri, Adina} } @article {13243, title = {Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, pages = {e236636}, abstract = {

IMPORTANCE: There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.

OBJECTIVE: To examine the associations between SCCE and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.

EXPOSURES: SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).

MAIN OUTCOMES AND MEASURES: Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).

RESULTS: A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3\%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95\% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95\% CI, 1.12-1.60) and dental care (OR, 1.73; 95\% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95\% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95\% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4\%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95\% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95\% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95\% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95\% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95\% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95\% CI, 0.44-0.60).

CONCLUSIONS AND RELEVANCE: These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

}, keywords = {Aged, Cohort Studies, Delivery of Health Care, Female, Hospitalization, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.6636}, author = {Gao, Qian and Bone, Jessica K and Bu, Feifei and Paul, Elise and Sonke, Jill K and Fancourt, Daisy} } @article {13358, title = {Biological expressions of early life trauma in the immune system of older adults.}, journal = {PLoS One}, volume = {18}, year = {2023}, pages = {e0286141}, abstract = {

BACKGROUND: Poor immune function is associated with increased risk for a number of age-related diseases, however, little is known about the impact of early life trauma on immune function in late-life.

METHODS: Using nationally representative data from the Health and Retirement Study (n = 5,823), we examined the association between experiencing parental/caregiver death or separation before age 16 and four indicators of immune function in late-life: C-reactive Protein (CRP), Interleukin-6 (IL-6), soluble Tumor Necrosis Factor (sTNFR), and Immunoglobulin G (IgG) response to cytomegalovirus (CMV). We also examined racial/ethnic differences.

FINDINGS: Individuals that identified as racial/ethnic minorities were more likely to experience parental/caregiver loss and parental separation in early life compared to Non-Hispanic Whites, and had poorer immune function in late-life. We found consistent associations between experiencing parental/caregiver loss and separation and poor immune function measured by CMV IgG levels and IL-6 across all racial/ethnic subgroups. For example, among Non-Hispanic Blacks, those that experienced parental/caregiver death before age 16 had a 26\% increase in CMV IgG antibodies in late-life (β = 1.26; 95\% CI: 1.17, 1.34) compared to a 3\% increase in CMV antibodies among Non-Hispanic Whites (β = 1.03; 95\% CI: 0.99, 1.07) controlling for age, gender, and parental education.

INTERPRETATION: Our results suggest a durable association between experiencing early life trauma and immune health in late-life, and that structural forces may shape the ways in which these relationships unfold over the life course.

}, keywords = {Adolescent, Aged, Cytomegalovirus Infections, Humans, Immune System, Immunoglobulin G, Interleukin-6, United States, White}, issn = {1932-6203}, doi = {10.1371/journal.pone.0286141}, author = {Noppert, Grace A and Duchowny, Kate A and Stebbins, Rebecca and Aiello, Allison E and Dowd, Jennifer B and Clarke, Philippa} } @article {13057, title = {Breast and prostate cancer screening rates by cognitive status in US older adults.}, journal = {J Am Geriatr Soc}, volume = {71}, year = {2023}, pages = {1558-1565}, abstract = {

INTRODUCTION: For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings.

METHODS: Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status.

RESULTS: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0\% and 7.6\% with dementia in each cohort, respectively. Among women with dementia, 12.3\% were screened for breast cancer. When stratified by age, 10.6\% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4\% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9\% were screened for prostate cancer. When stratified by age, 30.9\% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4\% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95\% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95\% CI 0.36-0.96).

DISCUSSION: Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.

}, keywords = {Aged, Breast Neoplasms, Cognition, Dementia, Early Detection of Cancer, Humans, Male, Mass Screening, Medicare, Prostate-Specific Antigen, Prostatic Neoplasms, United States}, issn = {1532-5415}, doi = {10.1111/jgs.18222}, author = {Schoenborn, Nancy L and Cidav, Tom and Boyd, Cynthia M and Pollack, Craig E and Sekhon, Vishaldeep Kaur and Yasar, Sevil} } @article {13137, title = {Centrally Acting ACE Inhibitor Use and Physical Performance in Older Adults.}, journal = {J Frailty Aging}, volume = {12}, year = {2023}, month = {2023}, pages = {103-108}, abstract = {

BACKGROUND: There is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier.

OBJECTIVE: The objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users.

METHODS: Design: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were >= 65 years (median age (IQR) 74.00 (69-80) years.

MEASUREMENTS: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min).

RESULTS: Compared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31\%)), those on a centrally-acting agent (251(69\%)) had stronger grip strength 28.9 {\textpm}1.0 vs 26.3{\textpm}1.0, p=.011 and higher peak expiratory flow rates 316.8{\textpm}130.4 vs. 280.0{\textpm}118.5, p= .011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95\% CI 2.24, 50.5, p = 0.032).

CONCLUSION: Our results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.

}, keywords = {Aged, Angiotensin-Converting Enzyme Inhibitors, Cross-Sectional Studies, Hand Strength, Humans, Muscle Strength, Physical Functional Performance}, issn = {2260-1341}, doi = {10.14283/jfa.2023.10}, author = {George, C J and Hall, C B and Weiss, E F and Verghese, J and Neptune, E and Abadir, P} } @article {13538, title = {Change in Purpose in Life Before and After Onset of Cognitive Impairment.}, journal = {JAMA Network Open}, volume = {6}, year = {2023}, month = {2023 Sep 05}, pages = {e2333489}, abstract = {

IMPORTANCE: Purpose in life is a critical aspect of psychological well-being that is associated with better cognitive outcomes across the continuum of dementia. To our knowledge, the natural history of purpose with onset of cognitive impairment has yet to be evaluated.

OBJECTIVE: To evaluate changes in purpose in life prior to and after onset of cognitive impairment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used assessments of purpose in life and cognitive status from March 2006 to May 2021 in the Health and Retirement Study (HRS) and from May 2011 to November 2021 in the National Health and Aging Trends Study (NHATS).

EXPOSURE: Cognitive impairment at each wave based on established thresholds in HRS and NHATS.

MAIN OUTCOMES AND MEASURES: The main outcome was purpose in life, measured with the Ryff Measures of Psychological Well-Being in HRS and a validated item in NHATS.

RESULTS: In HRS, 22 668 participants provided 50 985 assessments of purpose across all waves. In NHATS, 10 786 participants provided 53 880 assessments of purpose across all waves. In HRS, 58.3\% of participants were female, with mean (SD) age of 64.76 (10.41) years at baseline; in NHATS, 57.4\% were female, with mean (SD) age of 76.82 (7.71) years at baseline. Across waves, 6794 HRS participants (30\%) and 4446 NHATS participants (41.2\%) were in the cognitive impairment range. Accounting for demographic covariates and normative change in purpose, multilevel modeling indicated that standardized purpose in life declined significantly prior to onset of cognitive impairment (estimate for 10 years) in both HRS (b = -0.12; 95\% CI, -0.17 to -0.07; P < .001) and NHATS (b = -0.10; 95\% CI, -0.20 to -0.01; P = .03). Purpose declined significantly more rapidly following onset of cognitive impairment, with a standardized decline nearly 3 times larger compared with prior to impairment in HRS (b = -0.35; 95\% CI, -0.41 to -0.29; P < .001) and 4 times larger in NHATS (b = -0.44; 95\% CI, -0.53 to -0.34; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study, purpose in life declined with emergence of cognitive impairment. The decline before onset was too small to be useful to detect impending impairment in clinical settings. The steeper decline following impairment suggests that individuals are aware that their purpose is declining. Purpose may be an intervention target following cognitive impairment to maintain well-being and to reduce or slow emergence of behavioral symptoms associated with low purpose.

}, keywords = {Aged, Aging, Awareness, Cognitive Dysfunction, Cohort Studies, Female, Humans, Male, Middle Aged, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.33489}, author = {Sutin, Angelina R and Luchetti, Martina and Stephan, Yannick and Terracciano, Antonio} } @article {13086, title = {Changes in Self-Perceptions of Aging Among Black and White Older Adults: The Role of Volunteering.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, month = {2023 May 11}, pages = {830-840}, abstract = {

OBJECTIVES: Given the health consequences of self-perceptions of aging (SPA), understanding how SPA change among Black and White older adults may shed light on racial disparities in late-life health. The current study is the first to assess whether Black older adults exhibit less favorable patterns of change in SPA than White older adults. We also tested whether the salubrious effect of volunteering on SPA would be particularly salient among Black older adults.

METHODS: A pooled sample of adults aged 50+ (N~=~10,183; Black: n~=~1,672, White: n~=~8,511) from the Health and Retirement Study rated positive and negative SPA once every 4~years across 3 waves (2008/2010, 2012/2014, and 2016/2018). We assessed participants{\textquoteright} reports on volunteering status in each wave.

RESULTS: Growth curve models revealed that positive SPA decreased over time whereas negative SPA increased. Black older adults reported more positive and less negative SPA at baseline and flatter time-related changes than their White counterparts. We found that volunteering was significantly associated with more positive and less negative SPA across waves, but this effect was only evident in White older adults.

DISCUSSION: Findings revealed vulnerabilities in White older adults as they experience and perceive age-related changes but also identified volunteering as a way to uniquely protect them. More research is needed to refine our understanding of racial disparities in the United States and help tailor interventions intended to maximize benefits to older adults from diverse backgrounds.

}, keywords = {Aged, Aging, Black People, Humans, Racial Groups, Self Concept, United States, White}, issn = {1758-5368}, doi = {10.1093/geronb/gbad007}, author = {Huo, Meng and Kim, Kyungmin and Haghighat, Misha D} } @article {13503, title = {CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, month = {2023 Aug 01}, pages = {e2331460}, abstract = {

IMPORTANCE: While the Australian National University-Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited.

OBJECTIVE: To evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI).

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study-Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023.

MAIN OUTCOMES AND MEASURES: Risk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk.

RESULTS: Among the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5\%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5\%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1\%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95\% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95\% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95\% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95\% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95\% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95\% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95\% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95\% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95\% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95\% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95\% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar.

CONCLUSIONS AND RELEVANCE: CogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Australia, Cohort Studies, Female, Heart Disease Risk Factors, Humans, Male, Risk Factors}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.31460}, author = {Huque, Md Hamidul and Kootar, Scherazad and Eramudugolla, Ranmalee and Han, S Duke and Carlson, Michelle C and Lopez, Oscar L and Bennett, David A and Peters, Ruth and Anstey, Kaarin J} } @article {13444, title = {Cognitive activity at work and the risk of dementia.}, journal = {Health Econ}, volume = {32}, year = {2023}, pages = {1561-1580}, abstract = {

Dementia prevalence is projected to rise steeply in coming decades, producing tremendous burdens on families, and health and social services. Motivated by the need for further robust evidence on modifiable risk factors, we investigate the relationship between cognitive activity at work and later-life dementia. Using data from the US Health and Retirement Study matched to the O*NET occupational database, we find that a one standard deviation increase in the cognitive activity associated with one{\textquoteright}s longest held occupation is associated with a 0.9 percentage point reduction in (predicted) dementia, or a 24\% reduction relative to the mean. This relationship is consistently found across model specifications and robustness tests. When controlling for individual fixed-effects we find that the association between dementia and work cognitive activity increases with age. Overall, our results provide some evidence in support of the inclusion of cognitive activity at work as a recognized modifiable risk factor for dementia.

}, keywords = {Cognition, Dementia, Humans, Occupations, Retirement, Risk Factors}, issn = {1099-1050}, doi = {10.1002/hec.4679}, author = {Martin-Bassols, Nicolau and de New, Sonja C and Johnston, David W and Shields, Michael A} } @article {13184, title = {Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study.}, journal = {Age Ageing}, volume = {52}, year = {2023}, month = {2023 Feb 01}, abstract = {

BACKGROUND: The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries.

METHODS: Analyses were based on 70,846 participants, aged 60~years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education.

RESULTS: Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95\% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries.

CONCLUSION: Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.

}, keywords = {Aged, Cognition, Developing Countries, Educational Status, Female, Humans, Income, Male, Middle Aged, Sex Characteristics, United States}, issn = {1468-2834}, doi = {10.1093/ageing/afad019}, author = {Bloomberg, Mikaela and Dugravot, Aline and Sommerlad, Andrew and Kivim{\"a}ki, Mika and Singh-Manoux, Archana and Sabia, S{\'e}verine} } @article {13623, title = {The Construction of a Multidomain Risk Model of Alzheimer{\textquoteright}s Disease and Related Dementias.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {96}, year = {2023}, pages = {535-550}, abstract = {

BACKGROUND: Alzheimer{\textquoteright}s disease (AD) and related dementia (ADRD) risk is affected by multiple dependent risk factors; however, there is no consensus about their relative impact in the development of these disorders.

OBJECTIVE: To rank the effects of potentially dependent risk factors and identify an optimal parsimonious set of measures for predicting AD/ADRD risk from a larger pool of potentially correlated predictors.

METHODS: We used diagnosis record, survey, and genetic data from the Health and Retirement Study to assess the relative predictive strength of AD/ADRD risk factors spanning several domains: comorbidities, demographics/socioeconomics, health-related behavior, genetics, and environmental exposure. A modified stepwise-AIC-best-subset blanket algorithm was then used to select an optimal set of predictors.

RESULTS: The final predictive model was reduced to 10 features for AD and 19 for ADRD; concordance statistics were about 0.85 for one-year and 0.70 for ten-year follow-up. Depression, arterial hypertension, traumatic brain injury, cerebrovascular diseases, and the APOE4 proxy SNP rs769449 had the strongest individual associations with AD/ADRD risk. AD/ADRD risk-related co-morbidities provide predictive power on par with key genetic vulnerabilities.

CONCLUSION: Results confirm the consensus that circulatory diseases are the main comorbidities associated with AD/ADRD risk and show that clinical diagnosis records outperform comparable self-reported measures in predicting AD/ADRD risk. Model construction algorithms combined with modern data allows researchers to conserve power (especially in the study of disparities where disadvantaged groups are often grossly underrepresented) while accounting for a high proportion of AD/ADRD-risk-related population heterogeneity stemming from multiple domains.

}, keywords = {Alzheimer disease, Comorbidity, Dementia, Humans, Hypertension, Medicare, United States}, issn = {1875-8908}, doi = {10.3233/JAD-221292}, author = {Akushevich, Igor and Yashkin, Arseniy and Ukraintseva, Svetlana and Yashin, Anatoliy I and Kravchenko, Julia} } @article {13427, title = {Contributions of neighborhood social environment and air pollution exposure to Black-White disparities in epigenetic aging.}, journal = {PLoS One}, volume = {18}, year = {2023}, month = {2023}, pages = {e0287112}, abstract = {

Racial disparities in many aging-related health outcomes are persistent and pervasive among older Americans, reflecting accelerated biological aging for Black Americans compared to White, known as weathering. Environmental determinants that contribute to weathering are poorly understood. Having a higher biological age, measured by DNA methylation (DNAm), than chronological age is robustly associated with worse age-related outcomes and higher social adversity. We hypothesize that individual socioeconomic status (SES), neighborhood social environment, and air pollution exposures contribute to racial disparities in DNAm aging according to GrimAge and Dunedin Pace of Aging methylation (DPoAm). We perform retrospective cross-sectional analyses among 2,960 non-Hispanic participants (82\% White, 18\% Black) in the Health and Retirement Study whose 2016 DNAm age is linked to survey responses and geographic data. DNAm aging is defined as the residual after regressing DNAm age on chronological age. We observe Black individuals have significantly accelerated DNAm aging on average compared to White individuals according to GrimAge (239\%) and DPoAm (238\%). We implement multivariable linear regression models and threefold decomposition to identify exposures that contribute to this disparity. Exposure measures include individual-level SES, census-tract-level socioeconomic deprivation and air pollution (fine particulate matter, nitrogen dioxide, and ozone), and perceived neighborhood social and physical disorder. Race and gender are included as covariates. Regression and decomposition results show that individual-level SES is strongly associated with and accounts for a large portion of the disparity in both GrimAge and DPoAm aging. Higher neighborhood deprivation for Black participants significantly contributes to the disparity in GrimAge aging. Black participants are more vulnerable to fine particulate matter exposure for DPoAm, perhaps due to individual- and neighborhood-level SES, which may contribute to the disparity in DPoAm aging. DNAm aging may play a role in the environment "getting under the skin", contributing to age-related health disparities between older Black and White Americans.

}, keywords = {Aged, Aging, Air Pollution, Black or African American, Cross-Sectional Studies, Epigenesis, Genetic, Humans, Particulate Matter, Retrospective Studies, Social Environment, United States, White}, issn = {1932-6203}, doi = {10.1371/journal.pone.0287112}, author = {Yannatos, Isabel and Stites, Shana and Brown, Rebecca T and McMillan, Corey T} } @article {13371, title = {Cross-Lagged Associations Between Physical Activity, Self-Rated Health, and Psychological Resilience Among Older American Adults: A 3-Wave Study.}, journal = {J Phys Act Health}, volume = {20}, year = {2023}, pages = {625-632}, abstract = {

The current study examined the reciprocal association between psychological resilience, physical activity, and self-rated health in older America adults. A 3-wave cross-lagged panel design was employed using data sampled from the Health and Retirement Study 2010, 2014, and 2018. In total, 8380 older adults, age ranged between 56 and 95~years at the baseline (mean age = 68.06, SD = 7.77), were analyzed. Using structural equation modeling, standardized path coefficients were estimated to determine the relationship between physical activity, self-rated health, and psychological resilience across 2 follow-up points. Cross-lagged analysis revealed that higher levels of physical activity at T1 and T2 were significantly associated with higher levels of self-rated health at T2 and T3, respectively. Self-rated health at T1 and T2 were significantly associated with physical activity at T2 and T3, respectively. Self-rated health and psychological resilience were positively related to one another at each time point. However, relationship between physical activity and psychological resilience was complex across time. Study findings support reciprocal prospective relationship between physical activity and self-rated health and the relationship between self-rated health and psychological resilience.

}, keywords = {Aged, Aged, 80 and over, Exercise, Humans, Middle Aged, Prospective Studies, Resilience, Psychological}, issn = {1543-5474}, doi = {10.1123/jpah.2022-0455}, author = {Lee, Sunwoo} } @article {13686, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy} } @article {13684, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy and Harrati, Amal and Jim{\'e}nez Vel{\'a}zquez, Ivonne Z and Liu, Mao-Mei and Guerra, Jorge J Llibre and Rodriguez, Juan de Jes{\'u}s Llibre and Dow, William H} } @article {13163, title = {Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study.}, journal = {Nutrients}, volume = {15}, year = {2023}, month = {2023 Jan 30}, abstract = {

: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). : We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. : Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (>=17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (>=1.8 vs. <0.8 mg) was -0.52 (95\% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). : In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

}, keywords = {Aged, Cognition, Copper, Cross-Sectional Studies, Eating, Humans, Iron, Manganese, Trace Elements, Zinc}, issn = {2072-6643}, doi = {10.3390/nu15030704}, author = {Zhao, Dong and Huang, Yilun and Wang, Binghan and Chen, Hui and Pan, Wenfei and Yang, Min and Xia, Zhidan and Zhang, Ronghua and Yuan, Changzheng} } @article {13090, title = {Does peak expiratory flow moderate trajectories of cognitive function among individuals with lung diseases? A longitudinal analysis of the National Health and Aging Trends Study.}, journal = {Respir Med}, volume = {207}, year = {2023}, pages = {107120}, abstract = {

INTRODUCTION: Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases.

METHODS: This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles.

RESULTS: In females, interactions of time-by-PEF were found for both immediate (n~=~489, t~=~2.73, p<0.01) and delayed recall (n~=~489, t~=~3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n~=~296, t~=~-3.08, p~<~0.01; delayed recall: n~=~292, t~=~-2.46, p~=~0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n~=~484, t~=~0.25, p~=~0.81; males: n~=~291, t~=~-0.61, p~=~0.55).

CONCLUSION: Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

}, keywords = {Aging, Cognition, Female, Humans, Lung Diseases, Male, Peak Expiratory Flow Rate, Respiratory Function Tests}, issn = {1532-3064}, doi = {10.1016/j.rmed.2023.107120}, author = {Wiley, Elise and Brooks, Dina and MacDermid, Joy C and Sakakibara, Brodie and Stratford, Paul W and Tang, Ada} } @article {13622, title = {Does personality always matter for health? Examining the moderating effect of age on the personality-health link from life span developmental and aging perspectives.}, journal = {Journal of personality and social psychology}, volume = {125}, year = {2023}, pages = {1189-1206}, abstract = {

Extensive evidence has been found for the associations between personality traits and health. However, it remains unknown whether the relationships between personality and health show differential patterns across different life stages. The current research examined how the associations between the levels of and changes in the Big Five personality traits and different types of health outcomes (self-rated, physical, and physiological health outcomes) differ across ages over the life span (Sample 1, age range: 15-100) and during the aging process (Sample 2, age range: 50-109) in particular. Using data from the two large longitudinal studies-the Household, Income, and Labor Dynamics in Australia Survey and the Health and Retirement Study, we observed three important patterns. First, levels of and changes in personality traits were significantly associated with health across different life phases, and these effects were observed even in very old ages. Second, overall, the prospective relations between personality traits/changes in personality traits and health outcomes increased in strength in middle adulthood and/or early stages of late adulthood; however, the strength of their connections diminished in very old ages. Finally, there were some trait-specific and health outcome-specific patterns in the age-differential associations between personality and health. Findings from the present study contribute to enhancing our understanding of the personality-health link from a developmental perspective and provide critical information for the design and implementation of screening and interventions targeting health promotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Aging, Humans, Longevity, Longitudinal Studies, Middle Aged, Personality, Personality Disorders, Young Adult}, issn = {1939-1315}, doi = {10.1037/pspp0000485}, author = {Luo, Jing and Zhang, Bo and Graham, Eileen K and Mroczek, Daniel K} } @article {13291, title = {Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life.}, journal = {J Geriatr Oncol}, volume = {14}, year = {2023}, pages = {101530}, abstract = {

INTRODUCTION: Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors.

MATERIALS AND METHODS: Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12~years, "low"; 12 to <16~years, "intermediate"; >=16~years, "high").

RESULTS: Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95\% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95\% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95\% CI: -0.08, 0.01; p-value for education as an effect modifier~=~0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free.

DISCUSSION: Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.

}, keywords = {Aged, Aging, Cancer Survivors, Educational Status, Humans, Longitudinal Studies, Memory Disorders, Middle Aged, Neoplasms}, issn = {1879-4076}, doi = {10.1016/j.jgo.2023.101530}, author = {Ospina-Romero, Monica and Brenowitz, Willa D and Glymour, M Maria and Westrick, Ashly and Graff, Rebecca E and Hayes-Larson, Eleanor and Mayeda, Elizabeth Rose and Ackley, Sarah F and Lindsay C Kobayashi} } @article {13122, title = {The effect of housing wealth on older adults{\textquoteright} health care utilization: Evidence from fluctuations in the U.S. housing market.}, journal = {J Health Econ}, volume = {88}, year = {2023}, month = {2023 Mar}, pages = {102737}, abstract = {

Do wealthier individuals use more health care services than those less affluent? Our paper addresses this question by examining the relationship between housing wealth and health care utilization. Exploiting fluctuations in the U.S. housing market, we estimate the effect of unanticipated wealth shocks on older adults{\textquoteright} health care utilization, using county-year variation in house prices to construct an instrumental variable. Using data from the 1996-2016 Health and Retirement Study, we find that an increase in wealth significantly increases numbers of doctor visits, prescription drugs, outpatient surgery, and dental services. Notably, an economic downturn like that in the Great Recession, when housing wealth declined by 16 percent on average, could reduce the utilization of prescription drugs by 0.4 percent, outpatient services by 0.5 percent, dental care by 0.6 percent, and numbers of doctor visits by 0.5 visits annually.

}, keywords = {Aged, Housing, Humans, Patient Acceptance of Health Care, prescription drugs, Retirement}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2023.102737}, author = {Tran, My and Gannon, Brenda and Rose, Christiern} } @article {13690, title = {The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {78}, year = {2023}, pages = {2147-2155}, abstract = {

OBJECTIVES: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.

METHODS: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.

RESULTS: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black {\texttimes} Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.

DISCUSSION: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.

}, keywords = {Black or African American, Cognition, Cognitive Dysfunction, Humans, Middle Aged, Stress, Psychological, White}, issn = {1758-5368}, doi = {10.1093/geronb/gbad143}, author = {Mitchell, Uchechi A and Shaw, Benjamin A and Torres, Jacqueline M and Brown, Lauren L and Barnes, Lisa L} } @article {13691, title = {The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {78}, year = {2023}, pages = {2147-2155}, abstract = {

OBJECTIVES: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.

METHODS: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.

RESULTS: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black {\texttimes} Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.

DISCUSSION: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.

}, keywords = {Black or African American, Cognition, Cognitive Dysfunction, Humans, Middle Aged, Stress, Psychological, White}, issn = {1758-5368}, doi = {10.1093/geronb/gbad143}, author = {Mitchell, Uchechi A and Shaw, Benjamin A and Torres, Jacqueline M and Brown, Lauren L} } @article {13096, title = {Effects of weight stigma on BMI and inflammatory markers among people living with obesity.}, journal = {Physiol Behav}, volume = {262}, year = {2023}, pages = {114088}, abstract = {

OBJECTIVE: Weight stigma (WS) and prejudice are one of the most prevalent ways of discrimination among adults, comparable with rates of racial discrimination. Exposure to WS among patients with obesity (PWO) may make the adoption of healthy dietary patterns and regular physical activity even more challenging and, therefore, the achievement of weight loss. Additionally, WS could also induce physiological responses such as increased levels of inflammatory markers, due to stress exposure.

METHOD: Subjects attending two obesity clinics were evaluated at baseline and after a minimum follow-up of six months. The weight Bias Internalization Scale (WBIS) and the Stigmatizing Situations Inventory (SSI) were administered to evaluate WS. Also, anthropometric and inflammatory markers, including cortisol, ferritin and C-reactive protein (CRP), were recorded at baseline.

RESULTS: 79 PWO (87.3\%♀, 45.5~{\textpm}~1.3 years, 35.9~{\textpm}~6.3~kg/m) were included. At baseline, 72.2\% started liraglutide as anti-obesity drug. Baseline body mass index (BMI) correlated positively with both WBIS (r~=~0.23; p~=~0.03) and SSI (r~=~0.25; p~=~0.02) scores. Mean percentual weight loss after a mean follow-up of six months was -7.28\%. However, there was a negative, but not statistically significant, correlation between weight loss and both WBIS (r=-0.14; p~=~0.2) and SSI (r=-0.19; p~=~0.08). Regarding inflammatory markers, plasma cortisol levels at baseline correlated positively with WBIS (p~=~0.005) and SSI (p~=~0.02). CRP at baseline also presented a positive correlation with SSI (p~=~0.03). No significant correlations were found for stigma tests and ferritin levels.

DISCUSSION: As weight increases among PWO, so does stigma. Despite we did not find a significant negative association between the presence of WS and weight loss outcomes, there was an increase in inflammatory markers among PWO who experienced higher levels of WS.

}, keywords = {Adult, Body Mass Index, C-reactive protein, Ferritins, Humans, Hydrocortisone, Obesity, Weight Loss, Weight Prejudice}, issn = {1873-507X}, doi = {10.1016/j.physbeh.2023.114088}, author = {Nicolau, Joana and Tof{\'e}, Santiago and Bonet, Aina and Sanch{\'\i}s, Pilar and Pujol, Antelm and Ayala, Luisa and Gil, Apolonia and Masmiquel, Llu{\'\i}s} } @article {13315, title = {Epigenetic age acceleration mediates the association between smoking and diabetes-related outcomes.}, journal = {Clin Epigenetics}, volume = {15}, year = {2023}, pages = {94}, abstract = {

BACKGROUND: Smoking can lead to the deterioration of lung function and susceptibility to diabetes. Recently, smoking was found to induce DNA methylation (DNAm) changes in some cytosine-phosphate-guanine sites (CpGs). As linear combinations of DNAm levels of aging-related CpGs, five measures of epigenetic age acceleration (EAA) have received extensive attention: HannumEAA, IEAA, PhenoEAA, GrimEAA, and DunedinPACE. It is of interest to explore whether some measures of EAA can mediate the associations of smoking with diabetes-related outcomes and indices of ventilatory lung function.

METHODS AND RESULTS: In this study, we included self-reported smoking variables (smoking status, the number of pack-years, and years since smoking cessation), seven DNAm markers (HannumEAA, IEAA, PhenoEAA, GrimEAA, DNAm-based smoking pack-years, DNAm plasminogen activator inhibitor 1 [PAI-1] levels, and DunedinPACE), and four health outcomes (fasting glucose, hemoglobin A1C, forced expiratory volume in 1.0~s [FEV1], and forced vital capacity [FVC]) from 2474 Taiwan Biobank participants. Mediation analyses were conducted while adjusting for chronological age, sex, body mass index, drinking status, regular exercise status, educational attainment, and five cell-type proportions. We demonstrated that GrimEAA, DNAm-based smoking pack-years, DNAm PAI-1 levels, DunedinPACE, and PhenoEAA mediated smoking associations with diabetes-related outcomes. Moreover, current and former smoking both had an adverse indirect effect on FVC through DNAm PAI-1 levels. For former smokers, a long time since smoking cessation had a positive indirect impact on FVC through GrimEAA and on FEV1 through PhenoEAA.

CONCLUSIONS: This is one of the first studies to comprehensively investigate the role of five measures of EAA in mediating the associations of smoking with the health outcomes of an Asian population. The results showed that the second-generation epigenetic clocks (GrimEAA, DunedinPACE, and PhenoEAA) significantly mediated the associations between smoking and diabetes-related outcomes. In contrast, the first-generation epigenetic clocks (HannumEAA and IEAA) did not significantly mediate any associations of smoking variables with the four health outcomes. Cigarette smoking can, directly and indirectly, deteriorate human health through DNAm changes in aging-related CpG sites.

}, keywords = {Aging, Diabetes Mellitus, DNA Methylation, Epigenesis, Genetic, Humans, Plasminogen Activator Inhibitor 1, Smoking}, issn = {1868-7083}, doi = {10.1186/s13148-023-01512-x}, author = {Chang, Xue-Yong and Lin, Wan-Yu} } @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 {13113, title = {Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, pages = {866-879}, abstract = {

OBJECTIVES: This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS: Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N~=~1,934) and IADL limitations (N~=~2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS: One-unit increase in everyday discrimination was associated with a 25\% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION: Everyday discrimination represents a significant stressor that negatively affects older African Americans{\textquoteright} performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Humans, Incidence, Middle Aged, Residence Characteristics, Retirement}, issn = {1758-5368}, doi = {10.1093/geronb/gbad001}, author = {Qin, Weidi and Nguyen, Ann W and Wang, Yi and Hamler, Tyrone C and Wang, Fei} } @article {13467, title = {Examining racial and ethnic differences in disability among older adults: A polysocial score approach.}, journal = {Maturitas}, volume = {172}, year = {2023}, pages = {1-8}, abstract = {

OBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability.

STUDY DESIGN: Cohort study.

MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65~years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score.

RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5~\% and 24.4~\% risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1~\% and 12.1~\% in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9~\% and 8.7~\% risk of ADL disability, respectively.

CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Disabled Persons, ethnicity, Health Status Disparities, Humans, Racial Groups, United States}, issn = {1873-4111}, doi = {10.1016/j.maturitas.2023.03.010}, author = {Tang, Junhan and Chen, Ying and Liu, Hua and Wu, Chenkai} } @article {13737, title = {Explaining disparities in cognitive functioning: a test of competing hypotheses.}, journal = {Longitudinal and Life Courses Studies: International Journal}, volume = {15}, year = {2023}, pages = {45-68}, abstract = {

This study seeks to examine how the trajectories of total cognition scores exhibited by two birth cohorts vary by race/ethnicity, gender and the level of education. The empirical work of this study is be based on the 1998-2014 Health and Retirement Study (HRS) and the HRS Cross-Wave Tracker file. The analysis is limited to individuals with available information on cognitive functioning, sex, race/ethnicity, wave, highest level of education, and the physical comorbidities associated with cognitive functioning (20,985 from the Traditionalist cohort and 11,077 from the Baby Boomer cohort). Growth curve modelling is used to assess the aims of this study. Findings reveal that the cumulative advantage (disadvantage), persistent inequality and age-as-leveller hypotheses explain heterogeneity in total cognition scores for different race/ethnicity-sex groups, race/ethnicity-education and education-sex groups. These findings suggest that the development of an integrated treatment and screening mechanisms for physical comorbidities and cognitive functioning, and for the design of preventive strategies with the purpose of slowing or avoiding cognitive decline and maintaining healthy cognitive function should have a particular focus on females, racial ethnic minorities and those with low education.

}, keywords = {Cognition, Cognitive Dysfunction, ethnicity, Health Status Disparities, Humans, Racial Groups}, issn = {1757-9597}, doi = {10.1332/175795921X16836624887393}, author = {Liew, Hui-Peng} } @article {13246, title = {Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {539-562}, abstract = {

The present study documents differences in exposure to family member deaths among foreign-born and U.S.-born Hispanic individuals compared with non-Hispanic Black and non-Hispanic White individuals. We use data from the Health and Retirement Study (HRS; 1992-2016, ages 51+; N = 23,228) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Waves I-V, ages 12-43; N = 11,088) to estimate the risk of exposure to the death of a mother, father, spouse, sibling, and child across the life course. HRS results show more inequities in exposure to family deaths compared with Add Health results, suggesting differences by age or birth cohort. Compared with non-Hispanic Whites, U.S.-born Hispanic individuals in the HRS have a higher risk of experiencing a child{\textquoteright}s death throughout adulthood and a sibling{\textquoteright}s death in later life; the latter is explained by larger sibship size, indicating a greater lifetime risk of bereavement experiences. The higher risk of parental death during childhood for U.S.-born and foreign-born Hispanic individuals is explained by covariates (e.g., lower levels of educational attainment). Hispanic individuals generally have a lower risk of family deaths than non-Hispanic Black individuals, but at times a higher risk of exposure relative to non-Hispanic White individuals.

}, keywords = {Adolescent, Adult, Child, Death, Family, Hispanic or Latino, Humans, Life Change Events, Longitudinal Studies, Middle Aged, United States, White, Young Adult}, issn = {1533-7790}, doi = {10.1215/00703370-10604036}, author = {Donnelly, Rachel and Garcia, Michael A and Cha, Hyungmin and Hummer, Robert A and Umberson, Debra} } @article {13222, title = {Female APOE ɛ4 Carriers with Slow Rates of Biological Aging Have Better Memory Performances Compared to Female ɛ4 Carriers with Accelerated Aging.}, journal = {J Alzheimers Dis}, volume = {92}, year = {2023}, pages = {1269-1282}, abstract = {

BACKGROUND: Evidence suggests that APOE ɛ4 carriers have worse memory performances compared to APOE ɛ4 non-carriers and effects may vary by sex and age. Estimates of biological age, using DNA methylation may enhance understanding of the associations between sex and APOE ɛ4 on cognition.

OBJECTIVE: To investigate whether associations between APOE ɛ4 status and memory vary according to rates of biological aging, using a DNA methylation age biomarker, in older men and women without dementia.

METHODS: Data were obtained from 1,771 adults enrolled in the 2016 wave of the Health and Retirement Study. A series of ANCOVAs were used to test the interaction effects of APOE ɛ4 status and aging rates (defined as 1 standard deviation below (i.e., slow rate), or above (i.e., fast rate) their sex-specific mean rate of aging on a composite measure of verbal learning and memory.

RESULTS: APOE ɛ4 female carriers with slow rates of GrimAge had significantly better memory performances compared to fast and average aging APOE ɛ4 female carriers. There was no effect of aging group rate on memory in the female non-carriers and no significant differences in memory according to age rate in either male APOE ɛ4 carriers or non-carriers.

CONCLUSION: Slower rates of aging in female APOE ɛ4 carriers may buffer against the negative effects of the ɛ4 allele on memory. However, longitudinal studies with larger sample sizes are needed to evaluate risk of dementia/memory impairment based on rates of aging in female APOE ɛ4 carriers.

}, keywords = {Aged, Aging, Apolipoprotein E4, Cognition, Dementia, Female, Humans, Longitudinal Studies, Male, Memory Disorders}, issn = {1875-8908}, doi = {10.3233/JAD-221145}, author = {O{\textquoteright}Shea, Deirdre M and Galvin, James E} } @article {13102, title = {From financial wealth shocks to ill-health: Allostatic load and overload.}, journal = {Health Econ}, volume = {32}, year = {2023}, pages = {939-952}, abstract = {

A number of studies have associated financial wealth changes with health-related outcomes arguing that the effect is due to psychological distress and is immediate. In this paper, I examine this relationship for cumulative shocks to the financial wealth of American retirees using the allostatic load model of pathways from stress to poor health. Wealth shocks are identified from Health and Retirement Study reports of stock ownership along with significant negative discontinuities in high-frequency S\&P500 index data. I find that a one standard deviation increase in cumulative shocks over two years increases the probability of elevated blood pressure by 9.5\%, increases waist circumference by 1.2\% and the cholesterol ratio by 6.1\% for those whose wealth is all in shares. My findings suggest that the combined effect of random shocks to financial wealth over time is salient for health outcomes. This is consistent with the allostatic load model in which repeated activation of stress responses leads to cumulative wear and tear on the body.

}, keywords = {Allostasis, Cholesterol, Humans, Retirement, Stress, Psychological, United States}, issn = {1099-1050}, doi = {10.1002/hec.4648}, author = {French, Declan} } @article {13249, title = {Gender differences in the association of polygenic risk and divergent depression trajectories from mid to late life: a national longitudinal study.}, journal = {Biodemography Soc Biol}, volume = {68}, year = {2023}, pages = {32-53}, abstract = {

Our research fills a critical gap in the depression literature by utilizing a life course perspective to examine gender-gene interactions in association with depression trajectories over time. Using data from the Health and Retirement Study, we estimated multi-level negative binomial and logistic mixed models to analyze gender-specific trajectories of depressive symptoms (CESD-8) and potential clinical depression risk from middle to late adulthood in relation to gender-by-polygenic-risk (PRS) interactions. We found increasingly greater female-male gaps in the CESD-8 scale and a higher probability of clinical depression risk with increasing polygenic risk scores. Furthermore, females{\textquoteright} higher genetic vulnerabilities to depressive conditions than males vary from ages 51 to 90 years, (e.g. 0.28 higher CESD-8 scale for females at ages 76-85 years than for similar-aged males; higher 3.44\% probability of depression risk for females at ages 81-85 compared to similar-aged males) (e.g. about 2.40\% higher probability of depression risk for females at ages 61-70 years than for similar-aged males) . This study contributes to new knowledge of how gender-by-polygenic-risk interactions are associated with depression trajectories across the life course.

}, keywords = {Adult, Aged, Aged, 80 and over, depression, Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Sex Factors}, issn = {1948-5573}, doi = {10.1080/19485565.2023.2196710}, author = {Chen, Ping and Li, Yi and Wu, Fang} } @article {13170, title = {Genome-Wide Gene-Set Analysis Identifies Molecular Mechanisms Associated with ALS.}, journal = {Int J Mol Sci}, volume = {24}, year = {2023}, month = {2023 Feb 16}, abstract = {

Amyotrophic lateral sclerosis (ALS) is a fatal late-onset motor neuron disease characterized by the loss of the upper and lower motor neurons. Our understanding of the molecular basis of ALS pathology remains elusive, complicating the development of efficient treatment. Gene-set analyses of genome-wide data have offered insight into the biological processes and pathways of complex diseases and can suggest new hypotheses regarding causal mechanisms. Our aim in this study was to identify and explore biological pathways and other gene sets having genomic association to ALS. Two cohorts of genomic data from the dbGaP repository were combined: (a) the largest available ALS individual-level genotype dataset (N = 12,319), and (b) a similarly sized control cohort (N = 13,210). Following comprehensive quality control pipelines, imputation and meta-analysis, we assembled a large European descent ALS-control cohort of 9244 ALS cases and 12,795 healthy controls represented by genetic variants of 19,242 genes. Multi-marker analysis of genomic annotation (MAGMA) gene-set analysis was applied to an extensive collection of 31,454 gene sets from the molecular signatures database (MSigDB). Statistically significant associations were observed for gene sets related to immune response, apoptosis, lipid metabolism, neuron differentiation, muscle cell function, synaptic plasticity and development. We also report novel interactions between gene sets, suggestive of mechanistic overlaps. A manual meta-categorization and enrichment mapping approach is used to explore the overlap of gene membership between significant gene sets, revealing a number of shared mechanisms.

}, keywords = {Amyotrophic Lateral Sclerosis, Genome-Wide Association Study, Genotype, Humans, Motor Neurons}, issn = {1422-0067}, doi = {10.3390/ijms24044021}, author = {Vasilopoulou, Christina and McDaid-McCloskey, Sarah L and McCluskey, Gavin and Duguez, Stephanie and Morris, Andrew P and Duddy, William} } @article {13278, title = {Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts.}, journal = {BMC Geriatr}, volume = {23}, year = {2023}, pages = {268}, abstract = {

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

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

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

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

}, keywords = {Aged, Hand Strength, Heart Diseases, Humans, Longitudinal Studies, Middle Aged, Prospective Studies, Stroke}, issn = {1471-2318}, doi = {10.1186/s12877-023-03953-8}, author = {Li, Guochen and Lu, Yanqiang and Shao, Liping and Wu, Luying and Qiao, Yanan and Ding, Yi and Ke, Chaofu} } @article {13788, title = {How to construct a frailty index from an existing dataset in 10 steps.}, journal = {Age and Ageing}, volume = {52}, year = {2023}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Frail Elderly, Frailty, Geriatric Assessment, Humans, Retrospective Studies}, issn = {1468-2834}, doi = {10.1093/ageing/afad221}, author = {Theou, Olga and Haviva, Clove and Wallace, Lindsay and Searle, Samuel D and Rockwood, Kenneth} } @article {13176, title = {The identification of mediating effects using genome-based restricted maximum likelihood estimation.}, journal = {PLoS Genet}, volume = {19}, year = {2023}, month = {2023 Feb}, pages = {e1010638}, abstract = {

Mediation analysis is commonly used to identify mechanisms and intermediate factors between causes and outcomes. Studies drawing on polygenic scores (PGSs) can readily employ traditional regression-based procedures to assess whether trait M mediates the relationship between the genetic component of outcome Y and outcome Y itself. However, this approach suffers from attenuation bias, as PGSs capture only a (small) part of the genetic variance of a given trait. To overcome this limitation, we developed MA-GREML: a method for Mediation Analysis using Genome-based Restricted Maximum Likelihood (GREML) estimation. Using MA-GREML to assess mediation between genetic factors and traits comes with two main advantages. First, we circumvent the limited predictive accuracy of PGSs that regression-based mediation approaches suffer from. Second, compared to methods employing summary statistics from genome-wide association studies, the individual-level data approach of GREML allows to directly control for confounders of the association between M and Y. In addition to typical GREML parameters (e.g., the genetic correlation), MA-GREML estimates (i) the effect of M on Y, (ii) the direct effect (i.e., the genetic variance of Y that is not mediated by M), and (iii) the indirect effect (i.e., the genetic variance of Y that is mediated by M). MA-GREML also provides standard errors of these estimates and assesses the significance of the indirect effect. We use analytical derivations and simulations to show the validity of our approach under two main assumptions, viz., that M precedes Y and that environmental confounders of the association between M and Y are controlled for. We conclude that MA-GREML is an appropriate tool to assess the mediating role of trait M in the relationship between the genetic component of Y and outcome Y. Using data from the US Health and Retirement Study, we provide evidence that genetic effects on Body Mass Index (BMI), cognitive functioning and self-reported health in later life run partially through educational attainment. For mental health, we do not find significant evidence for an indirect effect through educational attainment. Further analyses show that the additive genetic factors of these four outcomes do partially (cognition and mental health) and fully (BMI and self-reported health) run through an earlier realization of these traits.

}, keywords = {Genome, Genome-Wide Association Study, Humans, Likelihood Functions, Multifactorial Inheritance, Phenotype}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1010638}, author = {Rietveld, Cornelius A and de Vlaming, Ronald and Slob, Eric A W} } @article {13332, title = {Immigrant Wealth Stratification and Return Migration: The Case of Mexican Immigrants in the United States During the Twentieth Century.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {809-835}, abstract = {

Considerable wealth stratification exists between U.S.-born and foreign-born populations (Campbell and Kaufman 2006), with low wealth attainment documented among Mexican immigrants (Hao 2007). High rates of Mexican return migration (Azose and Raftery 2019) suggest that nonrandom selection into return migration on wealth is a potential driver of stratification. Existing theories do not conclusively predict asset accumulation among returnees versus stayers, and empirical research on return migration and wealth stratification is scarce. Combining data from the 2000 U.S. Health and Retirement Study and the 2001 Mexican Health and Aging Study to create a novel data set representing all Mexicans aged 50 and older with a history of migration to the United States and adopting a life course perspective, I find that return migration at younger and older ages is associated with higher wealth accumulation and might be a way to maximize assets at older ages. Thus, return migration may contribute to nativity-based wealth stratification in the United States. The study{\textquoteright}s findings point to the greater financial risks for new cohorts of immigrants aging in place, suggest caution in interpreting wealth stratification as a measure of mobility, and inform theories about the links between return migration and wealth across the life course.

}, keywords = {Aged, Aging, Emigrants and Immigrants, Emigration and Immigration, Humans, Income, Independent Living, Mexican Americans, Mexico, Middle Aged, United States}, issn = {1533-7790}, doi = {10.1215/00703370-10693686}, author = {Sheftel, Mara Getz} } @article {13630, title = {Immune cells are associated with mortality: the Health and Retirement Study.}, journal = {Frontiers in immunology}, volume = {14}, year = {2023}, pages = {1280144}, abstract = {

INTRODUCTION: Age-related immunosenescence is characterized by changes in immune cell subsets and is associated with mortality. However, since immunosenescence is associated with other concurrent age-related changes such as inflammation and multi-organ dysfunction, it is unclear whether the association between age-related immunosenescence and mortality is independent of other concurrent age-related changes. To address these limitations, we evaluated the independent association between immune cell subsets and mortality after adjustment for age-related inflammation and biologic age.

METHODS: Data for this study was obtained from the 2016 interview of the Health and Retirement Study (N=6802). Cox proportional hazards regression models were used to estimate the association between 25 immune cell subsets (11 T-cell subsets, 4 B-cell subsets, 3 monocyte subsets, 3 natural killer cell subsets, 3 dendritic cell subsets, and neutrophils) and 4-year mortality adjusting for covariates such as the Klemera-Doubal algorithm biological age, chronological age, gender, race/ethnicity, BMI, smoking status, comorbidity index, CMV seropositivity, and inflammatory latent variable comprising C-reactive protein, and 4 cytokines (interleukin-10, interleukin-1 receptor antagonist, interleukin-6, and soluble tumor necrosis factor).

RESULTS: Four hundred and seventy-six participants died during the study period with an overall median follow up time of 2.5 years. After controlling for covariates and adjustment for sample-weights, total T cells [HR: 0.86, p=0.004], NK CD56LO cells [HR: 0.88, p=0.005], and neutrophils [HR: 1.22, p=0.004] were significantly associated with mortality.

CONCLUSIONS: These findings support the idea that an aging immune system is associated with short-term mortality independent of age-related inflammation or other age-related measures of physiological dysfunction. If replicated in other external cohorts, these findings could identify novel targets for both monitoring and intervention to reduce the age-related mortality.

}, keywords = {Aging, Humans, Immunosenescence, Inflammation, Retirement, T-Lymphocyte Subsets}, issn = {1664-3224}, doi = {10.3389/fimmu.2023.1280144}, author = {Seshadri, Gokul and Vivek, Sithara and Prizment, Anna and Crimmins, Eileen M and Klopack, Eric T and Jessica Faul and Guan, Weihua and Meier, Helen C S and Bharat Thyagarajan} } @article {13280, title = {The impact of a partner{\textquoteright}s nursing home admission on individuals{\textquoteright} mental well-being.}, journal = {Soc Sci Med}, volume = {327}, year = {2023}, pages = {115941}, abstract = {

This study analyzes the effect of a partner{\textquoteright}s nursing home admission on individuals{\textquoteright} mental well-being. To do so, we use longitudinal data on couples from the Health and Retirement Study and a quasi-experimental difference-in-differences design to isolate the causal effect of the transition. We hypothesize that: (i) a partner{\textquoteright}s nursing home admission has a negative impact on individuals{\textquoteright} mental well-being and (ii) the size of the negative effect is decreasing in the amount of caregiving provided by respondents pre-admission. We find that a partner{\textquoteright}s nursing home admission raises respondents{\textquoteright} depressive symptomology scores by 0.839, corresponding to a 50 percent increase from the average pre-admission baseline. Amongst respondents providing care to their partners pre-admission, a nursing home transition raises depression scores by 0.670, corresponding to a 36.8 increase from baseline. Non-caregiving respondents experience a corresponding 1.05 increase in depression scores, representing a 67.2 percent rise from baseline. Amongst pre-admission caregivers, we find that the negative well-being impact of a partner{\textquoteright}s admission decreases in the duration and intensity of caregiving pre-admission. We also find that partners of care recipients with more severe physical and cognitive impairment pre-admission experience less deterioration in mental well-being compared to their counterparts. Overall, our findings indicate that a partner{\textquoteright}s transition into residential care can provide respite from caregiving-related stressors. However, on average, the negative well-being effects of the transition tend to outweigh this positive respite effect. The policy implications are twofold: first, there is a need for continued support to families of care recipients during the latter{\textquoteright}s transition into institutional care. Second, nursing homes and other institutions have a role in providing respite care, especially for high-intensity caregivers.

}, keywords = {Caregivers, Hospitalization, Humans, Mental Health, Nursing homes, psychological well-being}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.115941}, author = {Teo, Hansel} } @article {13156, title = {The impact of hearing loss on trajectories of depressive symptoms in married couples.}, journal = {Soc Sci Med}, volume = {321}, year = {2023}, month = {2023 Mar}, pages = {115780}, abstract = {

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual{\textquoteright}s stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n~=~4881 couples), we estimate age-based mixed models to examine how 1) one{\textquoteright}s own hearing, 2) one{\textquoteright}s spouse{\textquoteright}s hearing, or 3) both spouses{\textquoteright} hearing influence changes in depressive symptoms. For men, their wives{\textquoteright} hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands{\textquoteright} hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

}, keywords = {Aged, depression, Female, Hearing loss, Humans, Male, Marriage, Retirement, Spouses}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.115780}, author = {West, Jessica S and Smith, Sherri L and Dupre, Matthew E} } @article {13180, title = {Inequalities in Retirement Life Span in the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, month = {2023 May 11}, pages = {891-901}, abstract = {

OBJECTIVES: The length of retirement life may be highly unequal due to persistent and significant discrepancies in old-age mortality. This study assesses gender and educational differences in the average retirement life span and the variation in retirement life span, taking into account individual labor force exit and reentry dynamics.

METHODS: We used longitudinal data from the Health and Retirement Study from 1996 to 2016, focusing on respondents aged 50 and older (N~=~32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement life span, as well as absolute and relative variation in retirement life span, were calculated analytically.

RESULTS: Among women, we found a persistent educational gradient in average retirement life span over the whole period studied; among men, the relationship between education and retirement expectancy differed across periods. Women and the lower-educated had higher absolute variation in retirement life span than men and the higher-educated-yet these relationships were reversed when examined by relative variation.

DISCUSSION: Our multistate approach provides an accurate and comprehensive picture of the retirement life span of older Americans over the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential effects on retirement initiation and reentry dynamics.

}, keywords = {Aged, Educational Status, Employment, Female, Humans, Life Expectancy, Life Tables, Longevity, Male, Middle Aged, Retirement, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbac180}, author = {Shi, Jiaxin and Dudel, Christian and Monden, Christiaan and van Raalte, Alyson} } @article {13255, title = {Inequality in housing transitions during cognitive decline.}, journal = {PLoS One}, volume = {18}, year = {2023}, pages = {e0282329}, abstract = {

Independent living can become challenging for people experiencing cognitive decline. With reduced functioning and greater care needs, many people with dementia (PWD) may need to move to another home with better safety features, move to live closer to or with relatives who can provide care, or enter a nursing home. Housing plays a key role in supporting quality of life for both PWD and their caregivers, so the ability to move when needed is crucial for their well-being. Yet the substantial costs of moving, housing, and care mean that PWD with limited financial resources may be unable to afford moving, exacerbating inequalities between more and less advantaged PWD. Emerging qualitative research considers the housing choices of PWD and their caregivers, yet little is known on a broader scale about the housing transitions PWD actually make over the course of cognitive decline. Prior quantitative research focuses specifically on nursing home admissions; questions remain about how often PWD move to another home or move in with relatives. This study investigates socioeconomic and racial/ethnic disparities in the timing and type of housing transitions among PWD in the United States, using Health and Retirement study data from 2002 through 2016. We find that over half of PWD move in the years around dementia onset (28\% move once, and 28\% move twice or more) while 44\% remain in place. Examining various types of moves, 35\% move to another home, 32\% move into nursing homes, and 11\% move in with relatives. We find disparities by educational attainment and race/ethnicity: more advantaged PWD are more likely to move to another home and more likely to enter a nursing home than less advantaged groups. This highlights the importance of providing support for PWD and their families to transition into different living arrangements as their housing needs change.

}, keywords = {Caregivers, Cognitive Dysfunction, Dementia, Housing, Humans, Nursing homes, Quality of Life, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0282329}, author = {Mawhorter, Sarah L and Wilkie, Rachel Z and Jennifer A Ailshire} } @article {13632, title = {Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {94}, year = {2023}, pages = {1431-1441}, abstract = {

BACKGROUND: Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life.

OBJECTIVE: We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data.

METHODS: The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95\% confidence intervals (CIs).

RESULTS: A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22\% (RR = 0.78, 95\% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication.

CONCLUSION: Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.

}, keywords = {Antihypertensive Agents, Cognition, Humans, Hypertension, Retirement, Risk Factors}, issn = {1875-8908}, doi = {10.3233/JAD-230398}, author = {Wei, Jingkai and Xu, Hanzhang and Zhang, Donglan and Tang, Huilin and Wang, Tiansheng and Steck, Susan E and Divers, Jasmin and Zhang, Jiajia and Merchant, Anwar T} } @article {13062, title = {Invited Commentary: Algorithmic Dementia Classification-Promises and Challenges.}, journal = {Am J Epidemiol}, volume = {192}, year = {2023}, pages = {535-538}, abstract = {

Dementia is a complex, progressive syndrome characterized by cognitive decline and disability. Gold-standard dementia diagnosis requires several hours of cognitive and clinical assessment and review by a panel of clinicians and is infeasible in large population-based cohort studies. Alternatively, algorithmic dementia classification methods, which use models that take into account measures of cognition and functional limitations or cognitive and functional-limitation score cutoffs, have been developed to predict dementia status for participants in large studies. Developing accurate dementia classification algorithms is crucial for high-quality studies of the distribution and determinants of dementia. The accompanying article by Nichols et al. (Am J Epidemiol. 2023;192(4):520-534) assesses differences in associations of measures of cognition and functional limitations with prevalent dementia versus incident dementia and discusses implications for algorithmic dementia classification in research studies. This work highlights important opportunities for tailoring measures of cognition and functional limitations to study goals by selecting optimal measures and developing and validating algorithms specific to study needs. Combining efficient, high-quality assessments of cognition and functional limitations with innovative study designs will facilitate collection of higher-quality measurements in larger samples and support future development of accurate dementia classifications, ultimately leading to more impactful epidemiologic studies.

}, keywords = {Cognition, Cognitive Dysfunction, Dementia, Humans}, issn = {1476-6256}, doi = {10.1093/aje/kwad003}, author = {Mayeda, Elizabeth Rose and Shaw, Crystal} } @article {13261, title = {Life course engagement in enriching activities: When and how does it matter for cognitive aging?}, journal = {Psychol Aging}, volume = {38}, year = {2023}, pages = {263-276}, abstract = {

Growing evidence suggests that participation in enriching activities (physical, social, and mental) across the life course is beneficial for cognitive functioning in older age. However, few studies have examined the effects of enrichment across the entire life course within the same participants. Using 2,931 participants in the Health and Retirement Study, we linked self-report data from later life and retrospective self-report data from early life and midlife to cognitive performance after Age 65. We categorized participants as having either high (top \~{}25\%) or average to low (bottom \~{}75\%) level of enrichment during each life period. Thus, eight groups were identified that reflected unique patterns of enrichment during early, mid, and later life (e.g., high-high-high). Using growth curve modeling, we found that life course enrichment patterns predicted both cognitive functioning and the rate of cognitive decline across five time points spanning 8 years (Aim 1). Groups with high enrichment during at least one life period had higher performance and slower decline in older age, compared to those who had average to low levels of enrichment throughout all three life periods. We also found that high enrichment during each life period independently predicted better cognitive performance and that high enrichment during early and later life also predicted slower cognitive decline (Aim 2). These findings support the idea that high enrichment is beneficial for cognition in later life and that the effects are long-lasting, even when individuals are inconsistent in enrichment engagement throughout the entire life course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

}, keywords = {Aged, Aging, Cognition, cognitive aging, Cognitive Dysfunction, Humans, Life Change Events, Longitudinal Studies, Retrospective Studies}, issn = {1939-1498}, doi = {10.1037/pag0000744}, author = {Frank, Colleen C and Mundy, Lindsey M and Jacqui Smith} } @article {13617, title = {Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {96}, year = {2023}, pages = {1183-1193}, abstract = {

BACKGROUND: Older adults with dementia including Alzheimer{\textquoteright}s disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits.

OBJECTIVE: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia.

METHODS: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions.

RESULTS: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences.

CONCLUSIONS: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.

}, keywords = {Aged, Alzheimer disease, Cohort Studies, Death, Humans, Medicare, Terminal Care, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230692}, author = {Zhu, Yingying and Olchanski, Natalia and Cohen, Joshua T and Freund, Karen M and Jessica Faul and Fillit, Howard M and Neumann, Peter J and Lin, Pei-Jung} } @article {13117, title = {Longitudinal Associations Between Loneliness and Prescription Medication Use.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, month = {2023 Apr 01}, pages = {730-735}, abstract = {

OBJECTIVES: Both loneliness and the use of psychotropic drugs are common in later life. Although loneliness has been found to be associated with psychotropic drug use, most studies have been cross-sectional, and we know less about their longitudinal associations.

METHODS: Drawing on five waves of data from the Health and Retirement Study and two statistical approaches (fixed-effects and cross-lagged panel models), we examine longitudinal associations between loneliness and the use of prescription pain and depression/anxiety medications.

RESULTS: Across 57,654 observations among 20,589 respondents, 22.8\% reported regular use of pain prescription medications, 17.8\% regular use of depression/anxiety prescription medication, and 15.6\% feeling lonely in the past week. Loneliness and the use of depression/anxiety medications were associated according to both modeling approaches, net of covariates. In years when a respondent reported feeling lonely, the odds of regular use of depression/anxiety medications were 1.42 times higher (p < .001) than in years when they did not feel lonely. Regarding reciprocation, odds of regular depression/anxiety medication use in a given wave range from 1.3 to 1.5 times higher if loneliness was reported in the prior wave. Likewise, the odds of reporting loneliness in a given wave range from 1.5 to 1.8 times higher if regular depression/anxiety medication was reported in the prior wave.

DISCUSSION: Prior loneliness predicts contemporaneous regular use of depression/anxiety prescription medications. Although this confirms the directional association found in prior studies, we found prior use of depression/anxiety medications is also associated with increased odds of loneliness, suggesting further research is needed to understand mechanisms that explain their associations and potential interventions.

}, keywords = {Cross-Sectional Studies, depression, Humans, Loneliness, Longitudinal Studies, pain, Prescriptions}, issn = {1758-5368}, doi = {10.1093/geronb/gbad010}, author = {Lam, Jack and Vuolo, Michael} } @article {13181, title = {Longitudinal body weight dynamics in relation to cognitive decline over two decades: A prospective cohort study.}, journal = {Obesity (Silver Spring)}, volume = {31}, year = {2023}, month = {2023 Mar}, pages = {852-860}, abstract = {

OBJECTIVE: The aim of this study was to investigate the associations of body weight change (BWC) and body weight variability (BWV) with changes in cognitive function.

METHODS: In 10,340 Health and Retirement Study participants (mean age: 68.0 years), body weight was reported biennially from 1993/1994 to 2016, and cognitive function was measured biennially from 1998 to 2016. We calculated BWC and BWV as the slope and root-mean-square error by regressing body weight on time for each individual. BWC was categorized by quintiles (Q): stable weight (Q2 to Q4), weight loss (Q1), and weight gain (Q5). BWV was categorized by tertiles. We used linear mixed regression models to assess associations with cognitive change.

RESULTS: Compared with stable weight (median: 0~kg/y), weight loss (median: -1.3~kg/y) predicted faster cognitive decline as demonstrated by mean difference of -0.023 (95\% CI: -0.027 to -0.019) in cognitive change z score per year, whereas weight gain (median: 1~kg/y) was related to slower cognitive decline (β~=~0.006; 95\% CI: 0.003 to 0.009). Larger BWV was also associated with faster cognitive decline (β comparing the top with bottom tertile~=~-0.003; 95\% CI: -0.006 to -0.0002). Similar associations were observed for episodic and working memory.

CONCLUSIONS: Weight loss and large BWV over a long time independently predicted faster cognitive decline in middle-aged and older adults, underscoring the importance of long-term dynamic body weight monitoring.

}, keywords = {Aged, Body Weight, Cognitive Dysfunction, Humans, Longitudinal Studies, Middle Aged, Prospective Studies, Weight Gain, Weight Loss}, issn = {1930-739X}, doi = {10.1002/oby.23671}, author = {Zhou, Tianjing and Chen, Hui and Huang, Yuhui and Wang, Binghan and Zheng, Yan and Wang, Liang and Rong, Shuang and Ma, Yuan and Yuan, Changzheng} } @article {13628, title = {A longitudinal study of polygenic score and cognitive function decline considering baseline cognitive function, lifestyle behaviors, and diabetes among middle-aged and older US adults.}, journal = {Alzheimer{\textquoteright}s research \& therapy}, volume = {15}, year = {2023}, pages = {196}, abstract = {

BACKGROUND: Genomic study of cognition decline while considering baseline cognition and lifestyle behaviors is scarce. We aimed to evaluate the impact of a polygenic score for general cognition on cognition decline rate, while considering baseline cognition and lifestyle behaviors, among the general population and people with diabetes, a patient group commonly affected by cognition impairment.

METHODS: We tested associations of the polygenic score for general cognition with annual changing rates of cognition measures in 8~years of follow-up among 12,090 White and 3100 Black participants of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 50~years and older in the USA. Cognition measures including word recall, mental status, and total cognitive score were measured biannually. To maximize sample size and length of follow-up, we treated the 2010 wave of survey as baseline, and follow-up data until 2018 were analyzed. Baseline lifestyle behaviors, APOE status, and measured cognition were sequentially adjusted. Given racial differences in polygenic score, all analyses were conducted by race.

RESULTS: The polygenic score was significantly associated with annual changing rates of all cognition measures independent of lifestyle behaviors and APOE status. Together with age and sex, the polygenic score explained 29.9\%, 15.9\%, and 26.5\% variances of annual changing rates of word recall, mental status, and total cognitive scores among Whites and explained 17.2\%, 13.9\%, and 18.7\% variance of the three traits among Blacks. Among both White and Black participants, those in the top quartile of polygenic score had the three cognition measures increased annually, while those in the bottom quartile had the three cognition measures decreased annually. After further adjusting for the average cognition assessed in 3 visits around baseline, the polygenic score was still positively associated with annual changing rates of all cognition measures for White (P <= 2.89E - 19) but not for Black (P >= 0.07) participants. In addition, among participants with diabetes, physical activity offset the genetic susceptibility to decline of mental status (interaction P <= 0.01) and total cognitive scores (interaction P = 0.03).

CONCLUSIONS: Polygenic score predicted cognition changes in addition to measured cognition. Physical activity offset genetic risk for cognition decline among diabetes patients.

}, keywords = {Adult, Aged, Apolipoproteins E, Cognition, Cognitive Dysfunction, Diabetes Mellitus, Humans, Life Style, Longitudinal Studies, Middle Aged}, issn = {1758-9193}, doi = {10.1186/s13195-023-01343-1}, author = {Liu, Tingting and Li, Changwei and Zhang, Ruiyuan and Millender, Eugenia Flores and Miao, Hongyu and Ormsbee, Michael and Guo, Jinzhen and Westbrook, Adrianna and Pan, Yang and Wang, Jing and Kelly, Tanika N} } @article {13124, title = {Long-term variability in physiological measures in relation to mortality and epigenetic aging: prospective studies in the USA and China.}, journal = {BMC Med}, volume = {21}, year = {2023}, month = {2023 Jan 16}, pages = {20}, abstract = {

BACKGROUND: Visit-to-visit body weight variability (BWV), pulse rate variability (PRV), and blood pressure variability (BPV) have been respectively linked to multiple health outcomes. The associations of the combination of long-term variability in physiological measures with mortality and epigenetic age acceleration (EAA) remain largely unknown.

METHODS: We constructed a composite score of physiological variability (0-3) of large variability in BWV, PRV, and BPV~(the top tertiles) in 2006/2008-2014/2016 in the Health and Retirement Study (HRS) and 2011-2015 in the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was documented through 2018. EAA was calculated using thirteen DNA methylation-based epigenetic clocks~among 1047 participants in a substudy of the HRS. We assessed the relation of the composite score to the risk of mortality among 6566 participants in the HRS and 6906 participants in the CHARLS by Cox proportional models and then investigated its association with EAA using linear regression models.

RESULTS: A higher score of variability was associated with higher mortality risk in both cohorts (pooled hazard ratio [HR] per one-point increment, 1.27; 95\% confidence interval [CI], 1.18, 1.39; P-heterogeneity = 0.344), after adjustment for multiple confounders and baseline physiological measures. Specifically, each SD increment in BWV, PRV, and BPV was related to 21\% (95\% CI: 15\%, 28\%), 6\% (0\%, 13\%), and 12\% (4\%, 19\%) higher hazard of mortality, respectively. The composite score was significantly related to EAA in second-generation clocks trained on health outcomes (e.g., standardized coefficient = 0.126 in the Levine clock, 95\% CI: 0.055, 0.196) but not in most first-generation clocks trained on chronological age.

CONCLUSIONS: Larger variability in physiological measures was associated with a higher risk of mortality and faster EAA.

}, keywords = {Aging, China, Epigenesis, Genetic, Humans, Longitudinal Studies, Prospective Studies}, issn = {1741-7015}, doi = {10.1186/s12916-022-02674-w}, author = {Chen, Hui and Zhou, Tianjing and Wu, Shaowei and Cao, Yaying and Zong, Geng and Yuan, Changzheng} } @article {13190, title = {Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations.}, journal = {Alzheimers Dement}, volume = {19}, year = {2023}, month = {2023 May}, pages = {2218-2225}, abstract = {

INTRODUCTION: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings.

METHODS: We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N~=~11,250) to quantify associations between items on functional limitations and cognitive impairment.

RESULTS: Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD~=~0.73~vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR]~=~2.23~vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]).

DISCUSSION: Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies.

HIGHLIGHTS: There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.

}, keywords = {Activities of Daily Living, Aged, Cognitive Dysfunction, Dementia, England, Humans, Surveys and Questionnaires, United States}, issn = {1552-5279}, doi = {10.1002/alz.12994}, author = {Nichols, Emma and Ng, Derek K and Hayat, Shabina and Kenneth M. Langa and Lee, Jinkook and Steptoe, Andrew and Deal, Jennifer A and Gross, Alden L} } @article {13692, title = {Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults.}, journal = {Neurology}, volume = {101}, year = {2023}, pages = {e2355-e2363}, abstract = {

BACKGROUND AND OBJECTIVES: The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults.

METHODS: This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted.

RESULTS: This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95\% CI 1.90-3.66, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95\% CI 1.27-2.42, < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95\% CI 1.49-2.11, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95\% CI 1.36-1.90, < 0.001).

DISCUSSION: Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.

}, keywords = {Aged, Aging, Biology, Biomarkers, DNA Methylation, Heart Diseases, Humans, Middle Aged, Saliva, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000207909}, author = {Waziry, Reem and Gu, Yian and Boehme, Amelia K and Williams, Olajide A} } @article {13168, title = {The mediating role of Vitamin D in the association between personality and memory: Evidence from two samples.}, journal = {Biol Psychol}, volume = {178}, year = {2023}, month = {2023 Mar}, pages = {108525}, abstract = {

Five-Factor Model (FFM) personality traits are consistently related to cognition in old age. However, little is known about the biological mediators of this association. The present study examined whether levels of Vitamin D mediated the association between personality and memory. Participants were adults aged 50-96 years from the Health and Retirement Study (HRS, N~=~5229) and the English Longitudinal Study of Ageing (ELSA, N~=~4249). In HRS, personality and demographic factors were assessed in 2012/2014, Vitamin D was assessed in 2016, and memory was assessed in 2018. In ELSA, personality and demographic factors were obtained in 2010/2011, Vitamin D was measured in 2012/2013, and memory was assessed in 2014/2015. In both samples, higher extraversion and conscientiousness were related to higher levels of Vitamin D, whereas higher neuroticism was related to lower Vitamin D. In both samples, higher Vitamin D partly mediated the association between both higher extraversion and conscientiousness and better memory. The association between higher neuroticism and worse memory at follow-up was partially mediated by lower Vitamin D in the HRS and ELSA. Vitamin D did not mediate the association between higher openness and better memory. The present study extends the personality-cognition literature by providing new replicable evidence that Vitamin D is a biological mediator.

}, keywords = {Adult, Aging, Humans, Longitudinal Studies, Neuroticism, Personality, Vitamin D}, issn = {1873-6246}, doi = {10.1016/j.biopsycho.2023.108525}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Terracciano, Antonio} } @article {13064, title = {Milk intake, lactase persistence genotype, plasma proteins and risks of cardiovascular events in the Swedish general population.}, journal = {Eur J Epidemiol}, volume = {38}, year = {2023}, pages = {211-224}, abstract = {

To investigate the associations of milk intake (non-fermented and fermented milk), lactase persistence (LCT-13910~C/T) genotype (a proxy for long-term non-fermented milk intake), and gene-milk interaction with risks of cardiovascular disease (CVD) and CVD mortality. Also, to identify the CVD-related plasma proteins and lipoprotein subfractions associated with milk intake and LCT-13910~C/T genotype. The prospective cohort study included 20,499 participants who were followed up for a mean of 21 years. Dietary intake was assessed using a modified diet history method. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95\% confidence intervals (CIs). After adjusting for sociodemographic and lifestyle factors, higher non-fermented milk intake was significantly associated with higher risks of coronary heart disease (CHD) and CVD mortality, whereas higher fermented milk intake was significantly associated with lower risks of CVD and CVD mortality. The genotype associated with higher milk (mainly non-fermented) intake was positively associated with CHD (CT/TT vs. CC HR = 1.27; 95\% CI: 1.03, 1.55) and CVD (HR = 1.22; 95\% CI: 1.05, 1.42). The association between rs4988235 genotype and CVD mortality was stronger in participants with higher milk intake than among participants with lower intake (P for interaction < 0.05). Furthermore, leptin, HDL, and large HDL were associated with non-fermented milk intake, while no plasma proteins or lipoprotein subfractions associated with fermented milk intake and LCT-13910~C/T genotype were identified. In conclusion, non-fermented milk intake was associated with higher risks of CHD and CVD mortality, as well as leptin and HDL, whereas fermented milk intake was associated with lower risks of CVD and CVD mortality.

}, keywords = {Animals, Cardiovascular Diseases, diet, Genotype, Humans, Lactase, Leptin, Milk, Prospective Studies, Risk Factors, Sweden}, issn = {1573-7284}, doi = {10.1007/s10654-022-00937-7}, author = {Zhang, Shunming and Li, Huiping and Engstr{\"o}m, Gunnar and Niu, Kaijun and Qi, Lu and Born{\'e}, Yan and Sonestedt, Emily} } @article {13146, title = {More than just a bad day? Traumatic life events and self-control in old age.}, journal = {PLoS One}, volume = {18}, year = {2023}, month = {2023}, pages = {e0266312}, abstract = {

The behavioral economics literature suggests that exposure to traumatic events shifts preference features including risk aversion and time preference. In this study, we examined the association between traumatic life events and self-control in old age. Data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and early life characteristics. The results showed that experiences of serious physical attacks or assaults is associated with a 3.1\% reduction in self-control, adjusted for demographic and childhood socioeconomic characteristics. The attacks or assaults were experienced approximately 30 years prior to the survey, indicating that traumatic life events exert a lasting influence on self-control. Further analyses found no difference in the association between the experience of serious physical attacks or assaults and self-control according to the timing of occurrence. Our findings are consistent with the evidence that experiences of natural disasters or armed conflicts increase impatience among survivors.

}, keywords = {Armed Conflicts, Child, Humans, Retrospective Studies, Self-control, Stress Disorders, Post-Traumatic, Surveys and Questionnaires}, issn = {1932-6203}, doi = {10.1371/journal.pone.0266312}, author = {Choung, Youngjoo and Pak, Tae-Young} } @article {13468, title = {Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {826-838}, abstract = {

INTRODUCTION: Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.

METHODS: Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58\% female, 25\% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.

RESULTS: Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95\% CI = 1.01-1.20), diabetes (IRR = 1.19, 95\% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95\% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95\% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95\% CI = 1.02-1.11), hypertension (IRR = 1.06, 95\% CI = 1.02-1.11), heart disease (IRR = 1.06, 95\% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95\% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.

CONCLUSION: The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.

}, keywords = {Activities of Daily Living, Aged, Arthritis, C-reactive protein, Diabetes Mellitus, Disabled Persons, Female, Glycated Hemoglobin, Heart Diseases, Humans, Hypertension, Inflammation, Longitudinal Studies, Male, multimorbidity, Prospective Studies, Stroke}, issn = {1423-0003}, doi = {10.1159/000528648}, author = {Botoseneanu, Anda and Markwardt, Sheila and Qui{\~n}ones, Ana R} } @article {13576, title = {Neighborhood Characteristics and Elevated Blood Pressure in Older Adults.}, journal = {JAMA Network Open}, year = {2023}, month = {2023 Sep 05}, pages = {e2335534}, abstract = {

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.

OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.

EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009).

MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P <= .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.

RESULTS: Of 12 946 participants, 4565 (35\%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50\%] male; 228 [5\%] Hispanic or Latino, 502 [11\%] non-Hispanic Black, and 3761 [82\%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95\% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95\% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95\% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95\% CI, 0.65-1.09; P = .78 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

}, keywords = {Aged, Blood pressure, Cohort Studies, ethnicity, Female, Humans, Hypertension, Male, Neighborhood characteristics}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.35534}, author = {Sims, Kendra D and Willis, Mary D and Hystad, Perry W and Batty, G David and Bibbins-Domingo, Kirsten and Smit, Ellen and Odden, Michelle C} } @article {13155, title = {Obesity Stigma: Causes, Consequences, and Potential Solutions.}, journal = {Curr Obes Rep}, volume = {12}, year = {2023}, month = {2023 Mar}, pages = {10-23}, abstract = {

PURPOSE OF REVIEW: This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS: We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual{\textquoteright}s control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

}, keywords = {Body Weight, Humans, Obesity, Social Behavior, Social Stigma, Stereotyping}, issn = {2162-4968}, doi = {10.1007/s13679-023-00495-3}, author = {Westbury, Susannah and Oyebode, Oyinlola and van Rens, Thijs and Barber, Thomas M} } @article {13334, title = {Occupational characteristics and epigenetic aging among older adults in the United States.}, journal = {Epigenetics}, volume = {18}, year = {2023}, pages = {2218763}, abstract = {

Occupational characteristics have been studied as risk factors for several age-related diseases and are thought to impact the ageing process, although there has been limited empirical work demonstrating an association between adverse occupational characteristics and accelerated ageing and this prior work has yielded mixed results. We used the 2010 and 2016 waves of the Health and Retirement Study ( = 1,251) to examine the association between occupation categories and self-reported working conditions of American adults at midlife and their subsequent epigenetic ageing as measured through five epigenetic clocks: PCHorvath, PCHannum, PCPhenoAge, PCGrimAge, and DunedinPACE. We found that individuals working in sales/clerical, service, and manual work show evidence of epigenetic age acceleration compared to those working in managerial/professional jobs and that the associations were stronger with second- and third-generation clocks. Individuals reporting high stress and high physical effort at work showed evidence of epigenetic age acceleration only on PCGrimAge and DunedinPACE. Most of these associations were attenuated after adjustment for race/ethnicity, educational attainment, and lifestyle-related risk factors. Sales/clerical work remained significantly associated with PCHorvath and PCHannum, while service work remained significantly associated with PCGrimAge. The results suggest that manual work and occupational physical activity may appear to be risk factors for epigenetic age acceleration through their associations with socioeconomic status, while stress at work may be a risk factor for epigenetic age acceleration through its associations with health behaviours outside of work. Additional work is needed to understand when in the life course and the specific mechanisms through which these associations occur.

}, keywords = {Aged, Aging, DNA Methylation, Epigenesis, Genetic, ethnicity, Humans, United States}, issn = {1559-2308}, doi = {10.1080/15592294.2023.2218763}, author = {Andrasfay, Theresa and Crimmins, Eileen} } @article {13372, title = {Oral health issues of early baby boomers.}, journal = {Spec Care Dentist}, volume = {43}, year = {2023}, pages = {313-319}, abstract = {

OBJECTIVES: The purpose of this article is to detail the oral health status of early baby boomers and how it is affected by the cultural influences after World War II.

METHODS: National data on clinically and self-assessed oral conditions from the 2021 NIDCR Oral Health in America Report, National Health and Nutrition Examination Survey (2011-2014), Center for Disease Control and Prevention, National Cancer Institute (2018), the Indian Health Service (2022), and the Health and Retirement Study (2018) were tabulated and compared (where available) to similar data for older and younger cohorts.

RESULTS: Data analyses show that there is more tooth retention overall. There are higher levels of tooth loss, unrestored caries, and periodontitis among Black, American Indian, Alaskan Native, and Hispanic baby boomers, and the poor. Smokers had higher rates of periodontitis.

CONCLUSION: A life course approach to oral health care is warranted. Only by regular access and preventive care throughout life can avoidable, unnecessary, overly complex, and invasive procedures be prevented.

}, keywords = {Dental Caries, Humans, Nutrition Surveys, Oral Health}, issn = {1754-4505}, doi = {10.1111/scd.12844}, author = {Jones, Judith A and Moss, Kevin and Weintraub, Jane A} } @article {13101, title = {Out-of-Pocket Health Care Spending at Older Ages: Do Caregiving Arrangements Matter?}, journal = {J Appl Gerontol}, volume = {42}, year = {2023}, pages = {1013-1021}, abstract = {

Identifying the correlates of out-of-pocket (OOP) health care spending is an important step for ensuring the financial security of older adults. Whether or not someone has a family member providing assistance is one such factor that could be associated with OOP spending. If family caregivers facilitate better health, health care spending could be reduced. On the other hand, costs would be higher if family members facilitate more (or more costly) care for loved ones. This paper explores the relationship between caregiving arrangements and OOP spending using data from 5045 individuals in the 2000-2016 Health and Retirement Study with Medicare coverage and caregiving needs. We do not find a relationship between family caregiving and OOP health care costs, overall. However, among those with Medicare HMO insurance, having a family caregiver is associated with more spending than having no helper. This is mainly due to differences in spending on prescription medications.

}, keywords = {Aged, Delivery of Health Care, Health Expenditures, Humans, Medicare, Middle Aged, United States}, issn = {1552-4523}, doi = {10.1177/07334648231152401}, author = {Friedman, Esther M and Beach, Scott R and Schulz, Richard} } @article {13326, title = {Partners in Health: Investigating Social Genetic Effects Among Married and Cohabiting Couples.}, journal = {Behav Genet}, volume = {53}, year = {2023}, pages = {348-358}, abstract = {

Partners resemble each other in health behaviors and outcomes such as alcohol use, smoking, physical activity, and obesity. While this is consistent with social contagion theory suggesting partner influence, it is notoriously difficult to establish causality because of assortative mating and contextual confounding. We offer a novel approach to studying social contagion in health in long-term partnerships by combining genetic data of both partners in married/cohabiting couples with longitudinal data on their health behaviors and outcomes. We examine the influence of the partner{\textquoteright}s genetic predisposition for three health outcomes and behaviors (BMI, smoking, and drinking) among married/cohabiting couples. We use longitudinal data from the Health and Retirement Study and the English Longitudinal Study of Ageing with data on health outcomes and genotypes for both partners. Results show that changes over time in BMI, smoking, and drinking depend on the partner{\textquoteright}s genetic predispositions to these traits. These findings underline the importance of people{\textquoteright}s social surroundings for their health and highlight the potential of targeting health interventions at couples.

}, keywords = {Family Characteristics, Health Behavior, Humans, Longitudinal Studies, Marriage, Spouses}, issn = {1573-3297}, doi = {10.1007/s10519-023-10147-w}, author = {Otten, Kasper and Mandemakers, Jornt J} } @article {13703, title = {Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {1815-1841}, abstract = {

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27\% to 55\% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7\% to 11\%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

}, keywords = {Aging, Black or African American, Health Status Disparities, Humans, Life Change Events, Morbidity, Mortality, White}, issn = {1533-7790}, doi = {10.1215/00703370-11057546}, author = {Boen, Courtney E and Yang, Y Claire and Aiello, Allison E and Dennis, Alexis C} } @article {13704, title = {Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {1815-1841}, abstract = {

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27\% to 55\% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7\% to 11\%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

}, keywords = {Aging, Black or African American, Health Status Disparities, Humans, Life Change Events, Morbidity, Mortality, White}, issn = {1533-7790}, doi = {10.1215/00703370-11057546}, author = {Boen, Courtney E and Yang, Y Claire and Aiello, Allison E and Dennis, Alexis C} } @article {13702, title = {Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {1815-1841}, abstract = {

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27\% to 55\% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7\% to 11\%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

}, keywords = {Aging, Black or African American, Health Status Disparities, Humans, Life Change Events, Morbidity, Mortality, White}, issn = {1533-7790}, doi = {10.1215/00703370-11057546}, author = {Boen, Courtney E and Yang, Y Claire and Aiello, Allison E and Dennis, Alexis C and Harris, Kathleen Mullan and Kwon, Dayoon and Belsky, Daniel W} } @article {13262, title = {Personality and aging-related immune phenotype.}, journal = {Psychoneuroendocrinology}, volume = {153}, year = {2023}, pages = {106113}, abstract = {

An aging-related immune phenotype (ARIP) has been defined as a decrease in na{\"\i}ve T cells (T) relative to the accumulation of memory T cells (T). Recent research implicates ARIP measures, such as CD4~+T/T and CD8~+T/T ratios, in multimorbidity and mortality. This study examined whether psychological dispositions that assess how people think, feel, and behave are related to CD4~+T/T and CD8~+T/T. Participants were adults aged 50-104 years (N~=~4798; 58\% women, Mean Age= 67.95, SD= 9.56) from the Health and Retirement Study. Data on CD4~+T/T and CD8~+T/T were obtained in 2016. Data on personality, demographic factors, and potential clinical (body mass index, disease burden), behavioral (smoking, alcohol, physical activity), psychological (depressive symptoms, stress), and biological (cytomegalovirus IgG antibodies) mediating factors were obtained in 2014/2016. Controlling for demographic factors, higher conscientiousness was related to higher CD4~+T/T and CD8~+T/T. To a lesser extent, higher neuroticism and lower extraversion were associated with lower CD4~+T/T Physical activity, and to a lesser extent BMI and disease burden, were the most robust mediators between personality and ARIP measures. Cytomegalovirus IgG level mediated the association between conscientiousness and both CD4~+T/T and CD8~+T/T. This study provides novel evidence that personality is related to ARIP. Higher conscientiousness and, to a lesser extent, higher extraversion may be protective against age-related immunophenotype change, whereas neuroticism may be a risk factor.

}, keywords = {Female, Humans, Immunoglobulin G, Male, Neuroticism, Personality, Personality Disorders}, issn = {1873-3360}, doi = {10.1016/j.psyneuen.2023.106113}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Terracciano, Antonio} } @article {13431, title = {Personality and Risk of Incident Stroke in 6 Prospective Studies.}, journal = {Stroke}, volume = {54}, year = {2023}, pages = {2069-2076}, abstract = {

BACKGROUND: A large literature has examined a broad range of factors associated with increased risk of stroke. Few studies, however, have examined the association between personality and stroke. The present study adopted a systematic approach using a multi-cohort design to examine the associations between 5-Factor Model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident stroke using data from 6 large longitudinal samples of adults.

METHODS: Participants (age range: 16-104 years old, N=58 105) were from the MIDUS (Midlife in the United States) Study, the HRS (Health and Retirement Study), The US (Understanding Society) study, the WLS (Wisconsin Longitudinal Study), the NHATS (National Health and Aging Trends Study), and the LISS (Longitudinal Internet Studies for the Social Sciences). Personality traits, demographic factors, clinical and behavioral risk factors were assessed at baseline; stroke incidence was tracked over 7 to 20 years follow-up.

RESULTS: Meta-analyses indicated that higher neuroticism was related to a higher risk of incident stroke (hazard ratio, 1.15 [95\% CI, 1.10-1.20]; <0.001), whereas higher conscientiousness was protective (HR, 0.89 [95\% CI, 0.85-0.93]; <0.001). Additional meta-analyses indicated that BMI, diabetes, blood pressure, physical inactivity, and smoking as additional covariates partially accounted for these associations. Extraversion, openness, and agreeableness were unrelated to stroke incidence.

CONCLUSIONS: Similar to other cardiovascular and neurological conditions, higher neuroticism is a risk factor for stroke incidence, whereas higher conscientiousness is a protective factor.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Humans, Longitudinal Studies, Middle Aged, Neuroticism, Personality, Prospective Studies, Stroke, United States, Young Adult}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.123.042617}, author = {Stephan, Yannick and Sutin, Angelina R and Luchetti, Martina and Aschwanden, Damaris and Terracciano, Antonio} } @article {13127, title = {Predictive Models of Life Satisfaction in Older People: A Machine Learning Approach.}, journal = {Int J Environ Res Public Health}, volume = {20}, year = {2023}, month = {2023 Jan 30}, abstract = {

Studies of life satisfaction in older adults have been conducted extensively through empirical research, questionnaires, and theoretical analysis, with the majority of these studies basing their analyses on simple linear relationships between variables. However, most real-life relationships are complex and cannot be approximated with simple correlations. Here, we first investigate predictors correlated with life satisfaction in older adults. Then, machine learning is used to generate several predictive models based on a large sample of older adults (age >= 50 years; = 34,630) from the RAND Health and Retirement Study. Results show that subjective social status, positive emotions, and negative emotions are the most critical predictors of life satisfaction. The Support Vector Regression (SVR) model exhibited the highest prediction accuracy for life satisfaction in older individuals among several models, including Multiple Linear Regression (MLR), Ridge Regression (RR), Least Absolute Shrinkage and Selection Operator Regression (LASSO), K Nearest Neighbors (KNN), and Decision Tree Regression (DT) models. Although the KNN and DT models exhibited better model fitting than MLR, RR, and LASSO, their performances were poor in terms of model validation and model generalization. These results indicate that machine learning is superior to simple correlations for understanding life satisfaction among older adults.

}, keywords = {Aged, Humans, Linear Models, Machine learning, Middle Aged, Personal Satisfaction}, issn = {1660-4601}, doi = {10.3390/ijerph20032445}, author = {Shen, Xiaofang and Yin, Fei and Jiao, Can} } @article {13319, title = {Predictors of food insecurity among older adults before and during COVID-19 in the United States.}, journal = {Front Public Health}, volume = {11}, year = {2023}, month = {=}, pages = {1112575}, abstract = {

BACKGROUND: The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.

OBJECTIVE: The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.

METHODS: Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 ( = 2,413) and June 2020 ( = 2,216) using population-weighted multivariate logistic regression models.

RESULTS: The prevalence of food insecurity doubled among participants from 2018 (4.83\%) to June 2020 (9.54\%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.

CONCLUSION: Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.

}, keywords = {Aged, COVID-19, diet, Food insecurity, Food Supply, Humans, Middle Aged, Pandemics, United States}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1112575}, author = {Nicklett, Emily Joy and Cheng, Greta Jianjia and Morris, Zachary A} } @article {13054, title = {Preoperative Factors Predict Memory Decline After Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention in an Epidemiological Cohort of Older Adults.}, journal = {J Am Heart Assoc}, volume = {12}, year = {2023}, abstract = {

Background Durable memory decline may occur in older adults after surgical (coronary artery bypass grafting [CABG]) or nonsurgical (percutaneous coronary intervention) coronary revascularization. However, it is unknown whether individual memory risk can be predicted. We reanalyzed an epidemiological cohort of older adults to predict memory decline at ≈1 year after revascularization. Methods and Results We studied Health and Retirement Study participants who underwent CABG or percutaneous coronary intervention at age >=65 years between 1998 and 2015 and participated in >=1 biennial postprocedure assessment. Using a memory score based on direct and proxy cognitive tests, we identified participants whose actual postprocedure memory score was 1-2 ("mild") or >2 ("major") SDs below expected postprocedure performance. We modeled probability of memory decline using logistic regression on preoperatively known factors and evaluated model discrimination and calibration. A total of 1390 participants (551 CABG, 839 percutaneous coronary intervention) underwent CABG/percutaneous coronary intervention at 75{\textpm}6 years old; 40\% were women. The cohort was 83\% non-Hispanic White, 8.4\% non-Hispanic Black, 6.4\% Hispanic ethnicity, and 1.7\% from other groups masked by the HRS (Health and Retirement Study) to preserve participant confidentiality. At a median of 1.1 (interquartile range, 0.6-1.6) years after procedure, 267 (19\%) had mild memory decline and 88 (6.3\%) had major memory decline. Factors predicting memory decline included older age, frailty, and off-pump CABG; obesity was protective. The optimism-corrected area under the receiver operator characteristic curve was 0.73 (95\% CI, 0.71-0.77). A cutoff of 50\% probability of memory decline identified 14\% of the cohort as high risk, and was 94\% specific and 30\% sensitive for late memory decline. Conclusions Preoperative factors can be used to predict late memory decline after coronary revascularization in an epidemiological cohort with high specificity.

}, keywords = {Aged, Aged, 80 and over, Coronary Artery Bypass, Coronary Artery Bypass, Off-Pump, Coronary Artery Disease, Female, Humans, Male, Memory Disorders, Percutaneous Coronary Intervention, Treatment Outcome}, issn = {2047-9980}, doi = {10.1161/JAHA.122.027849}, author = {Tang, Angelina B and Diaz-Ramirez, L Grisell and Smith, Alexander K and Lee, Sei J and Whitlock, Elizabeth L} } @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 {13235, title = {Propensity Scores in Health Disparities Research: The Example of Cognitive Aging and the Hispanic Paradox.}, journal = {Epidemiology}, volume = {34}, year = {2023}, pages = {495-504}, abstract = {

BACKGROUND: Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups.

METHODS: We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994-2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting.

RESULTS: In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions.

CONCLUSIONS: Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study.

}, keywords = {Adult, cognitive aging, Hispanic or Latino, Humans, Mexican Americans, Propensity Score, Risk Factors, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000001620}, author = {Kezios, Katrina L and Zimmerman, Scott C and Zhang, Adina and Calonico, Sebastian and Jawadekar, Neal and Glymour, M Maria and Zeki Al Hazzouri, Adina} } @article {13465, title = {Psychological pathways explaining the prospective association between obesity and physiological dysregulation.}, journal = {Health Psychol}, volume = {42}, year = {2023}, pages = {472-484}, abstract = {

OBJECTIVE: Obesity is associated with a range of negative psychological conditions that may also affect physiological health. Across two studies, we tested whether a range of psychological measures explain why obesity is prospectively associated with physiological dysregulation, measured via clinical indicators of cardiovascular, immune system, and metabolic function.

METHOD: We used comparable 4-year follow-up representative longitudinal data of U.K. and U.S. older adults (>=50 years) from the English Longitudinal Study of Ageing (2008/2009-2012/2013; Study 1; n = 6,250) and the Health and Retirement Study (2008/2010-2012/2014; Study 2; n = 9,664). A diverse range of psychological measures (e.g., depressive symptoms, life satisfaction, weight stigma, positive affect) were tested as candidate mediators in Studies 1 (n = 14) and 2 (n = 21).

RESULTS: Obesity predicted physiological dysregulation at follow-up across both studies. In Study 1, only weight stigma (measured between baseline and follow-up) explained 37\% of the association between obesity and physiological dysregulation. In Study 2, only changes in weight stigma from baseline to follow-up (not baseline weight stigma) explained 13\% of the effect of obesity on future physiological dysregulation. Mediation by weight stigma in both studies was partially attenuated when changes in body mass index from baseline to follow-up were controlled for. No other psychological measures explained the association between obesity and physiological dysregulation in either study.

CONCLUSIONS: The prospective association between obesity and physiological dysregulation was largely not explained by psychological factors. However, experiencing weight stigma is associated with increased weight gain and this process may explain obesity-related declines in physiological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

}, keywords = {Aged, Body Mass Index, Body Weight, Humans, Longitudinal Studies, Obesity, Social Stigma, Weight Gain}, issn = {1930-7810}, doi = {10.1037/hea0001284}, author = {Putra, I Gusti Ngurah Edi and Daly, Michael and Sutin, Angelina and Steptoe, Andrew and Robinson, Eric} } @article {13608, title = {Race, everyday discrimination, and cognitive function in later life.}, journal = {PLoS One}, volume = {18}, year = {2023}, pages = {e0292617}, abstract = {

Discrimination is pernicious in many ways, but there are inconsistent findings regarding whether it is harmful to cognitive function in later life. To address the inconsistency, we use two closely related concepts of everyday discrimination to predict cognitive trajectories in a diverse sample. Using data from the Health and Retirement Study (HRS), we examine whether the frequency of discrimination, measured at baseline with six questions, is related to poorer cognitive function and change in function over time (2008-2016). Age at baseline ranged from 53 to 100. Growth curve models of initial cognitive function and change in function were estimated. Everyday global discrimination was associated with poorer initial cognition and slower declines over time, and these relationships were not moderated by race and ethnicity. By contrast, the relationship between everyday racial discrimination and cognition was moderated by race: more frequent everyday racial discrimination was associated with better initial cognitive function among Black adults but not among Hispanic and White adults. Discrimination is a multifaceted concept, and specific types of discrimination manifest lower or higher cognitive function during later life for White, Black, and Hispanic adults.

}, keywords = {Adult, Black or African American, Cognition, ethnicity, Hispanic or Latino, Humans, Racism}, issn = {1932-6203}, doi = {10.1371/journal.pone.0292617}, author = {Ferraro, Kenneth F and Zaborenko, Callie J} } @article {13248, title = {Racial and Ethnic Disparities in Health Care Use and Access Associated With Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level.}, journal = {JAMA Intern Med}, volume = {183}, year = {2023}, pages = {534-543}, abstract = {

IMPORTANCE: Medicaid supplemental insurance covers most cost sharing in Medicare. Among low-income Medicare beneficiaries, the loss of Medicaid eligibility above this program{\textquoteright}s income eligibility threshold (100\% of federal poverty level [FPL]) may exacerbate racial and ethnic disparities in Medicare beneficiaries{\textquoteright} ability to afford care.

OBJECTIVE: To examine whether exceeding the income threshold for Medicaid, which results in an abrupt loss of Medicaid eligibility, is associated with greater racial and ethnic disparities in access to and use of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a regression discontinuity design to assess differences in access to and use of care associated with exceeding the income threshold for Medicaid eligibility. We analyzed Medicare beneficiaries with incomes 0\% to 200\% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities associated with the loss of Medicaid eligibility, we compared discontinuities in outcomes among Black and Hispanic beneficiaries (n = 2885) and White beneficiaries (n = 5259). Analyses were conducted between January 1, 2022, and October 1, 2022.

MAIN OUTCOME MEASURES: Patient-reported difficulty accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data.

RESULTS: This cross-sectional study included 8144 participants (38 805 person-years), who when weighted represented 151 282 957 person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200\% FPL. In the weighted sample, the mean (SD) age was 75.4 (9.4) years, 66.1\% of beneficiaries were women, 14.8\% were non-Hispanic Black, 13.6\% were Hispanic, and 71.6\% were White. Findings suggest that exceeding the Medicaid eligibility threshold was associated with a 43.8 percentage point (pp) (95\% CI, 37.8-49.8) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp (95\% CI, 25.4-36.6) lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care (discontinuity: 5.7 pp; 95\% CI, 2.0-9.4), lower outpatient use (-6.3 services per person-year; 95\% CI, -10.4 to -2.2), and fewer medication fills (-6.9 fills per person-year; 95\% CI, -11.4 to -2.5), but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use (disparity: -6.2 services per person-year; 95\% CI, -11.7 to -0.6; P = .03) and medication fills (disparity: -7.2 fills per person-year; 95\% CI, -13.4 to -1.0; P = .02) among Black and Hispanic vs White beneficiaries.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that loss of eligibility for Medicaid supplemental insurance above the federal poverty level, which increases cost sharing in Medicare, was associated with increased racial and ethnic health care disparities among low-income Medicare beneficiaries. Expanding eligibility for Medicaid supplemental insurance may narrow these disparities.

}, keywords = {Aged, Cross-Sectional Studies, Female, Healthcare Disparities, Humans, Male, Medicaid, Medicare, Middle Aged, Poverty, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.0512}, author = {Roberts, Eric T and Kwon, Youngmin and Hames, Alexandra G and McWilliams, J Michael and Ayanian, John Z and Tipirneni, Renuka} } @article {13084, title = {Racial Differences in Employment and Poverty Histories and Health in Older Age.}, journal = {Am J Prev Med}, volume = {64}, year = {2023}, pages = {543-551}, abstract = {

INTRODUCTION: Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment-poverty histories for Black and White middle-aged adults and examined their association with health.

METHODS: Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (N=555, N=2,209) were included. Sequence analysis grouped respondents with similar employment-poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022.

RESULTS: More than 23\% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50\% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment-poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95\% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95\% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents.

CONCLUSIONS: Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.

}, keywords = {Aged, Black or African American, Employment, Humans, Middle Aged, Poverty, Race Factors, White}, issn = {1873-2607}, doi = {10.1016/j.amepre.2022.10.018}, author = {Lu, Peiyi and Kezios, Katrina and Milazzo, Floriana and Jawadekar, Neal and Shelley, Mack and Zeki Al Hazzouri, Adina} } @article {13160, title = {Reciprocal associations between social media use and self-perception of aging among older adults: Do men and women differ?}, journal = {Soc Sci Med}, volume = {321}, year = {2023}, month = {2023 Mar}, pages = {115786}, abstract = {

PURPOSE: Despite the positive impact of social media use in late adulthood, social media use is still low among older adults. Research in technology adoption and utilization indicates the importance of age-specific factors, such as self-perception of aging (SPA). As it is unclear whether SPA facilitates social media use or social media use promotes SPA, reverse causality has emerged as a major point of contention within this literature, with several studies reporting conflicting results. Thus, in this study, we aim to contribute unique insight by examining (1) whether positive and negative SPAs demonstrate unique associations with social media use and (2) whether these reciprocal associations differ by gender.

METHODS: Using two waves (2014 and 2018) from the Health and Retirement Study, 4101 older Americans (age >=65 years) with normal baseline cognition were included in this study. Autoregressive cross-lagged analyses were conducted to assess reciprocal associations between SPA and social media use among the total sample and by gender subgroups.

RESULTS: Controlling for covariates, we found that more frequent social media use marginally predicted higher positive SPA four years later (B~=~0.02, p~=~.07), and higher negative SPA marginally predicted less frequent social media use four years later (B~=~-0.07, p~=~.08). However, the by-gender analysis showed that the positive effect of social media use on positive SPA was only significant among older men (B~=~0.04, p~<~.05), whereas the negative impact of negative SPA on social media use only existed among older women (B~=~-0.13, p~<~.01).

CONCLUSIONS: The reciprocal associations between SPA and social media use differ by the valence of SPA (positive/negative) and gender. Future interventions for SPA and digital technology use among older adults should be gender-tailored.

}, keywords = {Adult, Age Factors, Aged, Aging, Female, Humans, Male, Retirement, Self Concept, Social media}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.115786}, author = {Wang, Kun and Gu, Danan} } @article {13109, title = {Relationships between Interpersonal Goals and Loneliness in Older Adults: A Cross-Sectional Study.}, journal = {Int J Environ Res Public Health}, volume = {20}, year = {2023}, abstract = {

Loneliness is linked to many physiological and psychological issues and disproportionately affects older adults. Interpersonal goals (compassion and self-image) are essential to interpersonal relationships; however, how they relate to loneliness in older adults is unknown. We investigated the impact of interpersonal goals on loneliness using the Ecosystem-Egosystem Theory of Social Motivation. This study, adopting a descriptive cross-sectional correlational design, used data from the 2016 Health and Retirement Study. Participants ( = 3212) included people aged >65 years (mean age: 75; female: 60.1\%). We performed exploratory factor analysis with principal axis factoring and varimax rotation to examine the suitability of compassionate and self-image goals as separate factors. The complex samples general linear model was used to assess the relationship between loneliness and interpersonal goals. Interpersonal goals were significantly negatively associated with loneliness. Respondents with higher compassion and self-image goals reported lower loneliness levels. Our results contribute to understanding how interpersonal goals relate to loneliness in older adults. These initial findings warrant further investigation.

}, keywords = {Aged, Cross-Sectional Studies, Ecosystem, Female, Goals, Humans, Interpersonal Relations, Loneliness}, issn = {1660-4601}, doi = {10.3390/ijerph20031914}, author = {Ezeokonkwo, Francesca C and Sekula, Kathleen L and Stokes, Jeffrey E and Theeke, Laurie A and Zoucha, Rick and Troutman-Jordan, Meredith and Sharma, Dinesh} } @article {13300, title = {Relationships Between Types of Leisure Activities and Mental Health among Older Adults With Diabetes During the COVID-19 Pandemic.}, journal = {Am J Health Behav}, volume = {47}, year = {2023}, pages = {228-236}, abstract = {

Three types of leisure activities such as sedentary, social, and leisure-time physical activity (LTPA) have been identified as essential factors that influence mental health outcomes among older adults with diabetes. In this study, we aimed to investigate what types of leisure activities are associated with mental health outcomes among older adults with diabetes during the COVID-19 pandemic. We used 2020 Health and Retirement Study (HRS) data. We extracted 310 records from 3266 individuals diagnosed with diabetes and conducted a hierarchical regression analysis to investigate the research question. LTPA was the strongest predictor of reduced loneliness and stress and increased happiness and life satisfaction among older adults with diabetes. Our findings highlight the relationship between different types of leisure activities and mental health for older adults with diabetes during the COVID-19 pandemic. Data suggest that LTPA, social leisure, and sedentary leisure reduce loneliness and stress and improve happiness and life satisfaction.

}, keywords = {Aged, COVID-19, Diabetes Mellitus, Humans, Leisure activities, Mental Health, Pandemics}, issn = {1945-7359}, doi = {10.5993/AJHB.47.2.3}, author = {Lee, Jungjoo and Han, Areum and Kim, Junhyoung and Park, Se-Hyuk} } @article {13709, title = {The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans.}, journal = {Journal of the American Directors Association}, volume = {24}, year = {2023}, pages = {1936-1941.e2}, abstract = {

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN: Longitudinal panel.

SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged >=65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45~kg/kg (body mass normalized), or <1.05~kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337~kg/kg, or <0.79~kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95\% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

}, keywords = {Aged, Body Mass Index, Cognition, Cognitive Dysfunction, Female, Geriatric Assessment, Hand Strength, Humans, Male}, issn = {1538-9375}, doi = {10.1016/j.jamda.2023.07.021}, author = {McGrath, Ryan and Tomkinson, Grant R and Hamm, Jeremy M and Juhl, Kirsten and Knoll, Kelly and Parker, Kelly and Smith, Ashleigh E and Rhee, Yeong} } @article {13464, title = {Self-Rated Health and Mortality: Moderation by Purpose in Life.}, journal = {Int J Environ Res Public Health}, volume = {20}, year = {2023}, abstract = {

Poor self-rated health consistently predicts reduced longevity, even when objective disease conditions and risk factors are considered. Purpose in life is also a reliable predictor of diverse health outcomes, including greater longevity. Given prior work in which we showed that purpose in life moderated the association between chronic conditions and health-related biological factors, the aim of the current study was to examine the role of purpose in life in moderating the relationship between subjective health and mortality. We also examined potential differences in these associations by race/ethnicity. Data were from two large national longitudinal studies-the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study-with a 12- to 14-year follow-up period for mortality estimates. Results of logistic regression analyses showed that purpose in life and self-rated health were both significantly positively associated with longevity, and that purpose in life significantly moderated the relationship between self-rated health and mortality. Stratified analyses showed similar results across all racial/ethnic groups, with the exception of Black MIDUS participants. These results suggest that greater purpose in life may provide a buffer against the greater probability of mortality associated with poor subjective health.

}, keywords = {ethnicity, Humans, Longevity, Longitudinal Studies, Mortality, Racial Groups, United States, White}, issn = {1660-4601}, doi = {10.3390/ijerph20126171}, author = {Friedman, Elliot M and Teas, Elizabeth} } @article {13271, title = {Sense of purpose in life and allostatic load in two longitudinal cohorts.}, journal = {J Psychosom Res}, volume = {170}, year = {2023}, pages = {111346}, abstract = {

OBJECTIVE: Sense of purpose in life has been linked with better physical health, longevity, and reduced risk for disability and dementia, but the mechanisms linking sense of purpose with diverse health outcomes are unclear. Sense of purpose may promote better physiological regulation in response to stressors and health challenges, leading to lower allostatic load and disease risk over time. The current study examined the association between sense of purpose in life and allostatic load over time in adults over age 50.

METHODS: Data from the nationally representative US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) were used to examine associations between sense of purpose and allostatic load across 8 and 12~years of follow-up, respectively. Blood-based and anthropometric biomarkers were collected at four-year intervals and used to compute allostatic load scores based on clinical cut-off values representing low, moderate, and high risk.

RESULTS: Population-weighted multilevel models revealed that sense of purpose in life was associated with lower overall levels of allostatic load in HRS, but not in ELSA after adjusting for relevant covariates. Sense of purpose in life did not predict rate of change in allostatic load in either sample.

CONCLUSIONS: The present investigation supports sense of purpose predicting preserved differentiation of allostatic regulation, with more purposeful individuals demonstrating consistently lower allostatic load over time. Persistent differences in allostatic burden may account for divergent health trajectories between individuals low and high in sense of purpose.

}, keywords = {Adult, Aging, Allostasis, Biomarkers, Humans, Longitudinal Studies, Middle Aged, Retirement}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2023.111346}, author = {Lewis, Nathan A and Hill, Patrick L} } @article {13083, title = {Sex differences in cognitive aging and the role of socioeconomic status: Evidence from multi-cohort studies.}, journal = {Psychiatry Res}, volume = {321}, year = {2023}, pages = {115049}, abstract = {

BACKGROUND: Sex differences exist in cognitive function, and socioeconomic status (SES) may play a role in changing these discrepancies. This study investigated the role of SES in contributing to sex differences in cognitive function.

METHODS: We conducted a pooled multi-cohort study on the basis of four comparative cohort studies from the UK, the US, Europe and China to assess sex differences and the role of SES in cognitive decline by birth cohort (1930-1938, 1939-1945, 1946-1968). Cognitive function was measured in three domains based on the mean and SD of the corresponding tests: episodic memory, working memory, and time orientation. SES was the summed scores of education and household wealth.

FINDINGS: 61,019 individuals were involved. Cognitive function of women declined faster than those of men as growing old (particularly after 80 years old). As SES increased, cognitive function increased more for women than for men in most cases among later-born cohorts (1930-1938, 1939-1945, 1946-1968) (e.g., episodic memory scores at 60 years old: women exhibited an increase from -0.09 [95\%CI -0.12, -0.07] in low SES to 0.89 [0.86, 0.92] in high SES; men from -0.16 [-0.19, -0.14] to 0.59 [0.56, 0.62]). However, sex-specific cognitive benefits were absent in the oldest birth cohort (1895-1929).

INTERPRETATION: These findings highlight the importance of considering the role of SES in the discrepancy of sex difference in cognitive aging.

}, keywords = {Aged, 80 and over, Aging, cognitive aging, Cohort Studies, Female, Humans, Male, Middle Aged, Sex Characteristics, Social Class, Socioeconomic factors}, issn = {1872-7123}, doi = {10.1016/j.psychres.2023.115049}, author = {Jin, Yinzi and Hong, Chenlu and Luo, Yanan} } @article {13205, title = {Short-term effect of retirement on health: Evidence from nonparametric fuzzy regression discontinuity design.}, journal = {Health Econ}, volume = {32}, year = {2023}, pages = {1323-1343}, abstract = {

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

}, keywords = {Female, Health Status, Humans, Male, Retirement, Surveys and Questionnaires}, issn = {1099-1050}, doi = {10.1002/hec.4669}, author = {Ebeid, Mohamed and Oguzoglu, Umut} } @article {13144, title = {Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults.}, journal = {Proc Natl Acad Sci U S A}, volume = {120}, year = {2023}, month = {2023 Feb 14}, pages = {e2209414120}, abstract = {

While social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact of social factor, many studies exclude social factors altogether. Our objective was to develop and validate a summary measure of social risk and determine its ability to risk-stratify beyond traditional risk models.~We examined participants in the Health and Retirement Study, a longitudinal, survey of US older adults. We developed the model from a comprehensive inventory of 183 social characteristics using least absolute shrinkage and selection operator, a penalized regression approach. Then, we assessed the predictive capacity of the model and its ability to improve on traditional prediction models.~We studied 8,250 adults aged~>=65 y. Within 4 y of the baseline interview, 22\% had died. Drawn from 183 possible predictors, the Social Frailty Index included age, gender, and eight social predictors: neighborhood cleanliness, perceived control over financial situation, meeting with children less than yearly, not working for pay, active with children, volunteering, feeling isolated, and being treated with less courtesy or respect. In the validation cohort, predicted and observed mortality were strongly correlated. Additionally, the Social Frailty Index meaningfully risk-stratified participants beyond the Charlson score (medical comorbidity index) and the Lee Index (comorbidity and function model).~The Social Frailty Index includes age, gender, and eight social characteristics and accurately risk-stratifies older adults. The model improves upon commonly used risk prediction tools and has application in clinical, population health, and research settings.

}, keywords = {Aged, Child, Frailty, Humans, Longitudinal Studies, Retirement, Sociological Factors}, issn = {1091-6490}, doi = {10.1073/pnas.2209414120}, author = {Shah, Sachin J and Oreper, Sandra and Jeon, Sun Young and Boscardin, W John and Fang, Margaret C and Covinsky, Kenneth E} } @article {13289, title = {Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic.}, journal = {J Patient Rep Outcomes}, volume = {7}, year = {2023}, pages = {46}, abstract = {

BACKGROUND: COVID-19 put older individuals at high risk for morbidity and mortality, isolation, reduced coping, and lower satisfaction with life. Many older adults experienced social isolation, fear, and anxiety. We hypothesized that successful coping with these stressors would maintain or improve satisfaction with life, a crucial psychological outcome during the pandemic. Our study investigated relationships between older people{\textquoteright}s coping and life satisfaction during the pandemic and their optimism, sense of mastery, closeness with spouse, family, and friends, and vulnerabilities from frailty, comorbid diseases, memory problems, and dependencies in instrumental activities of daily living (IADL).

METHODS: The study was based on a special COVID-19 sample of 1351 community-dwelling older adults who participated in the 2020 Health and Retirement Survey. A comprehensive structural equation modeling was used to test direct and indirect effects, with life satisfaction as the main outcome and coping as a mediator between the other variables and coping.

RESULTS: Most survey respondents were female and between the ages of 65-74~years. They averaged 1.7 chronic conditions, one in seven was frail, about one-third rated their memory as fair or poor, and about one in seven reported one or more difficulties in IADL. As hypothesized-older people with increased sense of mastery and optimism were better able to cope and had greater life satisfaction. In addition, close relationships with friends and with other family members besides the spouse/partner or children contributed to more successful coping, while the interpersonal closeness of all types contributed directly to greater life satisfaction. Finally, older people with more IADL limitations reported greater difficulty coping and lower life satisfaction, and those older people who were frail or had multiple comorbid diseases reported lower life satisfaction.

CONCLUSIONS: Optimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction, whereas frailty and comorbidities make coping more challenging and lead to lower life satisfaction particularly during a pandemic. Our study improves on prior research because of its nationally representative sample and formal specification and testing of a comprehensive theoretical framework.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Child, COVID-19, Female, Frailty, Humans, Independent Living, Male, Pandemics, Personal Satisfaction}, issn = {2509-8020}, doi = {10.1186/s41687-023-00583-x}, author = {Lalani, Nasreen and Dongjuan, Xu and Cai, Yun and Arling, Greg W} } @article {13161, title = {Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans.}, journal = {Inquiry}, volume = {60}, year = {2023}, month = {2023 Jan-Dec}, pages = {469580231155719}, abstract = {

Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.

}, keywords = {Adult, Aged, Aged, 80 and over, Black or African American, Humans, Income, Logistic Models, Middle Aged, Osteoporosis, Social Class, Socioeconomic factors}, issn = {1945-7243}, doi = {10.1177/00469580231155719}, author = {Gough Courtney, Margaret and Roberts, Josephine and Godde, Kanya} } @article {13499, title = {Subjective Memory Complaints Predict Decline in Memory, Instrumental Activities of Daily Living, and Social Participation in Older Adults: A Fixed-Effects Model.}, journal = {Am J Occup Ther}, volume = {77}, year = {2023}, abstract = {

IMPORTANCE: Although subjective memory complaints (SMCs) have been suggested to be associated with future memory impairment, limitations in instrumental activities of daily living (IADLs), and social participation restriction, these associations are still inconclusive.

OBJECTIVE: To determine whether changes in SMCs over time predict decline in memory, IADLs, and social participation in older adults.

DESIGN: Longitudinal study.

SETTING: Community.

PARTICIPANTS: Sample 1 included 2,493 community-dwelling older adults drawn from the Health and Retirement Study (HRS) data collected between 2004 and 2018. Sample 2 included 1,644 community-dwelling older adults drawn from the HRS data collected between 2008 and 2018.

OUTCOMES AND MEASURES: Self-reported SMCs, memory function, self-reported IADL performance, and self-reported social participation.

RESULTS: The mean age of Sample 1 at baseline was 70.16 yr; 1,468 (58.88\%) were female. In Sample 1, immediate and delayed memory (all ps < .001) and IADL performance (p < .01) declined over time. Increases in SMCs over time significantly predicted future immediate and delayed memory declines (p < .01 and p < .001, respectively) and future IADL performance decline (p < .001), after controlling for depressive symptoms. The mean age of Sample 2 at baseline was 71.52 yr; 928 (56.45\%) were female. In Sample 2, social participation declined over time (all ps < .001). Increases in SMCs over time significantly predicted future social participation decline (p < .05), after controlling for depressive symptoms.

CONCLUSIONS AND RELEVANCE: Increases in SMCs predict future decline in memory, IADL performance, and social participation after accounting for depressive symptoms. What This Article Adds: SMCs can be used as an early indicator of future memory impairment, IADL limitations, and social participation restrictions in older adults. Furthermore, interventions that minimize SMCs may help older adults achieve successful aging.

}, keywords = {Activities of Daily Living, Aged, Aging, Female, Humans, Independent Living, Longitudinal Studies, Male, Memory Disorders, Social participation}, issn = {0272-9490}, doi = {10.5014/ajot.2023.050151}, author = {Lee, Chang Dae and Foster, Erin R} } @article {13629, title = {Systemic inflammation and biological aging in the Health and Retirement Study.}, journal = {Geroscience}, volume = {45}, year = {2023}, pages = {3257-3265}, abstract = {

Chronic, low-level systemic inflammation associated with aging, or inflammaging, is a risk factor for several chronic diseases and mortality. Using data from the Health and Retirement Study, we generated a continuous latent variable for systemic inflammation from seven measured indicators of inflammation and examined associations with another biomarker of biological aging, DNA methylation age acceleration measured by epigenetic clocks, and 4-year mortality (N = 3,113). We found that greater systemic inflammation was positively associated with DNA methylation age acceleration for 10 of the 13 epigenetic clocks, after adjustment for sociodemographics and chronic disease risk factors. The latent variable for systemic inflammation was associated with 4-year mortality independent of DNA methylation age acceleration and was a better predictor of 4-year mortality than any of the epigenetic clocks examined, as well as mortality risk factors, including obesity and multimorbidity. Inflammaging and DNA methylation age acceleration may represent different biological processes contributing to mortality risk. Leveraging multiple measured inflammation markers to capture inflammaging is important for biology of aging research.

}, keywords = {Aging, Biomarkers, DNA Methylation, Epigenesis, Genetic, Humans, Inflammation, Retirement}, issn = {2509-2723}, doi = {10.1007/s11357-023-00880-9}, author = {Meier, Helen C S and Mitchell, Colter and Karadimas, Thomas and Jessica Faul} } @article {13129, title = {Time-varying exposure analysis of the relationship between sustained natural dentition and cognitive decline.}, journal = {J Clin Periodontol}, volume = {50}, year = {2023}, month = {2023 Jun}, pages = {727-735}, abstract = {

AIM: Tooth loss and cognitive decline progress over time and influence each other. This study estimated the impact of sustaining natural dentition on cognitive function in U.S. adults, accounting for the fact that dental and cognitive statuses change over time.

MATERIALS AND METHODS: Data from adults aged >=51 years who participated in five waves of the Health and Retirement Study from 2004 to 2016 (n~=~10,953) were analysed. The impact of retaining some natural teeth from 2006 to 2012 on cognitive function score (0-27) and cognitive impairment (defined as having a cognitive function score of <12) in 2016 was evaluated using the doubly robust targeted maximum likelihood estimation method by considering both time-invariant and time-varying confounders, including cognitive function at baseline and during follow-up.

RESULTS: Respondents with some natural teeth between 2006 and 2012 had a 0.40 point (95\% confidence interval [CI]: 0.10-0.71) higher cognitive function score and 3.27 percentage point (95\% CI: 0.11-6.66) lower cognitive impairment prevalence in 2016 than those with complete tooth loss.

CONCLUSIONS: Considering past cognitive function assessed at multiple time points, sustained natural dentition was associated with better cognitive function.

}, keywords = {Adult, Cognitive Dysfunction, Dentition, Humans, Mouth, Edentulous, Tooth Loss}, issn = {1600-051X}, doi = {10.1111/jcpe.13786}, author = {Matsuyama, Yusuke} } @article {13165, title = {Trajectories of self-reported hearing and their associations with cognition: evidence from the United Kingdom and United States of America.}, journal = {Age Ageing}, volume = {52}, year = {2023}, month = {2023 Feb 01}, abstract = {

OBJECTIVE: This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory.

METHODS: Data were drawn from 5 waves (2008-2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors.

RESULTS: Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (-1.260, P~< 0.001).

CONCLUSIONS: Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

}, keywords = {Cognition, hearing, Humans, Longitudinal Studies, Memory, Episodic, Self Report, United Kingdom, United States}, issn = {1468-2834}, doi = {10.1093/ageing/afad017}, author = {Matthews, Katey and Dawes, Piers and Elliot, Rebecca and Pendleton, Neil and Tampubolon, Gindo and Maharani, Asri} } @article {13164, title = {Under Different Roofs? Coresidence With Adult Children and Parents{\textquoteright} Mental Health Across Race and Ethnicity Over Two Decades.}, journal = {Demography}, volume = {60}, year = {2023}, month = {2023 Apr 01}, pages = {461-492}, abstract = {

Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents{\textquoteright} mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents{\textquoteright} age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.

}, keywords = {Adult, Adult children, ethnicity, Humans, Intergenerational Relations, Mental Health, Parents, Residence Characteristics}, issn = {1533-7790}, doi = {10.1215/00703370-10571923}, author = {Caputo, Jennifer and Cagney, Kathleen A} } @article {13157, title = {Understanding Alzheimer{\textquoteright}s disease in the context of aging: Findings from applications of stochastic process models to the Health and Retirement Study.}, journal = {Mech Ageing Dev}, volume = {211}, year = {2023}, month = {2023 Apr}, pages = {111791}, abstract = {

There is growing literature on applications of biodemographic models, including stochastic process models (SPM), to studying regularities of age dynamics of biological variables in relation to aging and disease development. Alzheimer{\textquoteright}s disease (AD) is especially good candidate for SPM applications because age is a major risk factor for this heterogeneous complex trait. However, such applications are largely lacking. This paper starts filling this gap and applies SPM to data on onset of AD and longitudinal trajectories of body mass index (BMI) constructed from the Health and Retirement Study surveys and Medicare-linked data. We found that APOE e4 carriers are less robust to deviations of trajectories of BMI from the optimal levels compared to non-carriers. We also observed age-related decline in adaptive response (resilience) related to deviations of BMI from optimal levels as well as APOE- and age-dependence in other components related to variability of BMI around the mean allostatic values and accumulation of allostatic load. SPM applications thus allow revealing novel connections between age, genetic factors and longitudinal trajectories of risk factors in the context of AD and aging creating new opportunities for understanding AD development, forecasting trends in AD incidence and prevalence in populations, and studying disparities in those.

}, keywords = {Aged, Aging, Alzheimer disease, Apolipoproteins E, Humans, Medicare, Retirement, United States}, issn = {1872-6216}, doi = {10.1016/j.mad.2023.111791}, author = {Arbeev, Konstantin G and Bagley, Olivia and Yashkin, Arseniy P and Duan, Hongzhe and Akushevich, Igor and Ukraintseva, Svetlana V and Yashin, Anatoliy I} } @article {13639, title = {United we thrive: friendship and subsequent physical, behavioural and psychosocial health in older adults (an outcome-wide longitudinal approach).}, journal = {Epidemiology and Psychiatric Sciences}, volume = {32}, year = {2023}, pages = {e65}, abstract = {

AIMS: Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a {\textquoteright}friendship recession{\textquoteright}. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a {\textquoteright}dark side{\textquoteright} and can potentially promote negative outcomes. To better capture friendship{\textquoteright}s potential heterogeneous effects, we took an outcome-wide analytic approach.

METHODS: We analysed data from 12,998 participants in the Health and Retirement Study (HRS) - a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between ; 2006/2008 and ; 2010/2012) were associated with better health/well-being across 35 outcomes (in ; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite {\textquoteright}friendship score{\textquoteright} that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.

RESULTS: Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).

CONCLUSIONS: Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.

}, keywords = {Aged, Aging, Friends, Humans, Interpersonal Relations, Prospective Studies}, issn = {2045-7979}, doi = {10.1017/S204579602300077X}, author = {Kim, E S and Chopik, W J and Chen, Y and Wilkinson, R and VanderWeele, T J} } @article {13252, title = {Working, Low Income, and Cancer Caregiving: Financial and Mental Health Impacts.}, journal = {J Clin Oncol}, volume = {41}, year = {2023}, pages = {2939-2948}, abstract = {

PURPOSE: Approximately 6 million people provide caregiving to people diagnosed with cancer. Many must remain employed to support their household and to have access to health insurance. It is unknown if caregiving for a spouse diagnosed with cancer is associated with greater financial and mental stress relative to providing care for a spouse with different conditions.

METHODS: Health and Retirement Study (2002-2020) data were used to compare employed caregivers, younger than age 65 years, caring for a spouse diagnosed with cancer (n = 103) and a matched control group caring for a spouse with other conditions (n = 515). We used logistic regression to examine a decrease in household income, increase in household debt, stopping work, and a new report of a mental health condition over a 4-year period, adjusting for socioeconomic and demographic characteristics, and health insurance status. Subanalyses stratified estimations by median household income.

RESULTS: Around a third of cancer caregivers reported they stopped working (35\%) and had an increase in household debt (30\%). Cancer caregivers in households below the median household income were more likely to report decreased income (13.4 percentage points [pp]; < .10), increased household debt (14.5 pp; < .10), and stopping work (18.8 pp; < .05) than similar noncancer caregivers. Mixed results were found for a change in mental health domains. The results were robust to multiple sensitivity analyses.

CONCLUSION: Cancer caregivers from low-income households were more likely to increase debt and incur work loss compared with noncancer caregivers in similar households. Policies such as paid sick leave and family leave are needed for this strained and important population who have financial and employment responsibilities in addition to caregiving.

}, keywords = {Aged, Caregivers, Employment, Humans, Income, Insurance, Health, Mental Health, Neoplasms}, issn = {1527-7755}, doi = {10.1200/JCO.22.02537}, author = {Bradley, Cathy J and Kitchen, Sara and Owsley, Kelsey M} } @article {12354, title = {Association of Playing College American Football With Long-term Health Outcomes and Mortality.}, journal = {JAMA Network Open}, volume = {5}, year = {2022}, pages = {e228775}, abstract = {

Importance: Exposure to repetitive head impacts from playing American football (including impacts resulting in symptomatic concussions and subconcussive trauma) is associated with increased risk for later-life health problems, including cognitive and neuropsychiatric decline and neurodegenerative disease. Most research on long-term health consequences of playing football has focused on former professional athletes, with limited studies of former college players.

Objectives: To estimate the prevalence of self-reported health conditions among former college football players compared with a sample of men in the general population as well as standardized mortality ratios (SMRs) among former college football players.

Design, Setting, and Participants: This cohort study included data from 447 former University of Notre Dame (ND) football players aged 59 to 75 years who were seniors on the rosters from 1964 to 1980. A health outcomes survey was distributed to living players and next of kin of deceased players for whom contact information was available. The survey was completed from December 2018 to May 2019.

Exposure: Participation in football at ND.

Main Outcomes and Measures: Prevalence of health outcomes was compared between living former players who completed the survey and propensity score-matched participants in the Health and Retirement Study (HRS). Standardized mortality ratios of all causes and specific causes of death among all former players were compared with those among men in the general US population.

Results: A total of 216 living players completed the health survey (median age, 67 years; IQR, 63-70 years) and were compared with 638 participants in the HRS (median age, 66 years; IQR, 63-70 years). Former players reported a higher prevalence of cognitive impairment (10 [5\%] vs 8 [1\%]; P = .02), headaches (22 [10\%] vs 22 [4\%]; P = .001), cardiovascular disease (70 [33\%] vs 128 [20\%]; P = .001), hypercholesterolemia (111 [52\%] vs 182 [29\%]; P = .001), and alcohol use (185 [86\%] vs 489 [77\%]; P = .02) and a lower prevalence of diabetes (24 [11\%] vs 146 [23\%]; P = .001). All-cause mortality (SMR, 0.54; 95\% CI, 0.42-0.67) and mortality from heart (SMR, 0.64; 95\% CI, 0.39-0.99), circulatory (SMR, 0.23; 95\% CI, 0.03-0.83), respiratory (SMR, 0.13; 95\% CI, 0.00-0.70), and digestive system (SMR, 0.13; 95\% CI, 0.00-0.74) disorders; lung cancer (SMR, 0.26; 95\% CI, 0.05-0.77); and violence (SMR, 0.10; 95\% CI, 0.00-0.58) were significantly lower in the ND cohort than in the general population. Mortality from brain and other nervous system cancers was significantly higher in the ND cohort (SMR, 3.82; 95\% CI, 1.04-9.77). Whereas point estimates were greater for all neurodegenerative causes (SMR, 1.42; 95\% CI, 0.29-4.18), amyotrophic lateral sclerosis (SMR, 2.93; 95\% CI, 0.36-10.59), and Parkinson disease (SMR, 2.07; 95\% CI, 0.05-11.55), the difference did not reach statistical significance.

Conclusions and Relevance: In this cohort study of former college football players, both positive and negative health outcomes were observed. With more than 800 000 former college players living in the US, additional research appears to be needed to provide stakeholders with guidance to maximize factors that improve health outcomes and minimize factors that may increase risk for later-life morbidity and mortality.

}, keywords = {Aged, Brain Concussion, Cohort Studies, Female, Football, Health Care, Humans, Male, Neurodegenerative Diseases, Outcome Assessment}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2022.8775}, author = {Phelps, Alyssa and Alosco, Michael L and Baucom, Zachary and Hartlage, Kaitlin and Palmisano, Joseph N and Weuve, Jennifer and Mez, Jesse and Tripodis, Yorghos and Stern, Robert A} } @article {12276, title = {Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {85}, year = {2022}, pages = {1621-1637}, abstract = {

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Cognitive Dysfunction, ethnicity, Female, Health Status, Humans, Male, Middle Aged, Mobility Limitation, Neuropsychological tests, Psychomotor Performance, Retirement, Risk Factors, Self Report, Surveys and Questionnaires}, issn = {1875-8908}, doi = {10.3233/JAD-215192}, author = {Wu, Benson and Toseef, Mohammad Usama and Stickel, Ariana M and Gonz{\'a}lez, Hector M and Tarraf, Wassim} } @article {12165, title = {Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults.}, journal = {JAMA Network Open}, volume = {5}, year = {2022}, pages = {e2147797}, abstract = {

Importance: Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people{\textquoteright}s health and well-being. Understanding if and to what degree aging satisfaction (one{\textquoteright}s beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.

Objectives: To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.

Design, Setting, and Participants: This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.

Exposure: Aging satisfaction.

Main Outcomes and Measures: A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.

Results: During the 4-year follow-up period, participants (N = 13 752; 8120 women [59\%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64\%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43\% reduced risk of mortality [risk ratio, 0.57; 95\% CI, 0.46-0.71]), better health behaviors (eg, 23\% increased likelihood of frequent physical activity [risk ratio, 1.23; 95\% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95\% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95\% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.

Conclusions and Relevance: This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.

}, keywords = {Aged, Aging, Female, Health Behavior, Humans, Male, Middle Aged, Personal Satisfaction, United States}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2021.47797}, author = {Julia S Nakamura and Hong, Joanna H and Jacqui Smith and William J. Chopik and Chen, Ying and Tyler J VanderWeele and Eric S Kim} } @article {12776, title = {Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?}, journal = {BMC Health Services Research}, volume = {22}, year = {2022}, pages = {1202}, abstract = {

BACKGROUND: Medical spending rises sharply with age. Even with universal health insurance, older adults may be at risk of catastrophic out-of-pocket medical spending. We aimed to compare catastrophic out-of-pocket medical spending among adults ages 65 and older in the United States, where seniors have near-universal coverage through Medicare, versus South Korea, where all residents have national health insurance.

METHODS: We used the 2016 Health and Retirement Study and the Korean Longitudinal Study of Aging. The study population were adults ages 65 and over in the US (n = 9,909) and South Korea (n = 4,450; N = 14,359). The primary outcome of interest was older adults{\textquoteright} exposure to catastrophic out-of-pocket medical expenditure, defined as out-of-pocket medical spending over the past two years that exceeded 50\% of annual household income. To examine the factors affecting catastrophic out-of-pocket medical spending of older adults in both countries, we performed logistic regression analyses. To compare the contribution of demographic factors versus health system-level factors to catastrophic out-of-pocket medical spending, we performed a Blinder-Oaxaca decomposition.

RESULTS: The proportion of respondents with catastrophic out-of-pocket medical expenditure was 5.8\% and 3.0\% in the US and South Korea, respectively. A Blinder-Oaxaca decomposition showed that the difference in the rate of catastrophic out-of-pocket medical expenditure spending between the two countries was attributable largely to unobservable system-level factors, rather than observed differences in the sociodemographic characteristics.

CONCLUSIONS: Exposure to catastrophic out-of-pocket medical spending is considerably higher in the US than South Korea. Most of the difference can be attributed to unobserved health system-level factors.

}, keywords = {Health Expenditures, Humans, KLoSA, Medicare, Poverty}, issn = {1472-6963}, doi = {10.1186/s12913-022-08575-1}, author = {Kim, Narae and Jacobson, Mireille} } @article {12435, title = {Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study.}, journal = {Drugs \& Aging}, volume = {39}, year = {2022}, pages = {377-387}, abstract = {

INTRODUCTION: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (>=~65 years) community-living adults prompted a more comprehensive investigation.

METHODS: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches.

RESULTS: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8\%, 12.8\%, and 4.7\% for the frailty index model, 4.2\%, 16.2\%, and 5.3\% for the functional domain model, and 4.3\%, 15.4\%, and 6.1\% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3\%, 36.1\%, and 14.2\% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses.

DISCUSSION: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.

}, keywords = {Analgesics, Frail Elderly, Frailty, Humans, Hypnotics and Sedatives, Opioid, prescription drugs, Prescriptions, Retirement decisions}, issn = {1179-1969}, doi = {10.1007/s40266-022-00941-2}, author = {Bergen, Andrew W and Cil, Gulcan and Sargent, Lana J and Dave, Chintan V} } @article {12240, title = {Geriatric Conditions Among Middle-aged and Older Adults on Methadone Maintenance Treatment: A Pilot Study.}, journal = {Journal of Addiction Medicine}, volume = {16}, year = {2022}, pages = {110-113}, abstract = {

OBJECTIVES: The number of older adults on methadone maintenance treatment (MMT) for opioid use disorder is increasing, but little is known about the characteristics and healthcare needs of this aging treatment population. This population may experience accelerated aging due to comorbidities and health behaviors. The aim of this study was to compare the prevalence of geriatric conditions among adults age >=50 on MMT to a nationally representative sample of community-dwelling older adults.

METHODS: We performed a geriatric assessment on 47 adults age >=50 currently on MMT enrolled in 2 opioid treatment programs, in New York City and in East Providence, Rhode Island. We collected data on self-reported geriatric conditions, healthcare utilization, chronic medical conditions, physical function, and substance use. The results were compared to 470 age, sex, and race/ethnicity-matched adults in the national Health and Retirement Study.

RESULTS: The mean age of the study sample was 58.8 years and 23.4\% were female. The most common chronic diseases were hypertension (59.6\%) and arthritis (55.3\%) with 66\% reporting >=2 diseases. For geriatric conditions, adults on MMT had a significantly higher prevalence of mobility, hearing, and visual impairments as well as falls, urinary incontinence, chronic pain, and insomnia than the Health and Retirement Study sample.

CONCLUSIONS: Older adults on MMT in 2 large opioid treatment programs have a high prevalence of geriatric conditions. An interdisciplinary, geriatric-based approach to care that focuses on function and addresses geriatric conditions is needed to improve the health of this growing population.

}, keywords = {Aged, Analgesics, Opioid, Female, Humans, Methadone, Middle Aged, Opiate Substitution Treatment, Opioid-Related Disorders, Pilot Projects}, issn = {1935-3227}, doi = {10.1097/ADM.0000000000000808}, author = {Benjamin H Han and Cotton, Brandi Parker and Polydorou, Soteri and Sherman, Scott E and Rosie Ferris and Arcila-Mesa, Mauricio and Qian, Yingzhi and McNeely, Jennifer} } @article {12346, title = {The importance of chronic conditions for potentially avoidable hospitalizations among non-Hispanic Black and non-Hispanic White older adults in the US: a cross-sectional observational study.}, journal = {BMC Health Services Research}, volume = {22}, year = {2022}, pages = {468}, abstract = {

BACKGROUND: Non-Hispanic (NH) Black older adults experience substantially higher rates of potentially avoidable hospitalization compared to NH White older adults. This study explores the top three chronic conditions preceding hospitalization and potentially avoidable hospitalization among NH White and NH Black Medicare beneficiaries in the United States.

METHODS: Data on 4993 individuals (4,420 NH White and 573 NH Black individuals) aged >= 65~years from 2014 Medicare claims were linked with sociodemographic data from previous rounds of the Health and Retirement Study. Conditional inference random forests were used to rank the importance of chronic conditions in predicting hospitalization and potentially avoidable hospitalization separately for NH White and NH Black beneficiaries. Multivariable logistic regression with the top three chronic diseases for each outcome adjusted for sociodemographic characteristics were conducted to quantify the associations.

RESULTS: In total, 22.1\% of NH White and 24.9\% of NH Black beneficiaries had at least one hospitalization during 2014. Among those with hospitalization, 21.3\% of NH White and 29.6\% of NH Black beneficiaries experienced at least one potentially avoidable hospitalization. For hospitalizations, chronic kidney disease, heart failure, and atrial fibrillation were the top three contributors among NH White beneficiaries and acute myocardial infarction, chronic obstructive pulmonary disease (COPD), and chronic kidney disease were the top three contributors among NH Black beneficiaries. These chronic conditions were associated with increased odds of hospitalization for both groups. For potentially avoidable hospitalizations, asthma, COPD, and heart failure were the top three contributors among NH White beneficiaries and fibromyalgia/chronic pain/fatigue, COPD, and asthma were the top three contributors among NH Black beneficiaries. COPD and heart failure were associated with increased odds of potentially avoidable hospitalization among NH White beneficiaries, whereas only COPD was associated with increased odds of potentially avoidable hospitalizations among NH Black beneficiaries.

CONCLUSION: Having at least one hospitalization and at least one potentially avoidable hospitalization was more prevalent among NH Black than NH White Medicare beneficiaries. This suggests greater opportunity for increasing prevention efforts among NH Black beneficiaries. The importance of COPD for potentially avoidable hospitalizations further highlights the need to focus on prevention of exacerbations for patients with COPD, possibly through greater access to primary care and continuity of care.

}, keywords = {Aged, Asthma, chronic, Chronic Obstructive, Heart Failure, Hospitalization, Humans, Medicare, Pulmonary Disease, Renal Insufficiency}, issn = {1472-6963}, doi = {10.1186/s12913-022-07849-y}, author = {J{\o}rgensen, Terese Sara H{\o}j and Allore, Heather and Elman, Miriam R and Nagel, Corey and Qui{\~n}ones, Ana R} } @article {12167, title = {Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic.}, journal = {International Journal of Geriatric Psychiatry}, volume = {37}, year = {2022}, abstract = {

OBJECTIVES: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance.

RESULTS: The rate of care delay or avoidance since March of 2020 was 29.1\% among all respondents (n~=~1997), and 10.1\% higher for lonely (n~=~1,150\%, 57.6\%) versus non-lonely respondents (33.5\% vs. 23.4\%; odds ratio~=~1.59, p~=~0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn{\textquoteright}t afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor{\textquoteright}s visit as the two most common care delayed or avoided.

CONCLUSIONS: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.

}, keywords = {Aged, COVID-19, Humans, Independent Living, Loneliness, Pandemics, SARS-CoV-2}, issn = {1099-1166}, doi = {10.1002/gps.5694}, author = {Li, Yue and Cheng, Zijing and Cai, Xueya and Holloway, Melissa and Maeng, Daniel and Simning, Adam} } @article {13055, title = {The positive impact of informal spousal caregiving on the physical activity of older adults.}, journal = {Front Public Health}, volume = {10}, year = {2022}, month = {2022}, pages = {977846}, abstract = {

INTRODUCTION: Although physical activity (PA) is crucial for health, the literature is mixed about how individuals{\textquoteright} PA decisions are affected by their spouses. To fill this gap, we examined the extent to which providing care for one spouse affects the PA of the other spouse among those aged 50 or older in the United States.

METHODS: We analyzed 9,173 older adults living with their spouses or partners from the 2004 to 2016 waves of the Health and Retirement Study. To identify the causal effect of spousal caregiving on the PA of older adults, we estimated individual-fixed effects models using a two-stage least squared instrumental variable approach with spousal falls as our instrument. We also estimated the models by splitting the sample by gender and race/ethnicity to identify heterogeneous impacts of spousal caregiving on PA decisions among subgroups.

RESULTS: We found that a one percentage point increase in the probability of providing care to spouses led to an increase in the probability of initiating moderate or vigorous PA (MVPA) by 0.34-0.52 percentage points. This effect was salient, especially among female and non-Hispanic white older adults.

DISCUSSION: Caregiving experience might provide opportunities to learn about caregiving burdens and trigger an emotional response about the salience of an event (i.e., they need care in the future). Older caregivers might start MVPA in an effort to improve or maintain their health and avoid burdening their families for caregiving in the future. This study demonstrated spousal influence on PA. Instead of delivering PA-promotion information (e.g., the harm of sedentary lifestyle and benefits of regular PA) to individuals, risk communication and education efforts on PA promotion might be more effective considering the family context. Family events such as health shocks or the emergence of caregiving needs from family members provide windows of opportunities for intervening. Subgroup differences should also be considered in targeted interventions.

}, keywords = {Aged, Caregivers, Female, Humans, Retirement, Spouses, United States}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.977846}, author = {Zan, Hua and Shin, Su Hyun} } @article {13138, title = {Projecting the chronic disease burden among the adult population in the United States using a multi-state population model.}, journal = {Front Public Health}, volume = {10}, year = {2022}, month = {2022}, pages = {1082183}, abstract = {

INTRODUCTION: As the United States population ages, the adult population with chronic diseases is expected to increase. Exploring credible, evidence-based projections of the future burden of chronic diseases is fundamental to understanding the likely impact of established and emerging interventions on the incidence and prevalence of chronic disease. Projections of chronic disease often involve cross-sectional data that fails to account for the transition of individuals across different health states. Thus, this research aims to address this gap by projecting the number of adult Americans with chronic disease based on empirically estimated age, gender, and race-specific transition rates across predetermined health states.

METHODS: We developed a multi-state population model that disaggregates the adult population in the United States into three health states, i.e., (a) healthy, (b) one chronic condition, and (c) multimorbidity. Data from the 1998 to 2018 Health and Retirement Study was used to estimate age, gender, and race-specific transition rates across the three health states, as input to the multi-state population model to project future chronic disease burden.

RESULTS: The number of people in the United States aged 50 years and older will increase by 61.11\% from 137.25 million in 2020 to 221.13 million in 2050. Of the population 50 years and older, the number with at least one chronic disease is estimated to increase by 99.5\% from 71.522 million in 2020 to 142.66 million by 2050. At the same time, those with multimorbidity are projected to increase 91.16\% from 7.8304 million in 2020 to 14.968 million in 2050. By race by 2050, 64.6\% of non-Hispanic whites will likely have one or more chronic conditions, while for non-Hispanic black, 61.47\%, and Hispanic and other races 64.5\%.

CONCLUSION: The evidence-based projections provide the foundation for policymakers to explore the impact of interventions on targeted population groups and plan for the health workforce required to provide adequate care for current and future individuals with chronic diseases.

}, keywords = {Adult, Aged, Chronic disease, Cross-Sectional Studies, ethnicity, Hispanic or Latino, Humans, Middle Aged, United States, White People}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.1082183}, author = {Ansah, John P and Chiu, Chi-Tsun} } @article {12295, title = {Rural-urban differences in food insecurity and associated cognitive impairment among older adults: findings from a nationally representative survey.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {287}, abstract = {

INTRODUCTION: Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment.

METHOD: Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study.

RESULTS: It was found that 7.7\% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2\%), 41.2\% of them did not eat enough food of their choice (urban, 38.3\%), 6.9\% were hungry but did not eat food (urban, 2.6\%), 5.0\% did not eat for whole day (urban, 2.2\%), and 6.9\% lost weight due to lack of food in their household (urban, 2.9\%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30\% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas.

CONCLUSION: The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits.

}, keywords = {Aged, Cognitive Dysfunction, COVID-19, Cross-Sectional Studies, Food insecurity, Food Supply, Humans, Pandemics}, issn = {1471-2318}, doi = {10.1186/s12877-022-02984-x}, author = {Srivastava, Shobhit and Muhammad, T} } @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} } @article {12246, title = {Trends in the Use of Residential Settings Among Older Adults.}, journal = {The Journals of Gerontology: Series B}, volume = {77}, year = {2022}, pages = {424-428}, abstract = {

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time.

METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002).

RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05).

DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Cross-Sectional Studies, Dementia, Female, Health Status Disparities, Health Transition, Homes for the Aged, Humans, Independent Living, Male, Medicare, Nursing homes, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbab092}, author = {Toth, Matt and Palmer, Lauren and Lawren E. Bercaw and Voltmer, Helena and Sarita Karon} } @article {12204, title = {The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises.}, journal = {Lancet}, volume = {397}, year = {2021}, pages = {129-170}, keywords = {Climate Change, Conservation of Natural Resources, COVID-19, Extreme Weather, Global Health, health policy, Humans, International Cooperation, Pandemics, SARS-CoV-2}, issn = {1474-547X}, doi = {10.1016/S0140-6736(20)32290-X}, author = {Watts, Nick and Amann, Markus and Arnell, Nigel and Ayeb-Karlsson, Sonja and Beagley, Jessica and Belesova, Kristine and Boykoff, Maxwell and Byass, Peter and Cai, Wenjia and Campbell-Lendrum, Diarmid and Capstick, Stuart and Chambers, Jonathan and Coleman, Samantha and Dalin, Carole and Daly, Meaghan and Dasandi, Niheer and Dasgupta, Shouro and Davies, Michael and Di Napoli, Claudia and Dominguez-Salas, Paula and Drummond, Paul and Dubrow, Robert and Ebi, Kristie L and Eckelman, Matthew and Ekins, Paul and Escobar, Luis E and Georgeson, Lucien and Golder, Su and Grace, Delia and Graham, Hilary and Haggar, Paul and Hamilton, Ian and Hartinger, Stella and Hess, Jeremy and Hsu, Shih-Che and Hughes, Nick and Jankin Mikhaylov, Slava and Marcia P Jimenez and Kelman, Ilan and Kennard, Harry and Kiesewetter, Gregor and Kinney, Patrick L and Kjellstrom, Tord and Kniveton, Dominic and Lampard, Pete and Lemke, Bruno and Liu, Yang and Liu, Zhao and Lott, Melissa and Lowe, Rachel and Martinez-Urtaza, Jaime and Maslin, Mark and McAllister, Lucy and McGushin, Alice and McMichael, Celia and Milner, James and Moradi-Lakeh, Maziar and Morrissey, Karyn and Munzert, Simon and Murray, Kris A and Neville, Tara and Nilsson, Maria and Sewe, Maquins Odhiambo and Oreszczyn, Tadj and Otto, Matthias and Owfi, Fereidoon and Pearman, Olivia and Pencheon, David and Quinn, Ruth and Rabbaniha, Mahnaz and Robinson, Elizabeth and Rockl{\"o}v, Joacim and Romanello, Marina and Semenza, Jan C and Sherman, Jodi and Shi, Liuhua and Springmann, Marco and Tabatabaei, Meisam and Taylor, Jonathon and Tri{\~n}anes, Joaquin and Shumake-Guillemot, Joy and Vu, Bryan and Wilkinson, Paul and Winning, Matthew and Gong, Peng and Montgomery, Hugh and Costello, Anthony} } @article {12310, title = {Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial.}, journal = {BMJ Open}, volume = {11}, year = {2021}, pages = {e043918}, abstract = {

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.

METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score >=4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao Jos{\'e} dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema {\'U}nico de Sa{\'u}de).6 months.The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score >=4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de S{\~a}o Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.

TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

}, keywords = {Aged, Alcohol Drinking, Alcoholism, Brazil, Community Health Workers, Cost-Benefit Analysis, Crisis Intervention, Humans, Primary Health Care, Quality of Life, Randomized Controlled Trials as Topic}, issn = {2044-6055}, doi = {10.1136/bmjopen-2020-043918}, author = {Paula, Tassiane Cristine Santos and Chagas, Camila and Noto, Ana Regina and Formigoni, Maria Lucia Oliveira Souza and Pereira, Tiago Veiga and Ferri, Cleusa Pinheiro} } @article {12565, title = {Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium.}, journal = {International Journal of Epidemiology}, volume = {50}, year = {2021}, pages = {880-892}, abstract = {

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

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

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

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

}, keywords = {Aging, Cohort Studies, Health Status, healthy aging, Humans, Reproducibility of Results}, issn = {1464-3685}, doi = {10.1093/ije/dyaa236}, author = {Sanchez-Niubo, Albert and Forero, Carlos G and Wu, Yu-Tzu and Gin{\'e}-V{\'a}zquez, Iago and Prina, Matthew and de la Fuente, Javier and Daskalopoulou, Christina and Critselis, Elena and De La Torre-Luque, Alejandro and Panagiotakos, Demosthenes and Arndt, Holger and Ayuso-Mateos, Jos{\'e} Luis and Bayes-Marin, Ivet and Bickenbach, Jerome and Bobak, Martin and Caballero, Francisco F{\'e}lix and Chatterji, Somnath and Egea-Cort{\'e}s, Laia and Garc{\'\i}a-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Mellor-Mars{\'a}, Blanca and Olaya, Beatriz and Paj{\k a}k, Andrzej and Prince, Martin and Raggi, Alberto and Rodr{\'\i}guez-Artalejo, Fernando and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Tobias-Adamczyk, Beata and Tyrovolas, Stefanos and Haro, Josep Maria} } @article {12121, title = {Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry.}, journal = {The American Journal of Human Genetics}, volume = {108}, year = {2021}, pages = {564-582}, abstract = {

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5\%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained <=20 variants in the credible sets that jointly account for 99\% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.

}, keywords = {Africa, African Americans, Blacks, Body Height, Europe, Female, Genome-Wide Association Study, Humans, Male, Polymorphism, Single Nucleotide}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2021.02.011}, author = {Graff, Mariaelisa and Justice, Anne E and Young, Kristin L and Marouli, Eirini and Zhang, Xinruo and Fine, Rebecca S and Lim, Elise and Buchanan, Victoria and Rand, Kristin and Feitosa, Mary F and Wojczynski, Mary K and Yanek, Lisa R and Shao, Yaming and Rohde, Rebecca and Adeyemo, Adebowale A and Aldrich, Melinda C and Matthew A. Allison and Ambrosone, Christine B and Ambs, Stefan and Amos, Christopher and Donna K Arnett and Atwood, Larry and Bandera, Elisa V and Traci M Bartz and Becker, Diane M and Berndt, Sonja I and Bernstein, Leslie and Bielak, Lawrence F and Blot, William J and Erwin P Bottinger and Bowden, Donald W and Bradfield, Jonathan P and Brody, Jennifer A and Broeckel, Ulrich and Burke, Gregory and Brian E Cade and Cai, Qiuyin and Caporaso, Neil and Carlson, Chris and John Carpten and Casey, Graham and Chanock, Stephen J and Chen, Guanjie and Chen, Minhui and Chen, Yii-Der I and Chen, Wei-Min and Chesi, Alessandra and Chiang, Charleston W K and Chu, Lisa and Coetzee, Gerry A and Conti, David V and Cooper, Richard S and Cushman, Mary and Ellen W Demerath and Deming, Sandra L and Dimitrov, Latchezar and Ding, Jingzhong and Diver, W Ryan and Duan, Qing and Michele K Evans and Falusi, Adeyinka G and Jessica Faul and Myriam Fornage and Caroline S Fox and Freedman, Barry I and Garcia, Melissa and Gillanders, Elizabeth M and Phyllis J Goodman and Gottesman, Omri and Grant, Struan F A and Guo, Xiuqing and Hakonarson, Hakon and Haritunians, Talin and Tamara B Harris and Harris, Curtis C and Henderson, Brian E and Hennis, Anselm and Dena G Hernandez and Hirschhorn, Joel N and McNeill, Lorna Haughton and Howard, Timothy D and Howard, Barbara and Hsing, Ann W and Hsu, Yu-Han H and Hu, Jennifer J and Huff, Chad D and Huo, Dezheng and Ingles, Sue A and Irvin, Marguerite R and John, Esther M and Johnson, Karen C and Jordan, Joanne M and Kabagambe, Edmond K and Kang, Sun J and Sharon L R Kardia and Keating, Brendan J and Rick A Kittles and Eric A Klein and Kolb, Suzanne and Kolonel, Laurence N and Charles Kooperberg and Kuller, Lewis and Kutlar, Abdullah and Leslie A Lange and Langefeld, Carl D and Loic Le Marchand and Leonard, Hampton and Lettre, Guillaume and Levin, Albert M and Li, Yun and Li, Jin and Liu, Yongmei and Liu, Youfang and Liu, Simin and Kurt Lohman and Lotay, Vaneet and Lu, Yingchang and Maixner, William and JoAnn E Manson and McKnight, Barbara and Meng, Yan and Monda, Keri L and Monroe, Kris and Moore, Jason H and Thomas H Mosley and Mudgal, Poorva and Murphy, Adam B and Nadukuru, Rajiv and Michael A Nalls and Nathanson, Katherine L and Nayak, Uma and N{\textquoteright}Diaye, Amidou and Nemesure, Barbara and Neslund-Dudas, Christine and Neuhouser, Marian L and Nyante, Sarah and Ochs-Balcom, Heather and Ogundiran, Temidayo O and Ogunniyi, Adesola and Ojengbede, Oladosu and Okut, Hayrettin and Olopade, Olufunmilayo I and Olshan, Andrew and Padhukasahasram, Badri and Palmer, Julie and Palmer, Cameron D and Palmer, Nicholette D and George J Papanicolaou and Patel, Sanjay R and Pettaway, Curtis A and Peyser, Patricia A and Press, Michael F and Rao, D C and Rasmussen-Torvik, Laura J and Redline, Susan and Reiner, Alex P and Rhie, Suhn K and Rodriguez-Gil, Jorge L and Charles N Rotimi and Rotter, Jerome I and Ruiz-Narvaez, Edward A and Rybicki, Benjamin A and Babatunde Salako and Sale, Michele M and Sanderson, Maureen and Eric E Schadt and Schreiner, Pamela J and Schurmann, Claudia and Schwartz, Ann G and Daniel Shriner and Signorello, Lisa B and Andrew B Singleton and David S Siscovick and Smith, Jennifer A and Smith, Shad and Elizabeth K Speliotes and Spitz, Margaret and Stanford, Janet L and Stevens, Victoria L and Stram, Alex and Strom, Sara S and Sucheston, Lara and Yan V Sun and Tajuddin, Salman M and Taylor, Herman and Taylor, Kira and Bamidele O Tayo and Michael J Thun and Tucker, Margaret A and Vaidya, Dhananjay and Van Den Berg, David J and Vedantam, Sailaja and Vitolins, Mara and Wang, Zhaoming and Erin B Ware and Wassertheil-Smoller, Sylvia and David R Weir and Wiencke, John K and Williams, Scott M and L Keoki Williams and Wilson, James G and Witte, John S and Wrensch, Margaret and Wu, Xifeng and Yao, Jie and Zakai, Neil and Zanetti, Krista and Zemel, Babette S and Zhao, Wei and Jing Hua Zhao and Zheng, Wei and Zhi, Degui and Zhou, Jie and Zhu, Xiaofeng and Ziegler, Regina G and Zmuda, Joe and Alan B Zonderman and Psaty, Bruce M and Ingrid B Borecki and Cupples, L Adrienne and Liu, Ching-Ti and Christopher A Haiman and Ruth J F Loos and Ng, Maggie C Y and Kari E North} } @article {12127, title = {Gene-educational attainment interactions in a multi-ancestry genome-wide meta-analysis identify novel blood pressure loci.}, journal = {Mol Psychiatry}, volume = {26}, year = {2021}, pages = {2111-2125}, abstract = {

Educational attainment is widely used as a surrogate for socioeconomic status (SES). Low SES is a risk factor for hypertension and high blood pressure (BP). To identify novel BP loci, we performed multi-ancestry meta-analyses accounting for gene-educational attainment interactions using two variables, "Some College" (yes/no) and "Graduated College" (yes/no). Interactions were evaluated using both a 1 degree of freedom (DF) interaction term and a 2DF joint test of genetic and interaction effects. Analyses were performed for systolic BP, diastolic BP, mean arterial pressure, and pulse pressure. We pursued genome-wide interrogation in Stage 1 studies (N = 117 438) and follow-up on promising variants in Stage 2 studies (N = 293 787) in five ancestry groups. Through combined meta-analyses of Stages 1 and 2, we identified 84 known and 18 novel BP loci at genome-wide significance level (P < 5 {\texttimes} 10). Two novel loci were identified based on the 1DF test of interaction with educational attainment, while the remaining 16 loci were identified through the 2DF joint test of genetic and interaction effects. Ten novel loci were identified in individuals of African ancestry. Several novel loci show strong biological plausibility since they involve physiologic systems implicated in BP regulation. They include genes involved in the central nervous system-adrenal signaling axis (ZDHHC17, CADPS, PIK3C2G), vascular structure and function (GNB3, CDON), and renal function (HAS2 and HAS2-AS1, SLIT3). Collectively, these findings suggest a role of educational attainment or SES in further dissection of the genetic architecture of BP.

}, keywords = {Blood pressure, Epistasis, Genetic, Genetic Loci, Genome-Wide Association Study, Humans, Hypertension, Polymorphism, Single Nucleotide}, issn = {1476-5578}, doi = {10.1038/s41380-020-0719-3}, author = {de Las Fuentes, Lisa and Yun Ju Sung and Noordam, Raymond and Thomas W Winkler and Feitosa, Mary F and Schwander, Karen and Bentley, Amy R and Brown, Michael R and Guo, Xiuqing and Alisa Manning and Daniel I Chasman and Aschard, Hugues and Traci M Bartz and Bielak, Lawrence F and Campbell, Archie and Cheng, Ching-Yu and Dorajoo, Rajkumar and Hartwig, Fernando P and Horimoto, A R V R and Li, Changwei and Li-Gao, Ruifang and Liu, Yongmei and Marten, Jonathan and Musani, Solomon K and Ntalla, Ioanna and Rankinen, Tuomo and Melissa Richard and Sim, Xueling and Smith, Albert V and Tajuddin, Salman M and Bamidele O Tayo and Vojinovic, Dina and Warren, Helen R and Xuan, Deng and Alver, Maris and Boissel, Mathilde and Jin-Fang Chai and Chen, Xu and Christensen, Kaare and Divers, Jasmin and Evangelou, Evangelos and Gao, Chuan and Giorgia G Girotto and Sarah E Harris and He, Meian and Hsu, Fang-Chi and K{\"u}hnel, Brigitte and Laguzzi, Federica and Li, Xiaoyin and Lyytik{\"a}inen, Leo-Pekka and Ilja M Nolte and Poveda, Alaitz and Rauramaa, Rainer and Riaz, Muhammad and Rueedi, Rico and Shu, Xiao-Ou and Snieder, Harold and Sofer, Tamar and Takeuchi, Fumihiko and Verweij, Niek and Erin B Ware and Weiss, Stefan and Yanek, Lisa R and Amin, Najaf and Dan E Arking and Donna K Arnett and Bergmann, Sven and Boerwinkle, Eric and Brody, Jennifer A and Broeckel, Ulrich and Brumat, Marco and Burke, Gregory and Cabrera, Claudia P and Canouil, Micka{\"e}l and Chee, Miao Li and Chen, Yii-Der Ida and Cocca, Massimiliano and Connell, John and de Silva, H Janaka and de Vries, Paul S and Eiriksdottir, Gudny and Jessica Faul and Fisher, Virginia and Forrester, Terrence and Fox, Ervin F and Friedlander, Yechiel and Gao, He and Gigante, Bruna and Giulianini, Franco and Gu, Chi Charles and Gu, Dongfeng and Tamara B Harris and He, Jiang and Heikkinen, Sami and Heng, Chew-Kiat and Hunt, Steven and Ikram, M Arfan and Irvin, Marguerite R and K{\"a}h{\"o}nen, Mika and Kavousi, Maryam and Khor, Chiea Chuen and Kilpel{\"a}inen, Tuomas O and Koh, Woon-Puay and Komulainen, Pirjo and Kraja, Aldi T and Krieger, J E and Langefeld, Carl D and Li, Yize and Liang, Jingjing and David C Liewald and Liu, Ching-Ti and Liu, Jianjun and Kurt Lohman and M{\"a}gi, Reedik and McKenzie, Colin A and Meitinger, Thomas and Andres Metspalu and Milaneschi, Yuri and Lili Milani and Dennis O Mook-Kanamori and Michael A Nalls and Nelson, Christopher P and Norris, Jill M and Jeff O{\textquoteright}Connell and Ogunniyi, Adesola and Padmanabhan, Sandosh and Palmer, Nicholette D and Nancy L Pedersen and Thomas T Perls and Peters, Annette and Petersmann, Astrid and Peyser, Patricia A and Polasek, Ozren and David J Porteous and Raffel, Leslie J and Rice, Treva K and Rotter, Jerome I and Rudan, Igor and Rueda-Ochoa, Oscar-Leonel and Sabanayagam, Charumathi and Babatunde Salako and Schreiner, Pamela J and Shikany, James M and Stephen Sidney and Sims, Mario and Sitlani, Colleen M and Smith, Jennifer A and John M Starr and Strauch, Konstantin and Swertz, Morris A and Teumer, Alexander and Tham, Yih Chung and Andr{\'e} G Uitterlinden and Vaidya, Dhananjay and van der Ende, M Yldau and Waldenberger, Melanie and Wang, Lihua and Wang, Ya-Xing and Wei, Wen-Bin and David R Weir and Wen, Wanqing and Yao, Jie and Yu, Bing and Yu, Caizheng and Yuan, Jian-Min and Zhao, Wei and Alan B Zonderman and Becker, Diane M and Bowden, Donald W and Ian J Deary and D{\"o}rr, Marcus and T{\~o}nu Esko and Freedman, Barry I and Froguel, Philippe and Paolo P. Gasparini and Gieger, Christian and Jost Bruno Jonas and Kammerer, Candace M and Kato, Norihiro and Lakka, Timo A and Leander, Karin and Lehtim{\"a}ki, Terho and Patrik K E Magnusson and Marques-Vidal, Pedro and Brenda W J H Penninx and Nilesh J Samani and van der Harst, Pim and Wagenknecht, Lynne E and Wu, Tangchun and Zheng, Wei and Zhu, Xiaofeng and Bouchard, Claude and Cooper, Richard S and Correa, Adolfo and Michele K Evans and Gudnason, Vilmundur and Caroline Hayward and Horta, Bernardo L and Tanika N Kelly and Stephen B Kritchevsky and Levy, Daniel and Walter R Palmas and Pereira, A C and Province, Michael M and Psaty, Bruce M and Ridker, Paul M and Charles N Rotimi and Tai, E Shyong and van Dam, Rob M and Cornelia M van Duijn and Wong, Tien Yin and Kenneth Rice and Gauderman, W James and Alanna C Morrison and Kari E North and Sharon L R Kardia and Caulfield, Mark J and Elliott, Paul and Munroe, Patricia B and Franks, Paul W and Rao, Dabeeru C and Myriam Fornage} } @article {12085, title = {Health dynamics shape life-cycle incomes.}, journal = {Journal of Health Economics}, volume = {75}, year = {2021}, pages = {102398}, abstract = {

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

}, keywords = {Demography, Economics, Educational Status, Employment, Fertility, Health Workforce, Humans, Income, Population Dynamics, Socioeconomic factors}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2020.102398}, author = {Rainer Kotschy} } @article {12144, title = {Peripheral edema: A common and persistent health problem for older Americans.}, journal = {PLoS One}, volume = {16}, year = {2021}, pages = {e0260742}, abstract = {

Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question "Have you had{\textellipsis} // Persistent swelling in your feet or ankles?" The weighted prevalence of edema among older U.S. adults was 19\% to 20\% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2-5.6; p-values <=0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Edema, ethnicity, Female, Follow-Up Studies, Humans, Longitudinal Studies, Lower Extremity, Male, Middle Aged, Mobility Limitation, Prognosis, Surveys and Questionnaires, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0260742}, author = {Besharat, Soroush and Grol-Prokopczyk, Hanna and Gao, Shan and Feng, Changyong and Akwaa, Frank and Gewandter, Jennifer S} } @article {11320, title = {APOE region molecular signatures of Alzheimer{\textquoteright}s disease across races/ethnicities.}, journal = {Neurobiol Aging}, volume = {87}, year = {2020}, month = {2020 03}, pages = {141.e1-141.e8}, abstract = {

The role of even the strongest genetic risk factor for Alzheimer{\textquoteright}s disease (AD), the apolipoprotein E (APOE) ε4 allele, in its etiology remains poorly understood. We examined molecular signatures of AD defined as differences in linkage disequilibrium patterns between AD-affected and -unaffected whites (2673/16,246), Hispanics (392/867), and African Americans (285/1789), separately. We focused on 29 polymorphisms from 5 genes in the APOE region emphasizing beneficial and adverse effects of the APOE ε2- and ε4-coding single-nucleotide polymorphisms, respectively, and the differences in the linkage disequilibrium structures involving these alleles between AD-affected and -unaffected subjects. Susceptibility to AD is likely the result of complex interactions of the ε2 and ε4 alleles with other polymorphisms in the APOE region, and these interactions differ across races/ethnicities corroborating differences in the adverse and beneficial effects of the ε4 and ε2 alleles. Our findings support complex race/ethnicity-specific haplotypes promoting and protecting against AD in this region. They contribute to better understanding of polygenic and resilient mechanisms, which can explain why even homozygous ε4 carriers may not develop AD.

}, keywords = {Alleles, Alzheimer disease, Apolipoproteins E, Continental Population Groups, Haplotypes, Heterozygote, Homozygote, Humans, Linkage Disequilibrium, Polymorphism, Single Nucleotide, Risk Factors}, issn = {1558-1497}, doi = {10.1016/j.neurobiolaging.2019.11.007}, author = {Alexander M Kulminski and Shu, Leonardo and Loika, Yury and Nazarian, Alireza and Konstantin G Arbeev and Svetlana Ukraintseva and Anatoliy Yashin and Culminskaya, Irina} } @article {11339, title = {Consumer Numeracy and Insurance Design Decisions: An Examination of Inflation Protection Take-Up Among Private Long-Term Care Insurance Policy Holders.}, journal = {Med Care Res Rev}, volume = {77}, year = {2020}, month = {2020 04}, pages = {187-195}, abstract = {

Given the rising cost of long-term care (LTC) services, the selection of a private long-term care insurance (LTCi) policy with inflation protection has critical implications for the ability of this coverage to protect against potentially catastrophic LTC expenses. This study examines the effect of consumers{\textquoteright} numeric abilities on the decision to add inflation protection to private LTCi policies. Over 40\% of current LTCi policies lack inflation protection. Higher scores on a three-question numeracy scale are associated with increases in the probability of choosing inflation protection at the time of policy purchase, with households answering all three questions correctly being 12 percentage points more likely to have this benefit type relative to those with a numeracy score of 0 ( = .002). Market reforms that simplify the task of evaluating LTCi plans and assessing the value of indexed benefits may be needed to ensure that LTCi policy purchasers are selecting adequate protection against future LTC costs.

}, keywords = {Consumer Behavior, Decision making, Humans, Inflation, Economic, Insurance, Long-Term Care, Long-term Care, Private Sector, Value-Based Health Insurance}, issn = {1552-6801}, doi = {10.1177/1077558718787742}, author = {Brian E McGarry and David C Grabowski} } @article {11153, title = {Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study.}, journal = {PLoS One}, volume = {15}, year = {2020}, pages = {e0238356}, abstract = {

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men{\textquoteright}s mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

}, keywords = {Adult, African Americans, Aged, Aged, 80 and over, Chronic disease, Communication, Cross-Sectional Studies, Follow-Up Studies, Healthcare Disparities, Hispanic Americans, Humans, Insurance Coverage, Male, Middle Aged, Patient Education as Topic, Patient-Centered Care, Physician-Patient Relations, Prognosis, Racism}, issn = {1932-6203}, doi = {10.1371/journal.pone.0238356}, author = {Mitchell, Jamie A and Perry, Ramona} } @article {12130, title = {Genome-wide association study of cognitive function in diverse Hispanics/Latinos: results from the Hispanic Community Health Study/Study of Latinos.}, journal = {Translational Psychiatry}, volume = {10}, year = {2020}, pages = {245}, abstract = {

Cognitive function such as reasoning, attention, memory, and language is strongly correlated with brain aging. Compared to non-Hispanic whites, Hispanics/Latinos have a higher risk of cognitive impairment and dementia. The genetic determinants of cognitive function have not been widely explored in this diverse and admixed population. We conducted a genome-wide association analysis of cognitive function in up to 7600 middle aged and older Hispanics/Latinos (mean = 55 years) from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). Four cognitive measures were examined: the Brief Spanish English Verbal Learning Test (B-SEVLT), the Word Fluency Test (WFT), the Digit Symbol Substitution Test (DSST), the Six-Item Screener (SIS). Four novel loci were identified: one for B-SEVLT at 4p14, two for WFT at 3p14.1 and 6p21.32, and one for DSST at 10p13. These loci implicate genes highly expressed in brain and previously connected to neurological diseases (UBE2K, FRMD4B, the HLA gene complex). By applying tissue-specific gene expression prediction models to our genotype data, additional genes highly expressed in brain showed suggestive associations with cognitive measures possibly indicating novel biological mechanisms, including IFT122 in the hippocampus for SIS, SNX31 in the basal ganglia for B-SEVLT, RPS6KB2 in the frontal cortex for WFT, and CSPG5 in the hypothalamus for DSST. These findings provide new information about the genetic determinants of cognitive function in this unique population. In addition, we derived a measure of general cognitive function based on these cognitive tests and generated genome-wide association summary results, providing a resource to the research community for comparison, replication, and meta-analysis in future genetic studies in Hispanics/Latinos.

}, keywords = {Aged, Cognition, Genome-Wide Association Study, Hispanic or Latino, Humans, Middle Aged, Neuropsychological tests, Public Health, Ubiquitin-Conjugating Enzymes}, issn = {2158-3188}, doi = {10.1038/s41398-020-00930-2}, author = {Jian, Xueqiu and Sofer, Tamar and Wassim Tarraf and Bressler, Jan and Jessica Faul and Zhao, Wei and Scott M Ratliff and Lamar, Melissa and Lenore J Launer and Laurie, Cathy C and Schneiderman, Neil and David R Weir and Wright, Clinton B and Kristine Yaffe and Zeng, Donglin and DeCarli, Charles and Thomas H Mosley and Smith, Jennifer A and Hector M Gonz{\'a}lez and Myriam Fornage} } @article {12080, title = {Long-term decline in intergenerational mobility in the United States since the 1850s.}, journal = {Proc Natl Acad Sci U S A}, volume = {117}, year = {2020}, month = {2020 01 07}, pages = {251-258}, abstract = {

We make use of newly available data that include roughly 5 million linked household and population records from 1850 to 2015 to document long-term trends in intergenerational social mobility in the United States. Intergenerational mobility declined substantially over the past 150 y, but more slowly than previously thought. Intergenerational occupational rank-rank correlations increased from less than 0.17 to as high as 0.32, but most of this change occurred to Americans born before 1900. After controlling for the relatively high mobility of persons from farm origins, we find that intergenerational social mobility has been remarkably stable. In contrast with relative stability in rank-based measures of mobility, absolute mobility for the nonfarm population-the fraction of offspring whose occupational ranks are higher than those of their parents-increased for birth cohorts born prior to 1900 and has fallen for those born after 1940.

}, keywords = {Censuses, Family Characteristics, Female, History, 19th Century, History, 20th Century, Humans, Income, Intergenerational Relations, Male, Parents, social mobility, Socioeconomic factors, United States}, issn = {1091-6490}, doi = {10.1073/pnas.1905094116}, author = {Song, Xi and Massey, Catherine G and Rolf, Karen A and Ferrie, Joseph P and Rothbaum, Jonathan L and Xie, Yu} } @article {12124, title = {Meta-analysis of up to 622,409 individuals identifies 40 novel smoking behaviour associated genetic loci.}, journal = {Molecular Psychiatry}, volume = {25}, year = {2020}, pages = {2392-2409}, abstract = {

Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking initiation, cigarettes per day, pack-years, and smoking cessation in a fixed effects meta-analysis of up to 61 studies (up to~346,813 participants). In a subset of 112,811 participants, a further one million SNVs were also genotyped and tested for association with the four smoking behaviour traits. SNV-trait associations with P < 5 {\texttimes} 10 in either analysis were taken forward for replication in up to 275,596 independent participants from UK Biobank. Lastly, a meta-analysis of the discovery and replication studies was performed. Sixteen SNVs were associated with at least one of the smoking behaviour traits (P < 5 {\texttimes} 10) in the discovery samples. Ten novel SNVs, including rs12616219 near TMEM182, were followed-up and five of them (rs462779 in REV3L, rs12780116 in CNNM2, rs1190736 in GPR101, rs11539157 in PJA1, and rs12616219 near TMEM182) replicated at a Bonferroni significance threshold (P < 4.5 {\texttimes} 10) with consistent direction of effect. A further 35 SNVs were associated with smoking behaviour traits in the discovery plus replication meta-analysis (up to 622,409 participants) including a rare SNV, rs150493199, in CCDC141 and two low-frequency SNVs in CEP350 and HDGFRP2. Functional follow-up implied that decreased expression of REV3L may lower the probability of smoking initiation. The novel loci will facilitate understanding the genetic aetiology of smoking behaviour and may lead to the identification of potential drug targets for smoking prevention and/or cessation.

}, keywords = {Biological Specimen Banks, Databases, Factual, Europe, Exome, Female, Genetic Loci, Humans, Male, Polymorphism, Single Nucleotide, Smoking, United Kingdom}, issn = {1476-5578}, doi = {10.1038/s41380-018-0313-0}, author = {Erzurumluoglu, A Mesut and Liu, Mengzhen and Jackson, Victoria E and Barnes, Daniel R and Datta, Gargi and Melbourne, Carl A and Young, Robin and Batini, Chiara and Surendran, Praveen and Jiang, Tao and Adnan, Sheikh Daud and Afaq, Saima and Agrawal, Arpana and Altmaier, Elisabeth and Antoniou, Antonis C and Asselbergs, Folkert W and Baumbach, Clemens and Laura Bierut and Bertelsen, Sarah and Boehnke, Michael and Bots, Michiel L and Brazel, David M and Chambers, John C and Chang-Claude, Jenny and Chen, Chu and Corley, Janie and Chou, Yi-Ling and David, Sean P and de Boer, Rudolf A and Christiaan de Leeuw and Joe G Dennis and Dominiczak, Anna F and Dunning, Alison M and Easton, Douglas F and Charles B Eaton and Elliott, Paul and Evangelou, Evangelos and Jessica Faul and Tatiana Foroud and Goate, Alison and Gong, Jian and Hans-J{\"o}rgen Grabe and Jeffrey Haessler and Christopher A Haiman and Hallmans, G{\"o}ran and Anke R Hammerschlag and Sarah E Harris and Andrew T Hattersley and Andrew C Heath and Hsu, Chris and Iacono, William G and Kanoni, Stavroula and Kapoor, Manav and Kaprio, Jaakko and Sharon L R Kardia and Karpe, Fredrik and Kontto, Jukka and Kooner, Jaspal S and Charles Kooperberg and Kuulasmaa, Kari and Laakso, Markku and Lai, Dongbing and Langenberg, Claudia and Le, Nhung and Lettre, Guillaume and Loukola, Anu and Luan, Jian{\textquoteright}an and Pamela A F Madden and Mangino, Massimo and Riccardo E Marioni and Marouli, Eirini and Marten, Jonathan and Nicholas G Martin and McGue, Matt and Michailidou, Kyriaki and Mihailov, Evelin and Moayyeri, Alireza and Moitry, Marie and M{\"u}ller-Nurasyid, Martina and Naheed, Aliya and Nauck, Matthias and Neville, Matthew J and Sune Fallgaard Nielsen and Kari E North and Markus Perola and Pharoah, Paul D P and Pistis, Giorgio and Tinca J Polderman and Posthuma, Danielle and Neil Poulter and Qaiser, Beenish and Rasheed, Asif and Reiner, Alex and Renstrom, Frida and Rice, John and Rohde, Rebecca and Rolandsson, Olov and Nilesh J Samani and Samuel, Maria and Schlessinger, David and H Steven Scholte and Scott, Robert A and Peter Sever and Shao, Yaming and Shrine, Nick and Smith, Jennifer A and John M Starr and Kathleen E Stirrups and Stram, Danielle and Heather M Stringham and Tachmazidou, Ioanna and Tardif, Jean-Claude and Thompson, Deborah J and Hilary A Tindle and Tragante, Vinicius and Trompet, Stella and Turcot, Val{\'e}rie and Tyrrell, Jessica and Vaartjes, Ilonca and Van Der Leij, Andries R and van der Meer, Peter and Varga, Tibor V and Verweij, Niek and V{\"o}lzke, Henry and Wareham, Nicholas J and Warren, Helen R and David R Weir and Weiss, Stefan and Wetherill, Leah and Yaghootkar, Hanieh and Yavas, Ersin and Jiang, Yu and Chen, Fang and Zhan, Xiaowei and Zhang, Weihua and Zhao, Wei and Zhao, Wei and Zhou, Kaixin and Amouyel, Philippe and Blankenberg, Stefan and Caulfield, Mark J and Chowdhury, Rajiv and Francesco Cucca and Ian J Deary and Deloukas, Panos and Di Angelantonio, Emanuele and Marco M Ferrario and Ferri{\`e}res, Jean and Franks, Paul W and Timothy M Frayling and Frossard, Philippe and Hall, Ian P and Caroline Hayward and Jansson, Jan-H{\r a}kan and Jukema, J Wouter and Kee, Frank and M{\"a}nnist{\"o}, Satu and Andres Metspalu and Munroe, Patricia B and B{\o}rge G Nordestgaard and Palmer, Colin N A and Veikko Salomaa and Sattar, Naveed and Timothy Spector and David P Strachan and van der Harst, Pim and Zeggini, Eleftheria and Saleheen, Danish and Adam S Butterworth and Wain, Louise V and Gon{\c c}alo R Abecasis and Danesh, John and Tobin, Martin D and Scott Vrieze and Liu, Dajiang J and Howson, Joanna M M} } @article {11987, title = {Population structure and pharmacogenomic risk stratification in the United States.}, journal = {BMC Biology}, volume = {18}, year = {2020}, month = {2020 10 13}, pages = {140}, abstract = {

BACKGROUND: Pharmacogenomic (PGx) variants mediate how individuals respond to medication, and response differences among racial/ethnic groups have been attributed to patterns of PGx diversity. We hypothesized that genetic ancestry (GA) would provide higher resolution for stratifying PGx risk, since it serves as a more reliable surrogate for genetic diversity than self-identified race/ethnicity (SIRE), which includes a substantial social component. We analyzed a cohort of 8628 individuals from the United States (US), for whom we had both SIRE information and whole genome genotypes, with a focus on the three largest SIRE groups in the US: White, Black (African-American), and Hispanic (Latino). Our approach to the question of PGx risk stratification entailed the integration of two distinct methodologies: population genetics and evidence-based medicine. This integrated approach allowed us to consider the clinical implications for the observed patterns of PGx variation found within and between population groups.

RESULTS: Whole genome genotypes were used to characterize individuals{\textquoteright} continental ancestry fractions-European, African, and Native American-and individuals were grouped according to their GA profiles. SIRE and GA groups were found to be highly concordant. Continental ancestry predicts individuals{\textquoteright} SIRE with > 96\% accuracy, and accordingly, GA provides only a marginal increase in resolution for PGx risk stratification. In light of the concordance between SIRE and GA, taken together with the fact that information on SIRE is readily available to clinicians, we evaluated PGx variation between SIRE groups to explore the potential clinical utility of race and ethnicity. PGx variants are highly diverged compared to the genomic background; 82 variants show significant frequency differences among SIRE groups, and genome-wide patterns of PGx variation are almost entirely concordant with SIRE. The vast majority of PGx variation is found within rather than between groups, a well-established fact for almost all genetic variants, which is often taken to argue against the clinical utility of population stratification. Nevertheless, analysis of highly differentiated PGx variants illustrates how SIRE partitions PGx variation based on groups{\textquoteright} characteristic ancestry patterns. These cases underscore the extent to which SIRE carries clinically valuable information for stratifying PGx risk among populations, albeit with less utility for predicting individual-level PGx alleles (genotypes), supporting the concept of population pharmacogenomics.

CONCLUSIONS: Perhaps most interestingly, we show that individuals who identify as Black or Hispanic stand to gain far more from the consideration of race/ethnicity in treatment decisions than individuals from the majority White population.

}, keywords = {Ethnic Groups, Genetics, Population, Genome, Human, Genotype, Humans, Pharmacogenetics, Risk Assessment, United States}, issn = {1741-7007}, doi = {10.1186/s12915-020-00875-4}, author = {Nagar, Shashwat Deepali and Conley, Andrew B and Jordan, I King} } @article {11366, title = {Relationship between smoking status and muscle strength in the United States older adults.}, journal = {Epidemiology and Health}, volume = {42}, year = {2020}, pages = {e2020055}, abstract = {

OBJECTIVES: Muscle strength in older adults is associated with greater physical ability. Identifying interventions to maintain muscle strength can therefore improve quality of life. The purpose of this study was to evaluate whether current or former smoking status is associated with a decrease in muscle strength in older adults.

METHODS: Data from the Health and Retirement Study from 2012-2014 were analyzed with regard to maximum dominant hand grip strength, maximum overall hand grip strength, and smoking status (current, former, or never). Unadjusted linear regression was conducted. Other factors known to be related to strength were included in the adjusted linear regression analyses.

RESULTS: For maximum grip strength, the regression coefficient was 4.91 for current smoking (standard error [SE], 0.58; p<0.001), 3.58 for former smoking (SE, 0.43; p<0.001), and 28.12 for never smoking (SE, 0.34). Fully adjusted linear regression on the relationship between dominant hand grip strength and smoking did not yield a significant result. The factors significantly associated with dominant hand grip strength were male sex, younger age, a race/ethnicity of non-Hispanic White or non-Hispanic Black, higher income, morbidity of <=1 condition, no pain, and moderate or vigorous exercise more than once a week.

CONCLUSIONS: Muscle strength in older adults was not associated with smoking status in the adjusted analysis.

}, keywords = {Aged, Aged, 80 and over, Female, Hand Strength, Humans, Male, Middle Aged, Muscle Strength, Smoking, United States}, issn = {2092-7193}, doi = {10.4178/epih.e2020055}, author = {Wiener, R Constance and Findley, Patricia A and Shen, Chan and Dwibedi, Nilanjana and Sambamoorthi, Usha} } @article {13065, title = {The World Health Organization (WHO) approach to healthy ageing.}, journal = {Maturitas}, volume = {139}, year = {2020}, pages = {6-11}, abstract = {

The ageing of the global population is the most important medical and social demographic problem worldwide. The World Health Organization (WHO) has defined healthy ageing as a process of maintaining functional ability to enable wellbeing in older age. The WHO, Member States and Partners for Sustainable Development Goals have created a Global Strategy and Action Plan for Ageing and Health for 2016-2020 and its continuation with the WHO programme The Decade of Healthy Ageing 2020-2030. The WHO has established main priorities such as supporting country planning and action, collecting better global data and promoting research on healthy ageing, aligning health systems to the needs of older people, laying the foundations and ensuring the human resources necessary for long-term integrated care, undertaking a global campaign to combat ageism, and enhancing the global network for age-friendly cities and communities. There are several reports of coordinated preventive health and social health initiatives in well developed countries. However, there is little evidence on the application of the active ageing frameworks in developing countries. Greater national capacities and closer monitoring of the progress through age-disaggregated data is needed to effectively implement the intended programmes on healthy ageing.

}, keywords = {Aged, Aging, Global Health, healthy aging, Humans, World Health Organization}, issn = {1873-4111}, doi = {10.1016/j.maturitas.2020.05.018}, author = {Rudnicka, Ewa and Napiera{\l}a, Paulina and Podfigurna, Agnieszka and M{\k e}czekalski, B{\l}a{\.z}ej and Smolarczyk, Roman and Grymowicz, Monika} } @article {12122, title = {Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use.}, journal = {Nature Genetics}, volume = {51}, year = {2019}, pages = {237-244}, abstract = {

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders. They are heritable and etiologically related behaviors that have been resistant to gene discovery efforts. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

}, keywords = {Alcohol Drinking, Female, Genetic Variation, Genome-Wide Association Study, Humans, Male, Middle Aged, Phenotype, Risk, Smoking, Tobacco, Tobacco Use Disorder}, issn = {1546-1718}, doi = {10.1038/s41588-018-0307-5}, author = {Liu, Mengzhen and Jiang, Yu and Wedow, Robbee and Li, Yue and Brazel, David M and Chen, Fang and Datta, Gargi and Davila-Velderrain, Jose and McGuire, Daniel and Tian, Chao and Zhan, Xiaowei and Choquet, H{\'e}l{\`e}ne and Docherty, Anna R and Jessica Faul and Foerster, Johanna R and Fritsche, Lars G and Gabrielsen, Maiken Elvestad and Gordon, Scott D and Jeffrey Haessler and Jouke-Jan Hottenga and Huang, Hongyan and Jang, Seon-Kyeong and Philip R Jansen and Ling, Yueh and M{\"a}gi, Reedik and Matoba, Nana and McMahon, George and Mulas, Antonella and Orr{\`u}, Valeria and Palviainen, Teemu and Anita Pandit and Reginsson, Gunnar W and Skogholt, Anne Heidi and Smith, Jennifer A and Taylor, Amy E and Turman, Constance and Gonneke Willemsen and Young, Hannah and Young, Kendra A and Zajac, Gregory J M and Zhao, Wei and Zhou, Wei and Bjornsdottir, Gyda and Boardman, Jason D and Boehnke, Michael and Dorret I Boomsma and Chen, Chu and Francesco Cucca and Davies, Gareth E and Charles B Eaton and Ehringer, Marissa A and T{\~o}nu Esko and Fiorillo, Edoardo and Gillespie, Nathan A and Gudbjartsson, Daniel F and Haller, Toomas and Kathleen Mullan Harris and Andrew C Heath and Hewitt, John K and Hickie, Ian B and Hokanson, John E and Hopfer, Christian J and Hunter, David J and Iacono, William G and Johnson, Eric O and Kamatani, Yoichiro and Sharon L R Kardia and Matthew C Keller and Kellis, Manolis and Charles Kooperberg and Kraft, Peter and Krauter, Kenneth S and Laakso, Markku and Penelope A Lind and Loukola, Anu and Lutz, Sharon M and Pamela A F Madden and Nicholas G Martin and McGue, Matt and Matthew B McQueen and Sarah E Medland and Andres Metspalu and Mohlke, Karen L and Nielsen, Jonas B and Okada, Yukinori and Peters, Ulrike and Tinca J Polderman and Posthuma, Danielle and Reiner, Alexander P and Rice, John P and Rimm, Eric and Rose, Richard J and Runarsdottir, Valgerdur and Stallings, Michael C and Stan{\v c}{\'a}kov{\'a}, Alena and Stefansson, Hreinn and Thai, Khanh K and Hilary A Tindle and Tyrfingsson, Thorarinn and Wall, Tamara L and David R Weir and Weisner, Constance and Whitfield, John B and Winsvold, Bendik Slagsvold and Yin, Jie and Zuccolo, Luisa and Laura Bierut and Hveem, Kristian and Lee, James J and Munaf{\`o}, Marcus R and Saccone, Nancy L and Willer, Cristen J and Marilyn C Cornelis and David, Sean P and Hinds, David A and Jorgenson, Eric and Kaprio, Jaakko and Stitzel, Jerry A and Stefansson, Kari and Thorgeirsson, Thorgeir E and Gon{\c c}alo R Abecasis and Liu, Dajiang J and Scott Vrieze} } @article {8808, title = {Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 02 15}, pages = {526-535}, abstract = {

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

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

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

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

}, keywords = {Adult, Adult Survivors of Child Abuse, African Americans, Aged, European Continental Ancestry Group, Female, Hand Strength, Health Status, Hispanic Americans, Humans, Male, Risk Factors, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbw147}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw147https://academic.oup.com/psychsocgerontology/article/2645640/Childhood-Misfortune-and-Handgrip-Strength-Among}, author = {Natalie R Smith and Kenneth F Ferraro and Blakelee R Kemp and Patricia M Morton and Sarah A Mustillo and Jacqueline L. Angel} } @article {8672, title = {Chronic Stress and Negative Marital Quality Among Older Couples: Associations With Waist Circumference.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 01 10}, pages = {318-328}, abstract = {

Objective: More than a third of the U.S. population of older adults is obese. The present study tests the Dyadic Biopsychosocial Model of Marriage and Health, which hypothesizes that, among married couples, individual and partner chronic stress predicts increased waist circumference and these links are exacerbated in negative quality marriages.

Method: Participants were from the nationally representative longitudinal Health and Retirement Study (HRS). A total of 2,042 married individuals (in 1,098 married couples) completed psychosocial and waist circumference assessments in 2006 and 2010. Analyses examined whether negative marital quality and chronic stress in Wave 1 (2006) were associated with changes in waist circumference over time.

Results: Actor-partner interdependence models revealed that greater partner stress, rather than individuals{\textquoteright} own reports of stress, was associated with increased waist circumference over time. Higher perceived negative marital quality among husbands and lower negative marital quality among wives exacerbated the positive link between partner stress and waist circumference.

Discussion: Consistent with the Dyadic Biopsychosocial Model of Marriage and Health, partner stress has direct associations with waist circumference among couples and this link is moderated by negative marital quality. Thus, dyadic perceptions of stress and negative marital quality are important to consider for understanding marriage and obesity.

}, keywords = {Family Conflict, Female, Humans, Interviews as Topic, Longitudinal Studies, Male, Marriage, Middle Aged, Obesity, Stress, Psychological, Surveys and Questionnaires, Waist Circumference}, issn = {1758-5368}, doi = {10.1093/geronb/gbw112}, author = {Kira S. Birditt and Nicky J Newton and James A. Cranford and Noah J Webster} } @article {12140, title = {Combined linkage and association analysis identifies rare and low frequency variants for blood pressure at 1q31.}, journal = {European Journal of Human Genetics}, volume = {27}, year = {2019}, pages = {269-277}, abstract = {

High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) and is more prevalent in African Americans as compared to other US groups. Although large, population-based genome-wide association studies (GWAS) have identified over 300 common polymorphisms modulating inter-individual BP variation, largely in European ancestry subjects, most of them do not localize to regions previously identified through family-based linkage studies. This discrepancy has remained unexplained despite the statistical power differences between current GWAS and prior linkage studies. To address this issue, we performed genome-wide linkage analysis of BP traits in African-American families from the Family Blood Pressure Program (FBPP) and genotyped on the Illumina Human Exome BeadChip v1.1. We identified a genomic region on chromosome 1q31 with LOD score 3.8 for pulse pressure (PP), a region we previously implicated in DBP studies of European ancestry families. Although no reported GWAS variants map to this region, combined linkage and association analysis of PP identified 81 rare and low frequency exonic variants accounting for the linkage evidence. Replication analysis in eight independent African ancestry cohorts (N = 16,968) supports this specific association with PP (P = 0.0509). Additional association and network analyses identified multiple potential candidate genes in this region expressed in multiple tissues and with a strong biological support for a role in BP. In conclusion, multiple genes and rare variants on 1q31 contribute to PP variation. Beyond producing new insights into PP, we demonstrate how family-based linkage and association studies can implicate specific rare and low frequency variants for complex traits.

}, keywords = {African Americans, Chromosomes, Human, Pair 1, Gene Frequency, Genome-Wide Association Study, Humans, Hypertension, Linkage Disequilibrium, Polymorphism, Single Nucleotide}, issn = {1476-5438}, doi = {10.1038/s41431-018-0277-1}, author = {Wang, Heming and Nandakumar, Priyanka and Tekola-Ayele, Fasil and Bamidele O Tayo and Erin B Ware and Gu, C Charles and Lu, Yingchang and Yao, Jie and Zhao, Wei and Smith, Jennifer A and Hellwege, Jacklyn N and Guo, Xiuqing and Edwards, Todd L and Ruth J F Loos and Donna K Arnett and Myriam Fornage and Charles N Rotimi and Sharon L R Kardia and Cooper, Richard S and Rao, D C and Georg B Ehret and Chakravarti, Aravinda and Zhu, Xiaofeng} } @article {13195, title = {Comparing Within- and Between-Family Polygenic Score Prediction.}, journal = {Am J Hum Genet}, volume = {105}, year = {2019}, month = {2019 Aug 01}, pages = {351-363}, abstract = {

Polygenic scores are a popular tool for prediction of complex traits. However, prediction estimates in samples of unrelated participants can include effects of population stratification, assortative mating, and environmentally mediated parental genetic effects, a form of genotype-environment correlation (rGE). Comparing genome-wide polygenic score (GPS) predictions in unrelated individuals with predictions between siblings in a within-family design is a powerful approach to identify these different sources of prediction. Here, we compared within- to between-family GPS predictions of eight outcomes (anthropometric, cognitive, personality, and health) for eight corresponding GPSs. The outcomes were assessed in up to 2,366 dizygotic (DZ) twin pairs from the Twins Early Development Study from age 12 to age 21. To account for family clustering, we used mixed-effects modeling, simultaneously estimating within- and between-family effects for target- and cross-trait GPS prediction of the outcomes. There were three main findings: (1) DZ twin GPS differences predicted DZ differences in height, BMI, intelligence, educational achievement, and ADHD symptoms; (2) target and cross-trait analyses indicated that GPS prediction estimates for cognitive traits (intelligence and educational achievement) were on average 60\% greater between families than within families, but this was not the case for non-cognitive traits; and (3) much of this within- and between-family difference for cognitive traits disappeared after controlling for family socio-economic status (SES), suggesting that SES is a major source of between-family prediction through rGE mechanisms. These results provide insights into the patterns by which rGE contributes to GPS prediction, while ruling out confounding due to population stratification and assortative mating.

}, keywords = {Adolescent, Adult, Child, Cognition, Cognition Disorders, Diseases in Twins, Educational Status, Family, Female, genes, Genetic Predisposition to Disease, Genome-Wide Association Study, Genotype, Humans, Male, Multifactorial Inheritance, Neurodevelopmental Disorders, Phenotype, Polymorphism, Single Nucleotide, Schizophrenia, Young Adult}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2019.06.006}, author = {Selzam, Saskia and Ritchie, Stuart J and Pingault, Jean-Baptiste and Reynolds, Chandra A and O{\textquoteright}Reilly, Paul F and Plomin, Robert} } @article {11056, title = {Effects of long-term care setting on spousal health outcomes.}, journal = {Health Serv Res}, volume = {54}, year = {2019}, month = {2019 02}, pages = {158-166}, abstract = {

OBJECTIVE: To provide empirical evidence on the effects of home and community-based services (HCBS) (vs nursing home) use on spousal health.

DATA SOURCES: Merged data from the 1996 to 2012 Health and Retirement Study (HRS) and the Area Health Resource File (AHRF).

STUDY DESIGN: We assess the impact of HCBS use on spousal health. We use an instrumental variable (IV) approach to account for the potential endogeneity of the choice of care setting and reverse causality. Our instrument is the supply of skilled nursing home beds per 1000 people older than 65~years.

DATA EXTRACTION METHODS: Our sample includes spouses of HCBS or nursing home users, resulting in 8608 observations.

PRINCIPAL FINDINGS: We find that HCBS use leads to harmful effects on spousal physical health, which may be caused by increased informal care responsibilities. We also find improved spousal mental health, especially in depression symptoms, which may be caused by increased satisfaction.

CONCLUSIONS: We find evidence of both beneficial (mental health) and harmful (physical health) consequences for spouses of individuals receiving LTC at home relative to in an institution. Our results are important in estimating the potential cost and effectiveness of HCBS expansion.

}, keywords = {Adaptation, Psychological, Aged, Caregivers, Community Health Services, Female, Humans, Long-term Care, Male, Patient Preference, social isolation, Spouses}, issn = {1475-6773}, doi = {10.1111/1475-6773.13053}, author = {Dong, Jing and Pollack, Harold and R. Tamara Konetzka} } @article {12125, title = {Exome Chip Meta-analysis Fine Maps Causal Variants and Elucidates the Genetic Architecture of Rare Coding Variants in Smoking and Alcohol~Use.}, journal = {Biological Psychiatry}, volume = {85}, year = {2019}, pages = {946-955}, abstract = {

BACKGROUND: Smoking and alcohol use have been associated with common genetic variants in multiple loci. Rare variants within these loci hold promise in the identification of biological mechanisms in substance use. Exome arrays and genotype imputation can now efficiently genotype rare nonsynonymous and loss of function variants. Such variants are expected to have deleterious functional consequences and to contribute to disease risk.

METHODS: We analyzed \~{}250,000 rare variants from 16 independent studies genotyped with exome arrays and augmented this dataset with imputed data from the UK Biobank. Associations were tested for five phenotypes: cigarettes per day, pack-years, smoking initiation, age of smoking initiation, and alcoholic drinks per week. We conducted stratified heritability analyses, single-variant tests, and gene-based burden tests of nonsynonymous/loss-of-function coding variants. We performed a novel fine-mapping analysis to winnow the number of putative causal variants within associated loci.

RESULTS: Meta-analytic sample sizes ranged from 152,348 to 433,216, depending on the phenotype. Rare coding variation explained 1.1\% to 2.2\% of phenotypic variance, reflecting 11\% to 18\% of the total single nucleotide polymorphism heritability of these phenotypes. We identified 171 genome-wide associated loci across all phenotypes. Fine mapping identified putative causal variants with double base-pair resolution at 24 of these loci, and between three and 10 variants for 65 loci. Twenty loci contained rare coding variants in the 95\% credible intervals.

CONCLUSIONS: Rare coding variation significantly contributes to the heritability of smoking and alcohol use. Fine-mapping genome-wide association study loci identifies specific variants contributing to the biological etiology of substance use behavior.

}, keywords = {Alcohol Drinking, Databases, Genetic, Exome, Genetic Predisposition to Disease, Genetic Variation, Genome-Wide Association Study, Genotype, Humans, Oligonucleotide Array Sequence Analysis, Phenotype, Polymorphism, Single Nucleotide, Smoking}, issn = {1873-2402}, doi = {10.1016/j.biopsych.2018.11.024}, author = {Brazel, David M and Jiang, Yu and Hughey, Jordan M and Turcot, Val{\'e}rie and Zhan, Xiaowei and Gong, Jian and Batini, Chiara and Weissenkampen, J Dylan and Liu, Mengzhen and Barnes, Daniel R and Bertelsen, Sarah and Chou, Yi-Ling and Erzurumluoglu, A Mesut and Jessica Faul and Jeffrey Haessler and Anke R Hammerschlag and Hsu, Chris and Kapoor, Manav and Lai, Dongbing and Le, Nhung and Christiaan de Leeuw and Loukola, Anu and Mangino, Massimo and Melbourne, Carl A and Pistis, Giorgio and Qaiser, Beenish and Rohde, Rebecca and Shao, Yaming and Heather M Stringham and Wetherill, Leah and Zhao, Wei and Agrawal, Arpana and Laura Bierut and Chen, Chu and Charles B Eaton and Goate, Alison and Christopher A Haiman and Andrew C Heath and Iacono, William G and Nicholas G Martin and Tinca J Polderman and Reiner, Alex and Rice, John and Schlessinger, David and H Steven Scholte and Smith, Jennifer A and Tardif, Jean-Claude and Hilary A Tindle and Van Der Leij, Andries R and Boehnke, Michael and Chang-Claude, Jenny and Francesco Cucca and David, Sean P and Tatiana Foroud and Howson, Joanna M M and Sharon L R Kardia and Charles Kooperberg and Laakso, Markku and Lettre, Guillaume and Pamela A F Madden and McGue, Matt and Kari E North and Posthuma, Danielle and Timothy Spector and Stram, Daniel and Tobin, Martin D and David R Weir and Kaprio, Jaakko and Gon{\c c}alo R Abecasis and Liu, Dajiang J and Scott Vrieze} } @article {11321, title = {Genetic heterogeneity of Alzheimer{\textquoteright}s disease in subjects with and without hypertension.}, journal = {Geroscience}, volume = {41}, year = {2019}, month = {2019 04}, pages = {137-154}, abstract = {

Alzheimer{\textquoteright}s disease (AD) is a progressive neurodegenerative disorder caused by the interplay of multiple genetic and non-genetic factors. Hypertension is one of the AD risk factors that has been linked to underlying pathological changes like senile plaques and neurofibrillary tangles formation as well as hippocampal atrophy. In this study, we investigated the differences in the genetic architecture of AD between hypertensive and non-hypertensive subjects in four independent cohorts. Our genome-wide association analyses revealed significant associations of 15 novel potentially AD-associated polymorphisms (P < 5E-06) that were located outside the chromosome 19q13 region and were significant either in hypertensive or non-hypertensive groups. The closest genes to 14 polymorphisms were not associated with AD at P < 5E-06 in previous genome-wide association studies (GWAS). Also, four of them were located within two chromosomal regions (i.e., 3q13.11 and 17q21.2) that were not associated with AD at P < 5E-06 before. In addition, 30 genes demonstrated evidence of group-specific associations with AD at the false discovery rates (FDR) < 0.05 in our gene-based and transcriptome-wide association analyses. The chromosomal regions corresponding to four genes (i.e., 2p13.1, 9p13.3, 17q12, and 18q21.1) were not associated with AD at P < 5E-06 in previous GWAS. These genes may serve as a list of prioritized candidates for future functional studies. Our pathway-enrichment analyses revealed the associations of 11 non-group-specific and four group-specific pathways with AD at FDR < 0.05. These findings provided novel insights into the potential genetic heterogeneity of AD among subjects with and without hypertension.

}, keywords = {Aged, Aged, 80 and over, Aging, Alzheimer disease, Cohort Studies, disease progression, Female, Genetic Heterogeneity, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Hypertension, Male, Polymorphism, Single Nucleotide, Prognosis, Prospective Studies, Risk Assessment}, issn = {2509-2723}, doi = {10.1007/s11357-019-00071-5}, author = {Nazarian, Alireza and Konstantin G Arbeev and Arseniy P Yashkin and Alexander M Kulminski} } @article {12132, title = {Genomics of 1 million parent lifespans implicates novel pathways and common diseases and distinguishes survival chances.}, journal = {Elife}, volume = {8}, year = {2019}, pages = {e39856}, abstract = {

We use a genome-wide association of 1 million parental lifespans of genotyped subjects and data on mortality risk factors to validate previously unreplicated findings near , , , , , and 13q21.31, and identify and replicate novel findings near , , and . We also validate previous findings near 5q33.3/ and , whilst finding contradictory evidence at other loci. Gene set and cell-specific analyses show that expression in foetal brain cells and adult dorsolateral prefrontal cortex is enriched for lifespan variation, as are gene pathways involving lipid proteins and homeostasis, vesicle-mediated transport, and synaptic function. Individual genetic variants that increase dementia, cardiovascular disease, and lung cancer - but not other cancers - explain the most variance. Resulting polygenic scores show a mean lifespan difference of around five years of life across the deciles.

Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor{\textquoteright}s assessment is that all the issues have been addressed (see decision letter).

}, keywords = {Age Factors, Aged, Bayes Theorem, Disease, DNA Methylation, Female, Genetic Loci, Genome-Wide Association Study, Genomics, Humans, Longevity, Male, Middle Aged, Multifactorial Inheritance, Parents, Polymorphism, Single Nucleotide, Risk Factors, Sex Characteristics, Signal Transduction, Survival Analysis}, issn = {2050-084X}, doi = {10.7554/eLife.39856}, author = {Paul Rhj Timmers and Mounier, Ninon and Lall, Kristi and Fischer, Krista and Ning, Zheng and Feng, Xiao and Bretherick, Andrew D and Clark, David W and Shen, Xia and T{\~o}nu Esko and Kutalik, Zolt{\'a}n and James F Wilson and Joshi, Peter K} } @article {11645, title = {Having a Happy Spouse Is Associated With Lowered Risk of Mortality.}, journal = {Psychological Science}, volume = {30}, year = {2019}, pages = {798-803}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Exercise, Female, Happiness, Humans, Interpersonal Relations, Longevity, Male, Middle Aged, Mortality, Personal Satisfaction, Risk Reduction Behavior, Self Report, Sexual Partners, Socioeconomic factors, Spouses, Survival Analysis}, issn = {1467-9280}, doi = {10.1177/0956797619835147}, author = {Stavrova, Olga} } @article {6488, title = {How Does Employment-Based Insurance Coverage Relate to Health After Early Retirement?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 Sep 15}, pages = {1211-1212}, keywords = {Activities of Daily Living, Age Factors, Aged, depression, Employment, Female, Health Benefit Plans, Employee, Humans, Male, Middle Aged, Retirement, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw020}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/17/geronb.gbw020.short}, author = {Ben Lennox Kail} } @article {12128, title = {Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity.}, journal = {Nature Communications}, volume = {10}, year = {2019}, pages = {376}, abstract = {

Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol, and triglyceride levels in up to 120,979 individuals of European, African, Asian, Hispanic, and Brazilian ancestry, with follow-up of suggestive associations in an additional 131,012 individuals. We find four loci, in/near CLASP1, LHX1, SNTA1, and CNTNAP2, that are associated with circulating lipid levels through interaction with physical activity; higher levels of physical activity enhance the HDL cholesterol-increasing effects of the CLASP1, LHX1, and SNTA1 loci and attenuate the LDL cholesterol-increasing effect of the CNTNAP2 locus. The CLASP1, LHX1, and SNTA1 regions harbor genes linked to muscle function and lipid metabolism. Our results elucidate the role of physical activity interactions in the genetic contribution to blood lipid levels.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Asians, Blacks, Brazil, Calcium-Binding Proteins, Cholesterol, Cholesterol, HDL, Cholesterol, LDL, Exercise, Female, Genetic Loci, Genome-Wide Association Study, Genotype, Hispanic or Latino, Humans, LIM-Homeodomain Proteins, Lipid Metabolism, Lipids, Male, Membrane Proteins, Microtubule-Associated Proteins, Middle Aged, Muscle Proteins, Nerve Tissue Proteins, Transcription Factors, Triglycerides, Whites, Young Adult}, issn = {2041-1723}, doi = {10.1038/s41467-018-08008-w}, author = {Kilpel{\"a}inen, Tuomas O and Bentley, Amy R and Noordam, Raymond and Yun Ju Sung and Schwander, Karen and Thomas W Winkler and Jakupovi{\'c}, Hermina and Daniel I Chasman and Alisa Manning and Ntalla, Ioanna and Aschard, Hugues and Brown, Michael R and de Las Fuentes, Lisa and Franceschini, Nora and Guo, Xiuqing and Vojinovic, Dina and Aslibekyan, Stella and Feitosa, Mary F and Kho, Minjung and Musani, Solomon K and Melissa Richard and Wang, Heming and Wang, Zhe and Traci M Bartz and Bielak, Lawrence F and Campbell, Archie and Dorajoo, Rajkumar and Fisher, Virginia and Hartwig, Fernando P and Horimoto, Andrea R V R and Li, Changwei and Kurt Lohman and Marten, Jonathan and Sim, Xueling and Smith, Albert V and Tajuddin, Salman M and Alver, Maris and Amini, Marzyeh and Boissel, Mathilde and Jin-Fang Chai and Chen, Xu and Divers, Jasmin and Evangelou, Evangelos and Gao, Chuan and Graff, Mariaelisa and Sarah E Harris and He, Meian and Hsu, Fang-Chi and Jackson, Anne U and Jing Hua Zhao and Kraja, Aldi T and K{\"u}hnel, Brigitte and Laguzzi, Federica and Lyytik{\"a}inen, Leo-Pekka and Ilja M Nolte and Rauramaa, Rainer and Riaz, Muhammad and Robino, Antonietta and Rueedi, Rico and Heather M Stringham and Takeuchi, Fumihiko and van der Most, Peter J and Varga, Tibor V and Verweij, Niek and Erin B Ware and Wen, Wanqing and Li, Xiaoyin and Yanek, Lisa R and Amin, Najaf and Donna K Arnett and Boerwinkle, Eric and Brumat, Marco and Brian E Cade and Canouil, Micka{\"e}l and Chen, Yii-Der Ida and Concas, Maria Pina and Connell, John and de Mutsert, Ren{\'e}e and de Silva, H Janaka and de Vries, Paul S and Demirkan, Ayse and Ding, Jingzhong and Charles B Eaton and Jessica Faul and Friedlander, Yechiel and Gabriel, Kelley P and Ghanbari, Mohsen and Giulianini, Franco and Gu, Chi Charles and Gu, Dongfeng and Tamara B Harris and He, Jiang and Heikkinen, Sami and Heng, Chew-Kiat and Hunt, Steven C and Ikram, M Arfan and Jost Bruno Jonas and Koh, Woon-Puay and Komulainen, Pirjo and Krieger, Jose E and Stephen B Kritchevsky and Kutalik, Zolt{\'a}n and Kuusisto, Johanna and Langefeld, Carl D and Langenberg, Claudia and Lenore J Launer and Leander, Karin and Lemaitre, Rozenn N and Lewis, Cora E and Liang, Jingjing and Liu, Jianjun and M{\"a}gi, Reedik and Manichaikul, Ani and Meitinger, Thomas and Andres Metspalu and Milaneschi, Yuri and Mohlke, Karen L and Thomas H Mosley and Murray, Alison D and Michael A Nalls and Nang, Ei-Ei Khaing and Nelson, Christopher P and Nona, Sotoodehnia and Norris, Jill M and Nwuba, Chiamaka Vivian and Jeff O{\textquoteright}Connell and Palmer, Nicholette D and Papanicolau, George J and Pazoki, Raha and Nancy L Pedersen and Peters, Annette and Peyser, Patricia A and Polasek, Ozren and David J Porteous and Poveda, Alaitz and Olli T Raitakari and Rich, Stephen S and Neil Risch and Robinson, Jennifer G and Rose, Lynda M and Rudan, Igor and Schreiner, Pamela J and Scott, Robert A and Stephen Sidney and Sims, Mario and Smith, Jennifer A and Snieder, Harold and Sofer, Tamar and John M Starr and Sternfeld, Barbara and Strauch, Konstantin and Tang, Hua and Kent D Taylor and Tsai, Michael Y and Tuomilehto, Jaakko and Andr{\'e} G Uitterlinden and van der Ende, M Yldau and van Heemst, Diana and Voortman, Trudy and Waldenberger, Melanie and Wennberg, Patrik and Wilson, Gregory and Xiang, Yong-Bing and Yao, Jie and Yu, Caizheng and Yuan, Jian-Min and Zhao, Wei and Alan B Zonderman and Becker, Diane M and Boehnke, Michael and Bowden, Donald W and de Faire, Ulf and Ian J Deary and Elliott, Paul and T{\~o}nu Esko and Freedman, Barry I and Froguel, Philippe and Paolo P. Gasparini and Gieger, Christian and Kato, Norihiro and Laakso, Markku and Lakka, Timo A and Lehtim{\"a}ki, Terho and Patrik K E Magnusson and Oldehinkel, Albertine J and Brenda W J H Penninx and Nilesh J Samani and Shu, Xiao-Ou and van der Harst, Pim and Jana V. van Vliet-Ostaptchouk and Vollenweider, Peter and Wagenknecht, Lynne E and Wang, Ya X and Wareham, Nicholas J and David R Weir and Wu, Tangchun and Zheng, Wei and Zhu, Xiaofeng and Michele K Evans and Franks, Paul W and Gudnason, Vilmundur and Caroline Hayward and Horta, Bernardo L and Tanika N Kelly and Liu, Yongmei and Kari E North and Pereira, Alexandre C and Ridker, Paul M and Tai, E Shyong and van Dam, Rob M and Fox, Ervin R and Sharon L R Kardia and Liu, Ching-Ti and Dennis O Mook-Kanamori and Province, Michael A and Redline, Susan and Cornelia M van Duijn and Rotter, Jerome I and Charles Kooperberg and Gauderman, W James and Psaty, Bruce M and Kenneth Rice and Munroe, Patricia B and Myriam Fornage and Cupples, L Adrienne and Charles N Rotimi and Alanna C Morrison and Rao, Dabeeru C and Ruth J F Loos} } @article {12123, title = {New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders.}, journal = {Nature Human Behaviour}, volume = {3}, year = {2019}, pages = {950-961}, abstract = {

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

}, keywords = {Adult, Aged, Alcohol Drinking, Alcoholism, Brain, Female, genes, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Magnetic Resonance Imaging, Male, Mental Disorders, Middle Aged, Neuroimaging, Polymorphism, Single Nucleotide, Quantitative Trait Loci, Schizophrenia, Whites}, issn = {2397-3374}, doi = {10.1038/s41562-019-0653-z}, author = {Evangelou, Evangelos and Gao, He and Chu, Congying and Ntritsos, Georgios and Blakeley, Paul and Butts, Andrew R and Pazoki, Raha and Suzuki, Hideaki and Koskeridis, Fotios and Yiorkas, Andrianos M and Karaman, Ibrahim and Elliott, Joshua and Luo, Qiang and Aeschbacher, Stefanie and Traci M Bartz and Baumeister, Sebastian E and Braund, Peter S and Brown, Michael R and Brody, Jennifer A and Clarke, Toni-Kim and Dimou, Niki and Jessica Faul and Homuth, Georg and Jackson, Anne U and Kentistou, Katherine A and Joshi, Peter K and Lemaitre, Rozenn N and Penelope A Lind and Lyytik{\"a}inen, Leo-Pekka and Mangino, Massimo and Milaneschi, Yuri and Nelson, Christopher P and Ilja M Nolte and Per{\"a}l{\"a}, Mia-Maria and Polasek, Ozren and David J Porteous and Scott M Ratliff and Smith, Jennifer A and Stan{\v c}{\'a}kov{\'a}, Alena and Teumer, Alexander and Tuominen, Samuli and Th{\'e}riault, S{\'e}bastien and Vangipurapu, Jagadish and Whitfield, John B and Wood, Alexis and Yao, Jie and Yu, Bing and Zhao, Wei and Dan E Arking and Auvinen, Juha and Liu, Chunyu and M{\"a}nnikk{\"o}, Minna and Risch, Lorenz and Rotter, Jerome I and Snieder, Harold and Veijola, Juha and Alexandra I Blakemore and Boehnke, Michael and Campbell, Harry and Conen, David and Johan G Eriksson and Hans-J{\"o}rgen Grabe and Guo, Xiuqing and van der Harst, Pim and Catharina A Hartman and Caroline Hayward and Andrew C Heath and J{\"a}rvelin, Marjo-Riitta and K{\"a}h{\"o}nen, Mika and Sharon L R Kardia and K{\"u}hne, Michael and Kuusisto, Johanna and Laakso, Markku and Lahti, Jari and Lehtim{\"a}ki, Terho and McIntosh, Andrew M and Mohlke, Karen L and Alanna C Morrison and Nicholas G Martin and Oldehinkel, Albertine J and Brenda W J H Penninx and Psaty, Bruce M and Olli T Raitakari and Rudan, Igor and Nilesh J Samani and Scott, Laura J and Timothy Spector and Verweij, Niek and David R Weir and James F Wilson and Levy, Daniel and Tzoulaki, Ioanna and Bell, Jimmy D and Matthews, Paul M and Rothenfluh, Adrian and Desrivi{\`e}res, Sylvane and Schumann, Gunter and Elliott, Paul} } @article {10875, title = {One-Year Mortality After Dialysis Initiation Among Older Adults.}, journal = {JAMA Intern Med}, volume = {179}, year = {2019}, month = {2019 07 01}, pages = {987-990}, abstract = {This cohort study examines the incidence of mortality 1 year after the start of hemodialysis in patients 65 years and older.}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Renal Dialysis, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2019.0125}, author = {Melissa W Wachterman and O{\textquoteright}Hare, Ann M and Rahman, Omari-Khalid and Karl A Lorenz and Edward R Marcantonio and Alicante, Gabrielle K and Amy Kelley} } @article {8584, title = {Activity Engagement and Activity-Related Experiences: The Role of Personality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 10 10}, pages = {1480-1490}, abstract = {

Objectives: The associations of personality with activity participation and well-being have been well studied. However, less is known concerning the relationship between personality and specific aspects of activity engagement in older adults. We conducted a fine-grained examination of the effects of extraversion and conscientiousness on reported activity engagement-which we define as participation, time allocated, and affective experience-during 8 everyday activities.

Method: Data were obtained using a day reconstruction measure from a subgroup of participants in the 2012 Health and Retirement Study (HRS: N = 5,484; mean age = 67.98 years).

Results: We found mixed support for hypotheses suggesting that specific personality traits would be associated with activity participation, time allocated, and activity-affective experience. For example, extraverts were more likely to socialize and experienced higher socializing-related positive affect, but did not spend more time socializing.

Discussion: Results are discussed in light of the value of including personality in, and its contribution to, studies of activity engagement in later life. In addition, the need to acknowledge the complexity of the concept of activity engagement in future research is highlighted.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Educational Status, Female, Humans, Interviews as Topic, Male, Marital Status, Middle Aged, Personality, Personality Inventory, Sex Factors, Social participation, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw098}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/08/12/geronb.gbw098.long}, author = {Nicky J Newton and Pladevall-Guyer, Jana and Gonzalez, Richard and Jacqui Smith} } @article {8803, title = {Antecedents of Gray Divorce: A Life Course Perspective.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 08 14}, pages = {1022-1031}, abstract = {

Objectives: Increasingly, older adults are experiencing divorce, yet little is known about the risk factors associated with divorce after age 50 (termed "gray divorce"). Guided by a life course perspective, our study examined whether key later life turning points are related to gray divorce.

Method: We used data from the 1998-2012 Health and Retirement Study to conduct a prospective, couple-level discrete-time event history analysis of the antecedents of gray divorce. Our models incorporated key turning points (empty nest, retirement, and poor health) as well as demographic characteristics and economic resources.

Results: Contrary to our expectations, the onset of an empty nest, the wife{\textquoteright}s or husband{\textquoteright}s retirement, and the wife{\textquoteright}s or husband{\textquoteright}s chronic conditions were unrelated to the likelihood of gray divorce. Rather, factors traditionally associated with divorce among younger adults were also salient for older adults. Marital duration, marital quality, home ownership, and wealth were negatively related to the risk of gray divorce.

Discussion: Gray divorce is especially likely to occur among couples who are socially and economically disadvantaged, raising new questions about the consequences of gray divorce for individual health and well-being.

}, keywords = {Age Factors, Divorce, Female, Humans, Interviews as Topic, Male, Marriage, Middle Aged, Prospective Studies, Retirement, Risk Factors, Socioeconomic factors, Spouses, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw164}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw164}, author = {Lin, I-Fen and Susan L. Brown and Matthew R Wright and Anna M Hammersmith} } @article {10714, title = {Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions.}, journal = {J Health Econ}, volume = {59}, year = {2018}, month = {2018 05}, pages = {125-138}, abstract = {

This paper measures the extent to which the price of nursing home care affects a potential substitute living arrangement: coresidence with adult children. Exploiting variation in state Medicaid income "spend-down" provisions over time, I find that living in a state with a spend-down provision decreases the prevalence of coresidence with adult children by 1-4 percentage points for single elderly individuals, with a corresponding increase in the use of nursing home care. These findings suggest that changes in Medicaid eligibility for long-term care benefits could have large impacts on living arrangements, care utilization patterns, and Medicaid expenditures.

}, keywords = {Adult children, Aged, Aged, 80 and over, Female, Health Expenditures, Homes for the Aged, Humans, Long-term Care, Male, Medicaid, Nursing homes, Residence Characteristics, United States}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2018.04.003}, author = {Corina D Mommaerts} } @article {8486, title = {Arthritis, Depression, and Falls Among Community-Dwelling Older Adults: Evidence From the Health and Retirement Study.}, journal = {J Appl Gerontol}, volume = {37}, year = {2018}, month = {2018 09}, pages = {1133-1149}, abstract = {

The aims of this study were to examine the association between different types of arthritis and falls and to investigate whether clinically significant depression symptoms (CSDS) moderate these relationships. The study used nationally representative data from the 2008 Health and Retirement Study ( n = 7,715, M age = 75, 62\% female, and 90\% White). Among the respondents, 42\% experienced at least one fall during the previous 2 years. About one third had some form of arthritis: 22\% osteoarthritis (OA), 4.8\% rheumatoid arthritis (RA), 2.3\% both OA and RA, and 7.9\% with other arthritis types. About one fifth of respondents had CSDS. OA and CSDS are associated with the odds of falling (17\% and 29\%, respectively), adjusting for socio-demographic characteristics, lifestyle, health conditions, and psychiatric medications. There was no statistically significant interaction between types of arthritis and CSDS. Health care providers should pay attention to managing arthritis, especially OA, and CSDS to prevent falls among older adults.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Comorbidity, depression, Female, Health Surveys, Humans, Independent Living, Male, Osteoarthritis, United States}, issn = {1552-4523}, doi = {10.1177/0733464816646683}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27178205}, author = {Lien Quach and Jeffrey A Burr} } @article {8576, title = {Differences in the Progression of Disability: A U.S.-Mexico Comparison.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {913-922}, abstract = {

Objectives: This article seeks to document the progression of disability in a developing country by implementing a model to examine how this process compares to a developed country.

Methods: Data come from the Mexican Health and Aging Study (MHAS), including a baseline survey in 2001 and a follow-up in 2003, and from the U.S. Health and Retirement Study (HRS), using the 2000 and 2002 waves. An ordinal logistic regression approach is used to examine a progression of disability that considers (a) no disability, (b) mobility problems, (c) mobility plus limitations with instrumental activities of daily living, (d) mobility plus limitations with activities of daily living (ADLs), (e) limitations in all three areas and (f) death.

Results: In both data sets, approximately 44\% of the sample remained in the same level of disability at the 2-year follow-up. However, the progression of limitations with two disabilities differs by gender in the MHAS but is consistent for both men and women in the HRS.

Discussion: Our model reflects the importance of ADLs in the disablement process in Mexico. We speculate that the difference in lifetime risk profiles and cultural context might be responsible for the divergence in the progression of disability by gender.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Disabled Persons, disease progression, Female, Humans, Male, Mexico, MHAS}, issn = {1758-5368}, doi = {10.1093/geronb/gbw082}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27436102}, author = {D{\'\i}az-Venegas, Carlos and Timothy A Reistetter and Rebeca Wong} } @article {8508, title = {Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 04 16}, pages = {655-665}, abstract = {

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Family Conflict, Female, Humans, Longitudinal Studies, Male, Marriage, Middle Aged, Sex Factors, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbw073}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27353031}, author = {Kira S. Birditt and James A. Cranford and Jasmine A Manalel and Toni C Antonucci} } @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 {6510, title = {Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Jun 14}, pages = {849-859}, abstract = {

OBJECTIVES: This study investigates education differences in levels and change in sense of control and hopelessness among older adults.

METHOD: We used data from the Health and Retirement Study, an ongoing biennial survey of a nationally representative sample of older Americans, to examine education differences in sense of control (e.g., mastery and perceived constraints) and hopelessness. Our sample included 8,495 adults aged 52 and older who were interviewed in 2006/2008 and 2010/2012. We assessed separate models for change in sense of control and hopelessness, accounting for recent changes in social circumstances and health status.

RESULTS: Low mastery, perceived constraints, and hopelessness were highest among individuals with less than a high school education. Over a 4-year period, this group experienced the greatest declines in psychosocial functioning, as indicated by greater increases in low mastery, perceived constraints, and hopelessness. Education differences existed net of recent negative experiences, specifically the loss of intimate social relationships and social support and increases in disease and disability.

DISCUSSION: These findings highlight the importance of education for sense of control and hopelessness in older adulthood and demonstrate the cumulative advantage of higher levels of education for psychosocial functioning.

}, keywords = {Activities of Daily Living, Aged, Educational Status, Female, Humans, Internal-External Control, Male, Middle Aged, Psychology, Sadness, Social participation, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbw031}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/23/geronb.gbw031.abstract}, author = {Uchechi A Mitchell and Jennifer A Ailshire and Lauren L Brown and Morgan E. Levine and Eileen M. Crimmins} } @article {8807, title = {Educational and Gender Differences in Health Behavior Changes After a Gateway Diagnosis.}, journal = {J Aging Health}, volume = {30}, year = {2018}, month = {2018 03}, pages = {342-364}, abstract = {

OBJECTIVE: Hypertension represents a gateway diagnosis to more serious health problems that occur as people age. We examine educational differences in three health behavior changes people often make after receiving this diagnosis in middle or older age, and test whether these educational differences depend on (a) the complexity of the health behavior change and (b) gender.

METHOD: We use data from the Health and Retirement Study and conduct logistic regression analysis to examine the likelihood of modifying health behaviors post diagnosis.

RESULTS: We find educational differences in three behavior changes-antihypertensive medication use, smoking cessation, and physical activity initiation-after a hypertension diagnosis. These educational differences in health behaviors were stronger among women compared with men.

DISCUSSION: Upon receiving a hypertension diagnosis, education is a more important predictor of behavior changes for women compared with men, which may help explain gender differences in the socioeconomic gradient in health in the United States.

}, keywords = {Aged, Attitude to Health, Educational Status, Exercise, Female, Health Behavior, Humans, Hypertension, Male, Middle Aged, Retirement, Sex Factors, Smoking cessation, United States}, issn = {1552-6887}, doi = {10.1177/0898264316678756}, url = {http://jah.sagepub.com/cgi/doi/10.1177/0898264316678756}, author = {Elaine M Hernandez and Rachel Margolis and Robert A Hummer} } @article {6507, title = {The Effects of Medicare Part D on Health Outcomes of Newly Covered Medicare Beneficiaries.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Jun 14}, pages = {890-900}, abstract = {

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

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

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

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

}, keywords = {Aged, Female, Health Status, Humans, Hypertension, Male, Medicare Part D, Medication Adherence, Models, Statistical, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw030}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/05/05/geronb.gbw030.abstract}, author = {Diebold, Jeffrey} } @article {10712, title = {Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals.}, journal = {Nature Genetics}, volume = {50}, year = {2018}, month = {2018 07 23}, pages = {1112-1121}, abstract = {

Here we conducted a large-scale genetic association analysis of educational attainment in a sample of approximately 1.1 million individuals and identify 1,271 independent genome-wide-significant SNPs. For the SNPs taken together, we found evidence of heterogeneous effects across environments. The SNPs implicate genes involved in brain-development processes and neuron-to-neuron communication. In a separate analysis of the X chromosome, we identify 10 independent genome-wide-significant SNPs and estimate a SNP heritability of around 0.3\% in both men and women, consistent with partial dosage compensation. A joint (multi-phenotype) analysis of educational attainment and three related cognitive phenotypes generates polygenic scores that explain 11-13\% of the variance in educational attainment and 7-10\% of the variance in cognitive performance. This prediction accuracy substantially increases the utility of polygenic scores as tools in research.

}, keywords = {Adult, Aged, Aged, 80 and over, Cohort Studies, Educational Status, Female, Genome-Wide Association Study, Humans, Male, Middle Aged, Multifactorial Inheritance, Phenotype, Polymorphism, Single Nucleotide}, issn = {1546-1718}, doi = {10.1038/s41588-018-0147-3}, author = {Lee, James J and Wedow, Robbee and Okbay, Aysu and Kong, Edward and Maghzian, Omeed and Zacher, Meghan and Nguyen-Viet, Tuan Anh and Bowers, Peter and Sidorenko, Julia and Richard Karlsson Linn{\'e}r and Mark Alan Fontana and Kundu, Tushar and Lee, Chanwook and Hui Liu and Li, Ruoxi and Royer, Rebecca and Pascal N Timshel and Walters, Raymond K and Willoughby, Emily A and Yengo, Loic and Alver, Maris and Bao, Yanchun and Clark, David W and Day, Felix R and Furlotte, Nicholas A and Joshi, Peter K and Kathryn E Kemper and Kleinman, Aaron and Langenberg, Claudia and M{\"a}gi, Reedik and Joey W Trampush and Verma, Shefali Setia and Wu, Yang and Lam, Max and Jing Hua Zhao and Zheng, Zhili and Jason D Boardman and Campbell, Harry and Freese, Jeremy and Kathleen Mullan Harris and Caroline Hayward and Herd, Pamela and Kumari, Meena and Lencz, Todd and Luan, Jian{\textquoteright}an and Anil K. Malhotra and Andres Metspalu and Lili Milani and Ong, Ken K and Perry, John R B and David J Porteous and Ritchie, Marylyn D and Smart, Melissa C and Smith, Blair H and Tung, Joyce Y and Wareham, Nicholas J and James F Wilson and Jonathan P. Beauchamp and Dalton C Conley and T{\~o}nu Esko and Lehrer, Steven F and Patrik K E Magnusson and Oskarsson, Sven and Pers, Tune H and Matthew R Robinson and Thom, Kevin and Watson, Chelsea and Chabris, Christopher F and Meyer, Michelle N and David I Laibson and Yang, Jian and Johannesson, Magnus and Philipp D Koellinger and Turley, Patrick and Peter M Visscher and Daniel J. Benjamin and Cesarini, David} } @article {9598, title = {A genome-wide association study for extremely high intelligence}, journal = {Molecular Psychiatry}, volume = {23}, year = {2018}, month = {Apr-05-2018}, pages = {1226 - 1232}, abstract = {We used a case-control genome-wide association (GWA) design with cases consisting of 1238 individuals from the top 0.0003 (~170 mean IQ) of the population distribution of intelligence and 8172 unselected population-based controls. The single-nucleotide polymorphism heritability for the extreme IQ trait was 0.33 (0.02), which is the highest so far for a cognitive phenotype, and significant genome-wide genetic correlations of 0.78 were observed with educational attainment and 0.86 with population IQ. Three variants in locus ADAM12 achieved genome-wide significance, although they did not replicate with published GWA analyses of normal-range IQ or educational attainment. A genome-wide polygenic score constructed from the GWA results accounted for 1.6\% of the variance of intelligence in the normal range in an unselected sample of 3414 individuals, which is comparable to the variance explained by GWA studies of intelligence with substantially larger sample sizes. The gene family plexins, members of which are mutated in several monogenic neurodevelopmental disorders, was significantly enriched for associations with high IQ. This study shows the utility of extreme trait selection for genetic study of intelligence and suggests that extremely high intelligence is continuous genetically with normal-range intelligence in the population.}, keywords = {Cognitive Ability, Education, Genome, Hereditary, Humans}, issn = {1359-4184}, doi = {10.1038/mp.2017.121}, url = {http://www.nature.com/doifinder/10.1038/mp.2017.121http://www.nature.com/doifinder/10.1038/mp.2017.121}, author = {Zabaneh, D and Krapohl, E and Gaspar, H A and Curtis, C and Lee, S H and Patel, H and Newhouse, S and Wu, H M and Simpson, M A and Putallaz, M and Lubinski, D and Plomin, R and Breen, G} } @article {8472, title = {Health Shocks and Initiation of Use of Preventive Services Among Older Adults.}, journal = {J Appl Gerontol}, volume = {37}, year = {2018}, month = {2018 07}, pages = {856-880}, abstract = {

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

}, keywords = {Aged, Cholesterol, Early Detection of Cancer, Female, Health Status, Health Surveys, Humans, Influenza, Human, Male, Mammography, Middle Aged, Papanicolaou Test, Prostatic Neoplasms, Vaccination, Vaginal Smears}, issn = {1552-4523}, doi = {10.1177/0733464816657474}, url = {http://jag.sagepub.com/cgi/doi/10.1177/0733464816657474}, author = {Ng, Boon Peng and Gail A Jensen} } @article {8552, title = {Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {901-912}, abstract = {

Objectives: Chronic disease data from longitudinal health interview surveys are frequently used in epidemiologic studies. These data may be limited by inconsistencies in self-report by respondents across waves. We examined disease inconsistencies in the Health and Retirement Study and investigated a multistep method of adjudication. We hypothesized a greater likelihood of inconsistences among respondents with cognitive impairment, of underrepresented race/ethnic groups, having lower education, or having less income/wealth.

Method: We analyzed Waves 1995-2010, including adults 51 years and older (N = 24,156). Diseases included hypertension, heart disease, lung disease, diabetes, cancer, stroke, and arthritis. We used questions about the diseases to formulate a multistep adjudication method to resolve inconsistencies across waves.

Results: Thirty percent had inconsistency in their self-report of diseases across waves, with cognitive impairment, proxy status, age, Hispanic ethnicity, and wealth as key predictors. Arthritis and hypertension had the most frequent inconsistencies; stroke and cancer, the fewest. Using a stepwise method, we adjudicated 60\%-75\% of inconsistent responses.

Discussion: Discrepancies in the self-report of diseases across multiple waves of health interview surveys are common. Differences in prevalence between original and adjudicated data may be substantial for some diseases and for some groups, (e.g., the cognitively impaired).

}, keywords = {Aged, Chronic disease, Data Accuracy, Epidemiologic Methods, Female, Health Surveys, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Self Report}, issn = {1758-5368}, doi = {10.1093/geronb/gbw063}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27260670}, author = {Christine T Cigolle and Corey L Nagel and Caroline S Blaum and Jersey Liang and Ana R Qui{\~n}ones} } @article {6515, title = {Later Life Marital Dissolution and Repartnership Status: A National Portrait.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Aug 14}, pages = {1032-1042}, abstract = {

OBJECTIVES: Our study compares two types of later life marital dissolution that occur after age 50-divorce and widowhood-and their associations with repartnership status (i.e., remarried, cohabiting, or unpartnered).

METHOD: We used data from the Health and Retirement Study to provide a portrait of later life divorce and widowhood for women and men. Next, we tested whether marital dissolution type is related to women{\textquoteright}s and men{\textquoteright}s repartnered status, distinguishing among remarrieds, cohabitors, and unpartnereds, net of key sociodemographic indicators.

RESULTS: Divorcees are more often repartnered through either remarriage or cohabitation than are widoweds. This gap persists among women net of an array of sociodemographic factors. For men, the differential is reduced to nonsignificance with the inclusion of these factors.

DISCUSSION: Later life marital dissolution increasingly occurs through divorce rather than widowhood, and divorce is more often followed by repartnership. The results from this study suggest that gerontological research should not solely focus on widowhood but also should pay attention to divorce and repartnering during later life.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Divorce, Female, Humans, Longitudinal Studies, Male, Marriage, Middle Aged, Socioeconomic factors, Spouses, United States, Widowhood}, issn = {1758-5368}, doi = {10.1093/geronb/gbw051}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/04/29/geronb.gbw051.abstract}, author = {Susan L. Brown and Lin, I-Fen and Anna M Hammersmith and Matthew R Wright} } @article {8493, title = {Linked Lives: Dyadic Associations of Mastery Beliefs With Health (Behavior) and Health (Behavior) Change Among Older Partners.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {787-798}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Dominance-Subordination, Female, Health Behavior, Health Status, Humans, Male, Marriage, Middle Aged, Models, Theoretical, Psychological Tests, Risk Reduction Behavior, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw058}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27229003}, author = {Drewelies, Johanna and William J. Chopik and Christiane A Hoppmann and Jacqui Smith and Denis Gerstorf} } @article {8676, title = {Loneliness and depressive symptoms: the moderating role of the transition into retirement.}, journal = {Aging Ment Health}, volume = {22}, year = {2018}, month = {2018 Jan}, pages = {135-140}, abstract = {

OBJECTIVES: The transition to retirement implies significant changes in daily routine and in the social environment. More specifically, it requires more self-directed efforts in order to stay socially engaged. Hence, for those who suffer from loneliness, the transition to retirement could result in increased depressive symptoms due to the lack of structured daily routine.

METHODS: We used two waves of the Health and Retirement Study, and tested whether the transition to retirement between the two waves moderates the effects of loneliness on depressive symptoms.

RESULTS: The transition to retirement moderated the effect of loneliness in wave 1 on depressive symptoms in wave 2, such that for those who retired, the effect was stronger in comparison to those who stayed employed.

CONCLUSIONS: Although many manage to easily transition into retirement, lonely older workers are at increased risk for maladjustment and the experience of depressive symptoms following retirement. This group could perhaps benefit from interventions aimed at increasing daily social interactions and establishing a socially satisfying routine.

}, keywords = {Aged, depression, Female, Humans, Loneliness, Male, Middle Aged, Retirement}, issn = {1364-6915}, doi = {10.1080/13607863.2016.1226770}, author = {Dikla Segel-Karpas and Liat Ayalon and Margie E Lachman} } @article {8683, title = {A Longitudinal Assessment of Perceived Discrimination and Maladaptive Expressions of Anger Among Older Adults: Does Subjective Social Power Buffer the Association?}, journal = {The Journals of Gerontology: Series B}, volume = {73}, year = {2018}, pages = {e120-e130}, abstract = {

Objectives: We examine whether perceived discrimination in older adults is associated with external conflict (anger-out) and internally directed anger (anger-in), as well as how subjective social power-as indicated by a sense of personal control and subjective social status-modifies these associations while holistically controlling for time-stable confounds and the five major dimensions of personality.

Method: The 2006 and 2008 psychosocial subsamples of the Health and Retirement Study were combined to create baseline observations, and the 2010 and 2012 waves were combined to create follow-up observations. Responses were analyzed with random-effects models that adjust for repeated observations and fixed-effects models that additionally control for all time-stable confounds.

Results: Discrimination was significantly associated with anger-in and anger-out. Fixed-effects models and controls for personality reduced these associations by more than 60\%, although they remained significant. Measures of subjective social power weaken associations with anger-out but not anger-in.

Discussion: The mental health consequences of perceived discrimination for older adults may be over-estimated if time-stable confounds and personality are not taken into account. Subjective social power can protect victims of discrimination from reactions that may escalate conflict, but not from internalized anger that is likely to be wearing and cause further health problems.

}, keywords = {African Americans, Aged, Anger, European Continental Ancestry Group, Female, Hispanic Americans, Humans, Longitudinal Studies, Male, Personality Inventory, Power, Psychological, Prejudice, Racism, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw110}, author = {Lee, Yeonjung and Bierman, Alex} } @article {8825, title = {Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States.}, journal = {Int J Health Serv}, volume = {48}, year = {2018}, month = {2018 01}, pages = {42-56}, abstract = {

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults{\textquoteright} overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

}, keywords = {Aged, Health Services for the Aged, Humans, Medicare Part D, United States}, issn = {1541-4469}, doi = {10.1177/0020731416676226}, url = {http://joh.sagepub.com/lookup/doi/10.1177/0020731416676226}, author = {Chen, Cheng-Chia and Hsien-Chang Lin and Seo, Dong-Chul} } @article {8597, title = {Perceived Age Discrimination: A Precipitator or a Consequence of Depressive Symptoms?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {860-869}, abstract = {

Objectives: The main purpose of the study was to examine a bidirectional temporal relationship between perceived age discrimination and depressive symptoms. A secondary goal was to examine whether the negative effects of perceived age discrimination on one{\textquoteright}s depressive symptoms are stronger among respondents older than 70 years old, compared with respondents between the ages of 51 and 70.

Methods: The Health and Retirement Study is a U.S. nationally representative sample of individuals over the age of 50 and their spouse of any age. A cross-lagged model was estimated to examine the reciprocal associations of depressive symptoms and perceived age discrimination, controlling for age, gender, education, ethnicity, marital status, employment status, satisfaction with financial status, number of medical conditions, mobility, strength and fine motor skills, and memory functioning.

Results: The baseline model for the overall sample resulted in adequate fit indices: CFI = .945, TLI = .940, RMSEA = .024 (90\% CI = .023, .025). The cross-lagged effect of perceived age discrimination on depressive symptoms was nonsignificant (B [SE] = -.01 [.04], p = .82), whereas the cross-lagged effect of depressive symptoms on perceived age discrimination was small, but significant (B [SE] = .04 [.02], p = .03). This implies that higher levels of depressive symptoms precede a greater likelihood of perceived age discrimination, net of sociodemographic and clinical variables. The cross-lagged effects did not vary according to age group (51-70 vs >70 years old).

Discussion: The subjective nature of perceived age discrimination is discussed.

}, keywords = {Age Factors, Aged, Ageism, depression, Female, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw101}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw101}, author = {Liat Ayalon} } @article {8581, title = {Perceived Control Mediates Effects of Socioeconomic Status and Chronic Stress on Physical Frailty: Findings From the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 09 20}, pages = {1175-1184}, abstract = {

Objective: To investigate the psychosocial etiology of physical frailty by examining the influence of chronic stress and perceived control.

Method: Using population-based samples of older adults from the Health and Retirement Study, this study employed structural equation modeling in cross-sectional (N = 5,250) and longitudinal (N = 2,013) samples to estimate the effects of chronic stress and socioeconomic status (SES) on baseline frailty and change in frailty status over 4 years and the extent to which perceived control mediates or moderates effects of chronic stress.

Results: Perceived control fully mediated effects of chronic stress and partially mediated effects of SES on both baseline frailty and change in frailty. Multigroup analyses revealed that the mediating role of perceived control was consistent across age, gender, and racial/ethnic subgroups. There was no evidence to support a moderating role of perceived control in the chronic stress and frailty relationship.

Discussion: Findings provide novel evidence for a mediating role of perceived control in pathways linking SES and chronic stress to frailty, further underscoring the importance of psychosocial constructs to the development and progression of frailty in older adults.

}, keywords = {Aged, Cross-Sectional Studies, Female, Frail Elderly, Frailty, Humans, Internal-External Control, Longitudinal Studies, Male, Models, Theoretical, Risk Factors, Socioeconomic factors, Stress, Psychological}, issn = {1758-5368}, doi = {10.1093/geronb/gbw096}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/08/12/geronb.gbw096.long}, author = {Christopher J Mooney and Ari J. Elliot and Kathryn Z. Douthit and Marquis, Andre and Christopher L Seplaki} } @article {6965, title = {The Potential Effects of Obesity on Social Security Claiming Behavior and Retirement Benefits.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Apr 16}, pages = {723-732}, publisher = {19}, abstract = {

OBJECTIVES: Obesity prevalence among Americans has increased for nearly three decades. We explore the relationship between the rise in obesity and Social Security retirement benefit claiming, a decision impacting nearly all aging Americans. Specifically, we investigate whether obesity can affect individuals{\textquoteright} decision to claim benefits early, a choice that has important implications for financial security in retirement, particularly for those with lower socioeconomic status (SES).

METHOD: We use a microsimulation model called MINT6 (Modeling Income in the Near Term, version 6) to demonstrate the potential effects of obesity on subjective life expectancy and claiming behavior. We impute obesity status using data from the National Health and Nutrition Examination Survey (NHANES), which describes the distribution of obesity prevalence within the United States by gender, poverty status, and race/ethnicity.

RESULTS: We find that the rise in obesity and the consequent incidence of obesity-related diseases may lead some individuals to make claiming decisions that lead to lower monthly and lifetime Social Security retirement benefits. Further, we find that the potential economic impact of this decision is larger for those with lower SES.

DISCUSSION: We present a behavioral perspective by addressing the potential effects that obesity can have on individuals{\textquoteright} retirement decisions and their resulting Social Security retirement benefits.

}, keywords = {Aged, Female, Humans, Life Expectancy, Male, Obesity, Pensions, Poverty, Social Class, Social Security, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw016}, author = {Michael D Hurd and James P Smith and Julie M Zissimopoulos} } @article {8509, title = {Smoking Cessation and Changes in Body Mass Index Among Middle Aged and Older Adults.}, journal = {J Appl Gerontol}, volume = {37}, year = {2018}, month = {2018 08}, pages = {1012-1036}, abstract = {

OBJECTIVE: This study contributes to the body of literature examining smoking cessation and body mass index (BMI) for adults aged 50 and older.

METHOD: Utilizing the 2004 and 2010 waves of the RAND Health and Retirement Study, this analysis utilized Fixed Effects (FE) regression on a sample of 1,316 adults aged 50 and older.

RESULTS: Older adults undergo a small change in BMI after a transition from smoking to nonsmoking during a 6-year period, and this occurs after accounting for individual-level unobserved heterogeneity. More specifically, men experience a BMI gain of 1.24 ( p< .01) and women experience a BMI gain of 1.58 ( p< .01).

DISCUSSION: Gerontologists/health professionals can use these results to inform older adults about the potential for a small increase in BMI and, in the process, assuage any apprehensions about excessive weight gain. This insight may encourage a greater number of older adults to cease smoking.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Female, Humans, Male, Middle Aged, Models, Statistical, Smoking cessation, Weight Gain}, issn = {1552-4523}, doi = {10.1177/0733464816655438}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27353834}, author = {Sharma, Andy} } @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 {12139, title = {Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function.}, journal = {Nature Communications}, volume = {9}, year = {2018}, pages = {2098}, abstract = {

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 {\texttimes} 10) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3\% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Cognition, Genetic Loci, Genetic Predisposition to Disease, Humans, Mental Disorders, Middle Aged, Multifactorial Inheritance, Neurodegenerative Diseases, Neurodevelopmental Disorders, Polymorphism, Single Nucleotide, Reaction Time, Young Adult}, issn = {2041-1723}, doi = {10.1038/s41467-018-04362-x}, author = {Gail Davies and Lam, Max and Sarah E Harris and Joey W Trampush and Luciano, Michelle and W David Hill and Hagenaars, Saskia P and Ritchie, Stuart J and Riccardo E Marioni and Fawns-Ritchie, Chloe and David C Liewald and Okely, Judith A and Ahola-Olli, Ari V and Barnes, Catriona L K and Bertram, Lars and Joshua C. Bis and Katherine E Burdick and Christoforou, Andrea and DeRosse, Pamela and Djurovic, Srdjan and Espeseth, Thomas and Giakoumaki, Stella and Giddaluru, Sudheer and Gustavson, Daniel E and Caroline Hayward and Edith Hofer and Ikram, M Arfan and Karlsson, Robert and Knowles, Emma and Lahti, Jari and Leber, Markus and Li, Shuo and Mather, Karen A and Melle, Ingrid and Morris, Derek and Christopher J Oldmeadow and Palviainen, Teemu and Payton, Antony and Pazoki, Raha and Katja E Petrovic and Chandra A Reynolds and Sargurupremraj, Muralidharan and Scholz, Markus and Smith, Jennifer A and Smith, Albert V and Terzikhan, Natalie and Thalamuthu, Anbupalam and Trompet, Stella and Sven J van der Lee and Erin B Ware and Windham, B Gwen and Margaret J Wright and Yang, Jingyun and Yu, Jin and Ames, David and Amin, Najaf and Amouyel, Philippe and Andreassen, Ole A and Armstrong, Nicola J and Assareh, Amelia A and John R. Attia and Attix, Deborah and Avramopoulos, Dimitrios and David A Bennett and B{\"o}hmer, Anne C and Patricia A. Boyle and Brodaty, Henry and Campbell, Harry and Tyrone D. Cannon and Elizabeth T. Cirulli and Congdon, Eliza and Conley, Emily Drabant and Corley, Janie and Cox, Simon R and Dale, Anders M and Dehghan, Abbas and Danielle M. Dick and Dickinson, Dwight and Johan G Eriksson and Evangelou, Evangelos and Jessica Faul and Ford, Ian and Nelson A. Freimer and Gao, He and Giegling, Ina and Gillespie, Nathan A and Gordon, Scott D and Gottesman, Rebecca F and Michael E Griswold and Gudnason, Vilmundur and Tamara B Harris and Hartmann, Annette M and Hatzimanolis, Alex and Gerardo Heiss and Holliday, Elizabeth G and Joshi, Peter K and K{\"a}h{\"o}nen, Mika and Sharon L R Kardia and Ida Karlsson and Kleineidam, Luca and David S Knopman and Kochan, Nicole A and Konte, Bettina and Kwok, John B and Stephanie Le Hellard and Lee, Teresa and Lehtim{\"a}ki, Terho and Li, Shu-Chen and Lill, Christina M and Liu, Tian and Koini, Marisa and London, Edythe and Longstreth, Will T and Lopez, Oscar L and Loukola, Anu and Luck, Tobias and Astri J Lundervold and Lundquist, Anders and Lyytik{\"a}inen, Leo-Pekka and Nicholas G Martin and Grant W Montgomery and Murray, Alison D and Anna C Need and Noordam, Raymond and Nyberg, Lars and William E R Ollier and Papenberg, Goran and Pattie, Alison and Polasek, Ozren and Russell A Poldrack and Psaty, Bruce M and Reppermund, Simone and Steffi G Riedel-Heller and Rose, Richard J and Rotter, Jerome I and Roussos, Panos and Rovio, Suvi P and Saba, Yasaman and Fred W Sabb and Sachdev, Perminder S and Satizabal, Claudia L and Schmid, Matthias and Rodney J Scott and Matthew A Scult and Simino, Jeannette and Slagboom, P Eline and Smyrnis, Nikolaos and Soumar{\'e}, A{\"\i}cha and Nikos C Stefanis and Stott, David J and Richard E Straub and Sundet, Kjetil and Taylor, Adele M and Kent D Taylor and Tzoulaki, Ioanna and Tzourio, Christophe and Andr{\'e} G Uitterlinden and Vitart, Veronique and Aristotle N Voineskos and Kaprio, Jaakko and Wagner, Michael and Wagner, Holger and Weinhold, Leonie and Wen, K Hoyan and Elisabeth Widen and Yang, Qiong and Zhao, Wei and Hieab H Adams and Dan E Arking and Robert M Bilder and Bitsios, Panos and Boerwinkle, Eric and Chiba-Falek, Ornit and Corvin, Aiden and Philip L de Jager and Debette, St{\'e}phanie and Donohoe, Gary and Elliott, Paul and Fitzpatrick, Annette L and Gill, Michael and David C. Glahn and H{\"a}gg, Sara and Narelle K Hansell and Ahmad R Hariri and Ikram, M Kamran and Jukema, J Wouter and Vuoksimaa, Eero and Matthew C Keller and Kremen, William S and Lenore J Launer and Lindenberger, Ulman and Aarno Palotie and Nancy L Pedersen and Pendleton, Neil and David J Porteous and Katri R{\"a}ikk{\"o}nen and Olli T Raitakari and Ramirez, Alfredo and Reinvang, Ivar and Rudan, Igor and Schmidt, Reinhold and Schmidt, Helena and Peter W Schofield and Peter R Schofield and John M Starr and Vidar M Steen and Trollor, Julian N and Turner, Steven T and Cornelia M van Duijn and Villringer, Arno and Daniel R Weinberger and David R Weir and James F Wilson and Anil K. Malhotra and McIntosh, Andrew M and Gale, Catharine R and Seshadri, Sudha and Thomas H Mosley and Bressler, Jan and Lencz, Todd and Ian J Deary} } @article {6499, title = {Survival Advantage Mechanism: Inflammation as a Mediator of Positive Self-Perceptions of Aging on Longevity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, note = {10.1093/geronb/gbw035}, month = {2018 Mar 02}, pages = {409-412}, abstract = {

OBJECTIVE: Previous studies have found that positive self-perceptions of aging (SPA) are associated with longer survival; however, a biological mechanism was unknown. We examined whether C-reactive protein (CRP), a marker of cumulative stress-related inflammation, mediates the relationship between SPA and survival.

METHOD: The SPA of participants aged 50 and older in the Health and Retirement Study (N = 4,149) were assessed at baseline. Inflammation was measured by the level of CRP 4 years later. Survival was followed for up to 6 years.

RESULTS: As hypothesized, CRP mediated the impact of SPA on survival. Following the steps of a mediation analysis, positive SPA at baseline predicted lower CRP after 4 years (β = -.29, p = .03) and longer survival in the 2 years following the CRP measurement (β = .20, p =.003); additionally, lower CRP predicted longer survival, after adjusting for positive SPA (β = -.02, p = .0001). All models adjusted for baseline age, CRP, health, sex, race, and education.

DISCUSSION: It was found that lower CRP partially mediates the relationship between positive SPA and longer survival. Hence, this study presents a novel pathway to explain the process by which positive SPA extend longevity.

}, keywords = {Aged, Aged, 80 and over, Aging, Biomarkers, C-reactive protein, Female, Humans, Inflammation, Longevity, Male, Middle Aged, Self Concept, Surveys and Questionnaires, Survival Analysis}, issn = {1758-5368}, doi = {10.1093/geronb/gbw035}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/26/geronb.gbw035.abstractN2 -}, author = {Becca R Levy and Bavishi, Avni} } @article {8598, title = {"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 09 20}, pages = {1278-1291}, chapter = {1278-1291}, abstract = {

Objectives: Recovery from self-reported walking limitation may be a turning point in an individual{\textquoteright}s health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods: Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results: Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion: This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult{\textquoteright}s functional health trajectory.

}, keywords = {Age Factors, Aged, Disabled Persons, Female, Humans, Logistic Models, Male, Mobility Limitation, Mortality, Recovery of Function, Risk Factors, Self Report, Sex Factors, Socioeconomic factors, Walking}, issn = {1758-5368}, doi = {10.1093/geronb/gbw113}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw113}, author = {Kenzie Latham} } @article {8673, title = {Aging perceptions and self-efficacy mediate the association between personality traits and depressive symptoms in older adults.}, journal = {Int J Geriatr Psychiatry}, volume = {32}, year = {2017}, month = {2017 12}, pages = {1217-1225}, abstract = {

OBJECTIVE: Personality traits have been shown to be predictors of depressive symptoms in late life. Thus, we examined whether other more modifiable sources of individual differences such as self-efficacy and self-perceptions of aging would mediate the association between personality traits and depressive symptoms in older adults.

METHOD: Data were obtained from 3,507 older adult participants who took part in the 2012 Health and Retirement Study. The "Big Five" personality traits, self-efficacy, aging perceptions, and depressive symptoms were assessed. Mediation analyses tested the hypothesis that self-efficacy and aging perceptions would mediate the relationship between personality traits and depressive symptoms.

RESULTS: All five personality traits were significant predictors of depressive symptoms. Neuroticism was positively associated with depressive symptoms and had the greatest effect compared with the other personality traits. There was a significant indirect effect of neuroticism, extraversion, and conscientiousness on depressive symptoms (including both mediators). The mediating effect of aging perceptions on the relationship between neuroticism and depressive symptoms was the strongest compared with self-efficacy, accounting for approximately 80\% of the total indirect effect.

CONCLUSION: Our results provide support for interventions aimed at improving self-perceptions related to efficacy and aging in order to reduce depressive symptoms in older adults. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Aged, 80 and over, Aging, Depressive Disorder, Female, Humans, Male, Middle Aged, Personality, Risk Factors, Self Concept, Self Efficacy}, issn = {1099-1166}, doi = {10.1002/gps.4584}, author = {O{\textquoteright}Shea, Deirdre M and Vonetta M Dotson and Fieo, Robert A} } @article {12135, title = {An Analysis of Two Genome-wide Association Meta-analyses Identifies a New Locus for Broad Depression Phenotype.}, journal = {Biological Psychiatry}, volume = {82}, year = {2017}, pages = {322-329}, abstract = {

BACKGROUND: The genetics of depression has been explored in genome-wide association studies that focused on either major depressive disorder or depressive symptoms with mostly negative findings. A broad depression phenotype including both phenotypes has not been tested previously using a genome-wide association approach. We aimed to identify genetic polymorphisms significantly associated with a broad phenotype from depressive symptoms to major depressive disorder.

METHODS: We analyzed two prior studies of 70,017 participants of European ancestry from general and clinical populations in the discovery stage. We performed a replication meta-analysis of 28,328 participants. Single nucleotide polymorphism (SNP)-based heritability and genetic correlations were calculated using linkage disequilibrium score regression. Discovery and replication analyses were performed using a p-value-based meta-analysis. Lifetime major depressive disorder and depressive symptom scores were used as the outcome measures.

RESULTS: The SNP-based heritability of major depressive disorder was 0.21 (SE = 0.02), the SNP-based heritability of depressive symptoms was 0.04 (SE = 0.01), and their genetic correlation was 1.001 (SE = 0.2). We found one genome-wide significant locus related to the broad depression phenotype (rs9825823, chromosome 3: 61,082,153, p = 8.2 {\texttimes} 10) located in an intron of the FHIT gene. We replicated this SNP in independent samples (p = .02) and the overall meta-analysis of the discovery and replication cohorts (1.0 {\texttimes} 10).

CONCLUSIONS: This large study identified a new locus for depression. Our results support a continuum between depressive symptoms and major depressive disorder. A phenotypically more inclusive approach may help to achieve the large sample sizes needed to detect susceptibility loci for depression.

}, keywords = {Acid Anhydride Hydrolases, depression, Depressive Disorder, Genetic Loci, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Neoplasm Proteins, Phenotype, Whites}, issn = {1873-2402}, doi = {10.1016/j.biopsych.2016.11.013}, author = {Nese Direk and Williams, Stephanie and Smith, Jennifer A and Ripke, Stephan and Air, Tracy and Amare, Azmeraw T and Amin, Najaf and Baune, Bernhard T and David A Bennett and Blackwood, Douglas H R and Dorret I Boomsma and Breen, Gerome and Buttensch{\o}n, Henriette N and Byrne, Enda M and B{\o}rglum, Anders D and Castelao, Enrique and Cichon, Sven and Clarke, Toni-Kim and Marilyn C Cornelis and Dannlowski, Udo and Philip L de Jager and Demirkan, Ayse and Domenici, Enrico and Cornelia M van Duijn and Dunn, Erin C and Johan G Eriksson and T{\~o}nu Esko and Jessica Faul and Luigi Ferrucci and Myriam Fornage and Eco J. C. de Geus and Gill, Michael and Gordon, Scott D and Hans-J{\"o}rgen Grabe and van Grootheest, Gerard and Hamilton, Steven P and Catharina A Hartman and Andrew C Heath and Karin Hek and Hofman, Albert and Homuth, Georg and Horn, Carsten and Jouke-Jan Hottenga and Sharon L R Kardia and Kloiber, Stefan and Karestan C Koenen and Kutalik, Zolt{\'a}n and Ladwig, Karl-Heinz and Lahti, Jari and Douglas F Levinson and Lewis, Cathryn M and Lewis, Glyn and Li, Qingqin S and David J Llewellyn and Lucae, Susanne and Kathryn L Lunetta and MacIntyre, Donald J and Pamela A F Madden and Nicholas G Martin and McIntosh, Andrew M and Andres Metspalu and Milaneschi, Yuri and Grant W Montgomery and Mors, Ole and Thomas H Mosley and Joanne M Murabito and M{\"u}ller-Myhsok, Bertram and Markus M N{\"o}then and Nyholt, Dale R and O{\textquoteright}Donovan, Michael C and Brenda W J H Penninx and Pergadia, Michele L and Perlis, Roy and Potash, James B and Preisig, Martin and Shaun M Purcell and Quiroz, Jorge A and Katri R{\"a}ikk{\"o}nen and Rice, John P and Rietschel, Marcella and Rivera, Margarita and Schulze, Thomas G and Shi, Jianxin and Shyn, Stanley and Sinnamon, Grant C and Johannes H Smit and Smoller, Jordan W and Snieder, Harold and Toshiko Tanaka and Tansey, Katherine E and Teumer, Alexander and Uher, Rudolf and Umbricht, Daniel and Van der Auwera, Sandra and Erin B Ware and David R Weir and Weissman, Myrna M and Gonneke Willemsen and Yang, Jingyun and Zhao, Wei and Henning Tiemeier and Patrick F. Sullivan} } @article {6509, title = {Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Feb}, pages = {3-24}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Emigrants and Immigrants, Female, Health Status, Humans, Male, Middle Aged, Models, Theoretical, Personal Satisfaction, Surveys and Questionnaires}, issn = {1552-6887}, doi = {10.1177/0898264315624901}, url = {http://jah.sagepub.com/content/early/2016/01/14/0898264315624901.abstract}, author = {Roc{\'\i}o Calvo and Dawn C Carr and Matz-Costa, Christina} } @article {8564, title = {Are Changes in Self-Rated Health Associated With Memory Decline in Older Adults?}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 12}, pages = {1410-1423}, abstract = {

OBJECTIVE: The association between patterns of change in self-rated health (SRH) and memory trajectories in older adults was examined using a systematic approach.

METHOD: Data from the Health and Retirement Study ( n = 6,016) and the English Longitudinal Study of Ageing ( n = 734) were analyzed. Individuals were grouped into five categories according to their pattern of change in SRH over 8 years: stable excellent/very good/good, stable fair/poor, improvement, decline, and fluctuating pattern without a trend. Memory was measured using immediate and delayed recall tests. Kruskal-Wallis, chi-squares tests, and linear mixed models were used to examine the association.

RESULTS: Different rates of decline in memory can be identified in the different patterns of change in SRH. Those who had a stable excellent/very good/good pattern had the slowest rate of decline.

DISCUSSION: Our findings suggest that SRH status and patterns of change could be used as a marker of cognitive decline in prevention screening programs.

}, keywords = {Aged, Cross-Sectional Studies, Diagnostic Self Evaluation, Female, Humans, Longitudinal Studies, Male, Memory Disorders, Self Report, United States}, issn = {1552-6887}, doi = {10.1177/0898264316661830}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27481931}, author = {Bendayan, Rebecca and Andrea M Piccinin and Scott M Hofer and Muniz, Graciela} } @article {8701, title = {The association between antidepressant use and hemoglobin A1C in older adults.}, journal = {Geriatr Nurs}, volume = {38}, year = {2017}, month = {2017 Mar - Apr}, pages = {141-145}, abstract = {

Depression is known to increase diabetes risk and worsen glycemic control in older adults, who already experience high rates of diabetes. The independent impact of antidepressants on glucose control is less clear. Data was drawn from the Health and Retirement Study, a large nationally-representative longitudinal study of retired individuals. Crude and adjusted linear models stratified by diabetes status were used to examine the cross-sectional associations between antidepressant use categorized by subclass and continuous hemoglobin A1C. The sample included 1,153 individuals, most over the age of 70. Antidepressant use was not associated with hemoglobin A1C in any model whether stratified or in the total combined sample. Antidepressants as a class were also not associated with hemoglobin A1C. These findings add to the literature suggesting that antidepressants are not associated with diabetes risk or glycemic control. Prospective studies with larger sample sizes are needed to confirm this finding.

}, keywords = {Aged, Aged, 80 and over, Antidepressive Agents, Blood Glucose, Cross-Sectional Studies, depression, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin A, Humans, Longitudinal Studies, Male, Risk Factors, Surveys and Questionnaires}, issn = {1528-3984}, doi = {10.1016/j.gerinurse.2016.09.002}, author = {Kammer, Jamie and Akiko S Hosler and Leckman-Westin, Emily and A. Gregory DiRienzo} } @article {6462, title = {Associations Among Individuals{\textquoteright} Perceptions of Future Time, Individual Resources, and Subjective Well-Being in Old Age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 May 01}, pages = {388-399}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Arthritis, Case-Control Studies, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Muscle Strength, Retirement, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw075}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2016/04/26/gerona.glw075.abstract}, author = {Nancy A. Baker and Kamil E Barbour and Charles G Helmick and Matthew M. Zack and Soham Al Snih} } @article {8805, title = {Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans.}, journal = {Soc Sci Med}, volume = {173}, year = {2017}, month = {2017 01}, pages = {118-125}, abstract = {

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency{\textquoteright}s database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a {\textquoteright}joint modelling{\textquoteright} approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Community Participation, Continental Population Groups, Disabled Persons, Disaster Planning, Disasters, Female, Humans, Income, Longitudinal Studies, Male, Middle Aged, Mortality, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.12.007}, url = {https://www.sciencedirect.com/science/article/abs/pii/S0277953616306785?via\%3Dihub}, author = {Samuel L. Brilleman and Wolfe, Rory and Moreno-Betancur, Margarita and Anne E Sales and Kenneth M. Langa and Yun Li and Elizabeth L. Daugher Biddison and Rubinson, Lewis and Theodore J Iwashyna} } @article {11175, title = {Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement.}, journal = {Journal of Gerontology, Series B }, volume = {72}, year = {2017}, pages = {532-539}, abstract = {

Objectives: Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life.

Method: Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (n = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized.

Results: When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78\% and 55\%, respectively (hazard ratio [HR]: 0.22, confidence interval [CI]: 0.06-0.87; HR: 0.45, CI: 0.21-0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities.

Discussion: Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Employment, Family, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, return to work}, issn = {1758-5368}, doi = {10.1093/geronb/gbv095}, author = {Gonzales, Ernest and Lee, Yeonjung and Brown, Celeste} } @article {6522, title = {Body weight status and telomere length in U.S. middle-aged and older adults.}, journal = {Obes Res Clin Pract}, volume = {11}, year = {2017}, month = {2017 Jan-Feb}, pages = {51-62}, abstract = {

OBJECTIVE: Telomere length has been proposed as a biomarker of biological aging. This study examined the relationship between body weight status and telomere length in U.S. middle-aged and older adults.

METHODS: Nationally representative data (N=2749) came from the Health and Retirement Study. Linear regressions were performed to examine the relationship between baseline body weight status reported in 1992 and telomere length measured in 2008 in the overall sample and by sex and racial/ethnic groups, adjusted for individual characteristics.

RESULTS: Baseline overweight (25kg/m<=body mass index [BMI]<30kg/m) and obesity (BMI>=30kg/m) status positively predicted telomere length 17 years later. Compared with their normal weight counterparts, telomere length ratio was on average 0.062 (95\% confidence interval=0.016, 0.109) and 0.125 (0.048, 0.202) larger among overweight and obese adults, respectively. In comparison to women and racial/ethnic minorities, the estimated positive associations between overweight and obesity status and telomere length were more salient among men and non-Hispanic whites, respectively.

CONCLUSIONS: The positive association between body weight status and telomere length found in this study was opposite to what existing biological model predicts, and could partially relate to the nonlinear relationship between body weight status and telomere length across age cohorts, and/or the lack of reliability of BMI as an indicator for adiposity in the older population. Large-scale longitudinal studies with baseline telomere length measures are warranted to replicate this study finding and explore the potential heterogeneous relationship between body weight status and telomere length.

}, keywords = {Aged, Aging, Body Mass Index, Body Weight, ethnicity, Female, Humans, Linear Models, Male, Middle Aged, Obesity, Overweight, Racial Groups, Risk Factors, Sex Factors, Telomere, Telomere Shortening, United States, White People}, issn = {1871-403X}, doi = {10.1016/j.orcp.2016.01.003}, author = {An, Ruopeng and Yan, Hai} } @article {8670, title = {Caregiver stressors and depressive symptoms among older husbands and wives in the United States.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017 Nov-Dec}, pages = {494-504}, abstract = {

Framed by Pearlin{\textquoteright}s Stress Process Model, this study prospectively examines the effects of primary stress factors reflecting the duration, amount, and type of care on the depressive symptoms of spousal caregivers over a2-year period, and whether the effects of stressors differ between husbands and wives. Data are from the 2004 and 2006 waves of the Health and Retirement Study and we included community-dwelling respondents providing activities of daily life (ADL) and/or instrumental activities of daily life (IADL) help to their spouses/partners (N = 774). Results from multivariate regression models indicate that none of the primary stressors were associated with depressive symptoms. However, wives providing only personal care had significantly more depressive symptoms than wives providing only instrumental care, while husbands providing different types of care showed no such differences. To illuminate strategies for reducing the higher distress experienced by wife caregivers engaged in personal care assistance, further studies are needed incorporating couples{\textquoteright} relational dynamics and gendered experiences in personal care.

}, keywords = {Activities of Daily Living, Aged, Caregivers, depression, Female, Humans, Independent Living, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Regression Analysis, Sex Factors, Spouses, Stress, Psychological, United States}, issn = {1540-7322}, doi = {10.1080/08952841.2016.1223962}, author = {Kim, Min Hee and Ruth E Dunkle and Amanda J Lehning and Shen, Huei-Wern and Sheila Feld and Angela K Perone} } @article {8853, title = {Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status?}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0168481}, abstract = {

Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Alabama, Body Mass Index, Child, Female, Health Behavior, Humans, Male, Middle Aged, Obesity, Residence Characteristics, Risk Factors, Social Class, Socioeconomic factors, Young Adult}, issn = {1932-6203}, doi = {10.1371/journal.pone.0168481}, url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168481}, author = {Gregory Pavela} } @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 {8857, title = {Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study.}, journal = {BMC Geriatr}, volume = {17}, year = {2017}, month = {2017 01 11}, pages = {13}, abstract = {

BACKGROUND: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.

METHODS: We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50~years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25~kg/m, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4~years of follow-up were determined through interviews with respondents{\textquoteright} family and the National Death Index.

RESULTS: After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores~odds ratio [OR] 1.37, 95\% CI 1.03-1.81; fourth quartile scores~OR 1.45, 95\% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5\% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4\% or less); observed mortality for these individuals was 1.8\% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.

CONCLUSION: Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Diabetes Mellitus, Female, Heart Failure, Humans, Internal-External Control, Lung Diseases, Male, Middle Aged, Neoplasms, Prospective Studies, Risk Factors, Self Concept, Survival Analysis}, issn = {1471-2318}, doi = {10.1186/s12877-016-0390-3}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28077089/}, author = {Wei Duan-Porter and Susan Nicole Hastings and Brian Neelon and Courtney Harold Van Houtven} } @article {8487, title = {Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity.}, journal = {Journal of Aging and Health}, volume = {29}, year = {2017}, pages = {805-825}, abstract = {

OBJECTIVE: To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults.

METHOD: Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where >=4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008.

RESULTS: A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95\% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95\% CI = [1.15, 2.05]; and aOR = 1.40, 95\% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95\% CI = [1.02, 2.33]).

DISCUSSION: Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.

}, keywords = {Adaptation, Psychological, Aged, California, Chronic disease, Continental Population Groups, depression, Ethnic Groups, Female, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Minority Groups, Risk-Taking, Stress, Psychological, Surveys and Questionnaires}, issn = {1552-6887}, doi = {10.1177/0898264316645548}, author = {Rodriquez, Erik J and Gregorich, Steven E and Livaudais-Toman, Jennifer and Eliseo J Perez-Stable} } @article {8686, title = {The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs.}, journal = {Health Serv Res}, volume = {52}, year = {2017}, month = {2017 10}, pages = {1794-1816}, abstract = {

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

}, keywords = {Accidental Falls, Age Factors, Aged, Aged, 80 and over, Female, Financing, Personal, Health Expenditures, Health Services, Humans, Male, Medicare, Models, Econometric, Sex Factors, Socioeconomic factors, United States, Wounds and Injuries}, issn = {1475-6773}, doi = {10.1111/1475-6773.12554}, author = {Geoffrey J Hoffman and Hays, Ron D and Martin F Shapiro and Steven P Wallace and Susan L Ettner} } @article {8592, title = {Death across the lifespan: Age differences in death-related thoughts and anxiety.}, journal = {Death Stud}, volume = {41}, year = {2017}, month = {2017 02}, pages = {69-77}, abstract = {

Many studies have found age-related declines in death-related anxiety. Why do death-related thoughts and anxiety decline across the lifespan when exposure to, and likelihood of, death increase over time? In Study 1, a cross-sectional survey of 2,363 adults, death-related thoughts declined across the lifespan. In Study 2, a longitudinal study of 9,815 adults followed over a 4-year period, death anxiety declined across the lifespan. Further, greater social support predicted lower levels of death anxiety over time, after controlling for self-rated health and chronic illnesses. Close relationships serve emotion regulation functions to decrease death anxiety and thoughts across the lifespan.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Aging, Anxiety, Attitude to Death, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Thinking, Young Adult}, issn = {1091-7683}, doi = {10.1080/07481187.2016.1206997}, url = {https://www.tandfonline.com/doi/full/10.1080/07481187.2016.1206997}, author = {William J. Chopik} } @article {8829, title = {Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults.}, journal = {Psychosom Med}, volume = {79}, year = {2017}, month = {2017 Feb/Mar}, pages = {234-242}, abstract = {

OBJECTIVE: To examine the association between depressive symptoms and salivary telomere length in a probability sample of middle-aged and older adults, and to evaluate age and sex as potential moderators of this association and test whether this association was incremental to potential confounds.

METHODS: Participants were 3,609 individuals from the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction on DNA extracted from saliva samples. Depressive symptoms were assessed via interview, and health and lifestyle factors, traumatic life events, and neuroticism were assessed via self-report. Regression analyses were conducted to examine the associations between predictor variables and salivary telomere length.

RESULTS: After adjusting for demographics, depressive symptoms were negatively associated with salivary telomere length (b = -.003; p = .014). Furthermore, this association was moderated by sex (b = .005; p = .011), such that depressive symptoms were significantly and negatively associated with salivary telomere length for men (b = - .006; p < .001) but not for women (b = - .001; p = .644). The negative association between depressive symptoms and salivary telomere length in men remained statistically significant after additionally adjusting for cigarette smoking, body mass index, chronic health conditions, childhood and lifetime exposure to traumatic life events, and neuroticism.

CONCLUSIONS: Higher levels of depressive symptoms were associated with shorter salivary telomeres in men, and this association was incremental to several potential confounds. Shortened telomeres may help account for the association between depression and poor physical health and mortality.

}, keywords = {Aged, Anxiety Disorders, Body Mass Index, Chronic disease, depression, Female, Humans, Life Style, Male, Middle Aged, Neuroticism, Psychological Trauma, Saliva, Sex Factors, Smoking, Telomere Shortening}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000383}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00006842-900000000-98910}, author = {Mark A Whisman and Emily D Richardson} } @article {8582, title = {Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 03 01}, pages = {410-416}, abstract = {

Background: Existing mortality prediction models for older adults have been each developed using a single study from the United States or Western Europe. We aimed to develop and validate a 10-year mortality prediction model for older adults using data from developed and developing countries.

Methods: We used data from five cohorts, including data from 16 developed and developing countries: ELSA (English Longitudinal Study of Aging), HRS (Health and Retirement Study), MHAS (Mexican Health and Aging Study), SABE-Sao Paulo (The Health, Well-being and Aging), and SHARE (Survey on Health, Ageing and Retirement in Europe). 35,367 older adults were split into training (two thirds) and test (one third) data sets. Baseline predictors included age, sex, comorbidities, and functional and cognitive measures. We performed an individual participant data meta-analysis using a sex-stratified Cox proportional hazards model, with time to death as the time scale. We validated the model using Harrell{\textquoteright}s C statistic (discrimination) and the estimated slope between observed and predicted 10-year mortality risk across deciles of risk (calibration).

Results: During a median of 8.6 years, 8,325 participants died. The final model included age, sex, diabetes, heart disease, lung disease, cancer, smoking, alcohol use, body mass index, physical activity, self-reported health, difficulty with bathing, walking several blocks, and reporting date correctly. The model showed good discrimination (Harrell{\textquoteright}s C = 0.76) and calibration (slope = 1.005). Models for developed versus developing country cohorts performed equally well when applied to data from developing countries.

Conclusion: A parsimonious mortality prediction model using data from multiple cohorts in developed and developing countries can be used to predict mortality in older adults in both settings.

}, keywords = {Aged, Aged, 80 and over, Developed Countries, Developing Countries, Female, Humans, Male, Meta-Analysis as Topic, Middle Aged, Models, Statistical, Mortality, Prognosis, Time Factors}, issn = {1758-535X}, doi = {10.1093/gerona/glw166}, url = {http://biomedgerontology.oxfordjournals.org/cgi/pmidlookup?view=long\&pmid=27522061}, author = {Suemoto, Claudia Kimie and Ueda, Hiroshi and Hiram Beltr{\'a}n-S{\'a}nchez and Lebr{\~a}o, Maria Lucia and Duarte, Yeda Aparecida and Rebeca Wong and Danaei, Goodarz} } @article {12136, title = {Discovery and fine-mapping of adiposity loci using high density imputation of genome-wide association studies in individuals of African ancestry: African Ancestry Anthropometry Genetics Consortium.}, journal = {PLoS Genetics}, volume = {13}, year = {2017}, pages = {e1006719}, abstract = {

Genome-wide association studies (GWAS) have identified >300 loci associated with measures of adiposity including body mass index (BMI) and waist-to-hip ratio (adjusted for BMI, WHRadjBMI), but few have been identified through screening of the African ancestry genomes. We performed large scale meta-analyses and replications in up to 52,895 individuals for BMI and up to 23,095 individuals for WHRadjBMI from the African Ancestry Anthropometry Genetics Consortium (AAAGC) using 1000 Genomes phase 1 imputed GWAS to improve coverage of both common and low frequency variants in the low linkage disequilibrium African ancestry genomes. In the sex-combined analyses, we identified one novel locus (TCF7L2/HABP2) for WHRadjBMI and eight previously established loci at P < 5{\texttimes}10-8: seven for BMI, and one for WHRadjBMI in African ancestry individuals. An additional novel locus (SPRYD7/DLEU2) was identified for WHRadjBMI when combined with European GWAS. In the sex-stratified analyses, we identified three novel loci for BMI (INTS10/LPL and MLC1 in men, IRX4/IRX2 in women) and four for WHRadjBMI (SSX2IP, CASC8, PDE3B and ZDHHC1/HSD11B2 in women) in individuals of African ancestry or both African and European ancestry. For four of the novel variants, the minor allele frequency was low (<5\%). In the trans-ethnic fine mapping of 47 BMI loci and 27 WHRadjBMI loci that were locus-wide significant (P < 0.05 adjusted for effective number of variants per locus) from the African ancestry sex-combined and sex-stratified analyses, 26 BMI loci and 17 WHRadjBMI loci contained <= 20 variants in the credible sets that jointly account for 99\% posterior probability of driving the associations. The lead variants in 13 of these loci had a high probability of being causal. As compared to our previous HapMap imputed GWAS for BMI and WHRadjBMI including up to 71,412 and 27,350 African ancestry individuals, respectively, our results suggest that 1000 Genomes imputation showed modest improvement in identifying GWAS loci including low frequency variants. Trans-ethnic meta-analyses further improved fine mapping of putative causal variants in loci shared between the African and European ancestry populations.

}, keywords = {Adiposity, Anthropometry, Blacks, Body Mass Index, Chromosome Mapping, Female, Gene Frequency, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Linkage Disequilibrium, Male, Obesity, Polymorphism, Single Nucleotide, Serine Endopeptidases, Transcription Factor 7-Like 2 Protein, Waist-Hip Ratio, Whites}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006719}, author = {Ng, Maggie C Y and Graff, Mariaelisa and Lu, Yingchang and Justice, Anne E and Mudgal, Poorva and Liu, Ching-Ti and Young, Kristin and Yanek, Lisa R and Feitosa, Mary F and Wojczynski, Mary K and Rand, Kristin and Brody, Jennifer A and Brian E Cade and Dimitrov, Latchezar and Duan, Qing and Guo, Xiuqing and Leslie A Lange and Michael A Nalls and Okut, Hayrettin and Tajuddin, Salman M and Bamidele O Tayo and Vedantam, Sailaja and Bradfield, Jonathan P and Chen, Guanjie and Chen, Wei-Min and Chesi, Alessandra and Irvin, Marguerite R and Padhukasahasram, Badri and Smith, Jennifer A and Zheng, Wei and Matthew A. Allison and Ambrosone, Christine B and Bandera, Elisa V and Traci M Bartz and Berndt, Sonja I and Bernstein, Leslie and Blot, William J and Erwin P Bottinger and John Carpten and Chanock, Stephen J and Chen, Yii-Der Ida and Conti, David V and Cooper, Richard S and Myriam Fornage and Freedman, Barry I and Garcia, Melissa and Phyllis J Goodman and Hsu, Yu-Han H and Hu, Jennifer and Huff, Chad D and Ingles, Sue A and John, Esther M and Rick A Kittles and Eric A Klein and Li, Jin and McKnight, Barbara and Nayak, Uma and Nemesure, Barbara and Ogunniyi, Adesola and Olshan, Andrew and Press, Michael F and Rohde, Rebecca and Rybicki, Benjamin A and Babatunde Salako and Sanderson, Maureen and Shao, Yaming and David S Siscovick and Stanford, Janet L and Stevens, Victoria L and Stram, Alex and Strom, Sara S and Vaidya, Dhananjay and Witte, John S and Yao, Jie and Zhu, Xiaofeng and Ziegler, Regina G and Alan B Zonderman and Adeyemo, Adebowale and Ambs, Stefan and Cushman, Mary and Jessica Faul and Hakonarson, Hakon and Levin, Albert M and Nathanson, Katherine L and Erin B Ware and David R Weir and Zhao, Wei and Zhi, Degui and Donna K Arnett and Grant, Struan F A and Sharon L R Kardia and Oloapde, Olufunmilayo I and Rao, D C and Charles N Rotimi and Sale, Michele M and L Keoki Williams and Zemel, Babette S and Becker, Diane M and Ingrid B Borecki and Michele K Evans and Tamara B Harris and Hirschhorn, Joel N and Li, Yun and Patel, Sanjay R and Psaty, Bruce M and Rotter, Jerome I and Wilson, James G and Bowden, Donald W and Cupples, L Adrienne and Christopher A Haiman and Ruth J F Loos and Kari E North} } @article {6503, title = {Do Regular Cholesterol Screenings Lead to Lower Cholesterol Levels and Better Health Behaviors for All? Spotlight on Middle-Aged and Older Adults in the United States.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Apr}, pages = {389-414}, abstract = {

OBJECTIVE: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds.

METHOD: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study ( N = 3,907).

RESULTS: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service.

DISCUSSION: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.

}, keywords = {Aged, Aged, 80 and over, Cholesterol, Female, Health Behavior, Humans, Longitudinal Studies, Male, Mass Screening, Middle Aged, Preventive Health Services, United States}, issn = {1552-6887}, doi = {10.1177/0898264316635588}, url = {http://europepmc.org/abstract/MED/26921271}, author = {Choi, Yool and Lee, Hyo Jung} } @article {6511, title = {Dog Walking, the Human-Animal Bond and Older Adults{\textquoteright} Physical Health.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 Oct 01}, pages = {930-939}, abstract = {

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

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

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

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

}, keywords = {Aged, Animals, Dogs, Female, Health Status, Human-Animal Bond, Humans, Least-Squares Analysis, Linear Models, Logistic Models, Male, Middle Aged, Ownership, Walking}, issn = {1758-5341}, doi = {10.1093/geront/gnw051}, url = {http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract}, author = {Angela L Curl and Bibbo, Jessica and Rebecca A Johnson} } @article {8751, title = {The Effect of Widowhood on Mental Health - an Analysis of Anticipation Patterns Surrounding the Death of a Spouse.}, journal = {Health Econ}, volume = {26}, year = {2017}, month = {2017 12}, pages = {1505-1523}, abstract = {

This study explores the effects of widowhood on mental health by taking into account the anticipation and adaptation to the partner{\textquoteright}s death. The empirical analysis uses representative panel data from the USA that are linked to administrative death records of the National Death Index. I estimate static and dynamic specifications of the panel probit model in which unobserved heterogeneity is modeled with correlated random effects. I find strong anticipation effects of the partner{\textquoteright}s death on the probability of depression, implying that the partner{\textquoteright}s death event cannot be assumed to be exogenous in econometric models. In the absence of any anticipation effects, the partner{\textquoteright}s death has long-lasting mental health consequences, leading to a significantly slower adaptation to widowhood. The results suggest that both anticipation effects and adaptation effects can be attributed to a caregiver burden and to the cause of death. The findings of this study have important implications for designing adequate social policies for the elderly US population that alleviate the negative consequences of bereavement. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Adaptation, Psychological, Aged, Bereavement, Cause of Death, Female, Humans, Interviews as Topic, Male, Mental Health, Middle Aged, Models, Econometric, Qualitative Research, Spouses, Widowhood}, issn = {1099-1050}, doi = {10.1002/hec.3443}, url = {http://doi.wiley.com/10.1002/hec.3443http://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002\%2Fhec.3443}, author = {Siflinger, Bettina} } @article {8675, title = {Effects of receipt of Social Security retirement benefits on older women{\textquoteright}s employment.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017}, pages = {448-459}, abstract = {

Labor force participation of women has declined since 1999; however, labor force participation of women 62+ has increased. The 2000-2006 waves of Health and Retirement Study (HRS) data, the initial years of the continuing upward trajectory, were used to test the effects of receipt of Social Security retirement benefits on older women{\textquoteright}s employment. The models tested: (a) the effect of receipt of Social Security retirement benefits on whether employed; and (b) for women receiving Social Security retirement benefits, the effect of age elected receipt of benefits on whether employed. Both models included the effects of human capital characteristics and income sources. Receipt of Social Security benefits, pension income, and current age reduced the likelihood of employment; while educational level, good to excellent health, and nonmarried marital status increased the likelihood of employment. The older the woman was when she elected Social Security benefits, the more likely she was to be employed.

}, keywords = {Aged, Employment, Female, Humans, Middle Aged, Retirement, Social Security, United States, Women{\textquoteright}s Health, Women, Working}, issn = {1540-7322}, doi = {10.1080/08952841.2016.1214035}, author = {Gillen, Martie and Claudia J Heath} } @article {8858, title = {Emergency Preparedness of Persons Over 50 Years Old: Further Results From the Health and Retirement Study.}, journal = {Disaster Med Public Health Prep}, volume = {11}, year = {2017}, month = {2017 02}, pages = {80-89}, abstract = {

OBJECTIVE: This article conceptualized emergency preparedness as a complex, multidimensional construct and empirically examined an array of sociodemographic, motivation, and barrier variables as predictors of levels of emergency preparedness.

METHODS: The authors used the 2010 wave of the Health and Retirement Study{\textquoteright}s emergency preparedness module to focus on persons 50 years old and older in the United States by use of logistic regression models and reconsidered a previous analysis.

RESULTS: The models demonstrated 3 key findings: (1) a lack of preparedness is widespread across virtually all sociodemographic variables and regions of the country; (2) an authoritative voice, in the role of health care personnel, was a strong predictor of preparedness; and (3) previous experience in helping others in a disaster predisposes individuals to be better prepared. Analyses also suggest the need for caution in creating simple summative indexes and the need for further research into appropriate measures of preparedness.

CONCLUSION: This population of older persons was generally not well prepared for emergencies, and this lack of preparedness was widespread across social, demographic, and economic groups in the United States. Findings with implications for policy and outreach include the importance of health care providers discussing preparedness and the use of experienced peers for outreach. (Disaster Med Public Health Preparedness. 2017;11:80-89).

}, keywords = {Aged, Aged, 80 and over, Attitude to Health, Civil Defense, Equipment and Supplies, Female, Help-Seeking Behavior, Humans, Male, Middle Aged, Retirement, United States, Vulnerable Populations}, issn = {1938-744X}, doi = {10.1017/dmp.2016.162}, author = {Timothy S Killian and Zola K Moon and McNeill, Charleen and Garrison, Betsy and Moxley, Shari} } @article {8590, title = {Extracting Response Style Bias From Measures of Positive and Negative Affect in Aging Research.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2017}, month = {2017 12 15}, pages = {64-74}, abstract = {

Objectives: This study investigated the role of response style biases in the assessment of positive and negative affect in aging research; it addressed whether response styles (a) are associated with age-related changes in cognitive abilities, (b) lead to distorted conclusions about age differences in affect, and (c) reduce the convergent and predictive validity of affect measures in relation to health outcomes.

Method: A multidimensional item response theory model was used to extract response styles from affect ratings provided by respondents to the psychosocial questionnaire (n = 6,295; aged 50-100 years) in the Health and Retirement Study (HRS).

Results: The likelihood of extreme response styles (disproportionate use of "not at all" and "very much" response categories) increased significantly with age, and this effect was mediated by age-related decreases in HRS cognitive test scores. Removing response styles from affect measures did not alter age patterns in positive and negative affect; however, it consistently enhanced the convergent validity (relationships with concurrent depression and mental health problems) and predictive validity (prospective relationships with hospital visits, physical illness onset) of the affect measures.

Discussion: The results support the importance of detecting and controlling response styles when studying self-reported affect in aging research.

}, keywords = {Affect, Age Factors, Aged, Aged, 80 and over, Bias, cognitive aging, Geriatrics, Humans, Male, Middle Aged, Models, Psychological, Psychology, Reproducibility of Results, Research, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw103}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw103}, author = {Stefan Schneider} } @article {8575, title = {Feeling Older and the Development of Cognitive Impairment and Dementia.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Oct 01}, pages = {966-973}, abstract = {

Objective: Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one{\textquoteright}s chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia.

Method: Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia.

Results: An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations.

Conclusion: An older subjective age is a marker of individuals{\textquoteright} risk of subsequent cognitive impairment and dementia.

}, keywords = {Aged, Aged, 80 and over, Aging, Alzheimer disease, Cognitive Dysfunction, depression, disease progression, Female, Health Behavior, Humans, Life Style, Likelihood Functions, Logistic Models, Longitudinal Studies, Male, Risk Factors, Self Concept}, issn = {1758-5368}, doi = {10.1093/geronb/gbw085}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27436103}, author = {Yannick Stephan and Angelina R Sutin and Martina Luchetti and Antonio Terracciano} } @article {8830, title = {Financial Care for Older Adults With Dementia.}, journal = {Int J Aging Hum Dev}, volume = {85}, year = {2017}, month = {2017 06}, pages = {108-122}, abstract = {

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

}, keywords = {Adult children, Aged, Aged, 80 and over, Dementia, Female, Humans, Male, Middle Aged, United States}, issn = {1541-3535}, doi = {10.1177/0091415016685327}, url = {http://journals.sagepub.com/doi/abs/10.1177/0091415016685327?url_ver=Z39.88-2003\&rfr_id=ori:rid:crossref.org\&rfr_dat=cr_pub\%3dpubmed}, author = {Pan, Xi and Lee, Yeonjung and Dye, Cheryl and Laurie Theriot Roley} } @article {6449, title = {Foundations of Activity of Daily Living Trajectories of Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Jan}, pages = {129-139}, abstract = {

OBJECTIVES: The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age.

METHOD: We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories.

RESULTS: Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models.

DISCUSSION: The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic pain, cognitive aging, Disability Evaluation, disease progression, Female, Humans, Individuality, Male, Middle Aged, Socioeconomic factors, Statistics as Topic, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv074}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/01/geronb.gbv074.abstract}, author = {Linda G Martin and Zachary Zimmer and Jinkook Lee} } @article {6448, title = {From Noise to Signal: The Age and Social Patterning of Intra-Individual Variability in Late-Life Health.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Jan}, pages = {168-179}, abstract = {

OBJECTIVES: Despite a long tradition of attending to issues of intra-individual variability in the gerontological literature, large-scale panel studies on late-life health disparities have primarily relied on average health trajectories, relegating intra-individual variability over time to random error terms, or "noise." This article reintegrates the systematic study of intra-individual variability back into standard growth curve modeling and investigates the age and social patterning of intra-individual variability in health trajectories.

METHOD: Using panel data from the Health and Retirement Study, we estimate multilevel growth curves of functional limitations and cognitive impairment and examine whether intra-individual variability in these two health outcomes varies by age, gender, race/ethnicity, and socioeconomic status, using level-1 residuals extracted from the adjusted growth curve models.

RESULTS: For both outcomes, intra-individual variability increases with age. Racial/ethnic minorities and individuals with lower socioeconomic status tend to have greater intra-individual variability in health. Relying exclusively on average health trajectories may have masked important "signals" of life course health inequality.

DISCUSSION: The findings contribute to scientific understanding of the source of heterogeneity in late-life health and highlight the need to further investigate specific life course mechanisms that generate the social patterning of intra-individual variability in health status.

}, keywords = {Activities of Daily Living, Aged, cognitive aging, Cognitive Dysfunction, Disability Evaluation, Female, Health Behavior, Health Status Disparities, Humans, Individuality, Male, Middle Aged, Minority Groups, Models, Statistical, Multilevel Analysis, Reference Values, Sex Characteristics, Sex Factors, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbv081}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/26/geronb.gbv081.abstract}, author = {Lin, Jielu and Jessica Kelley-Moore} } @article {8489, title = {Gender Differences in Spousal Care Across the Later Life Course.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {2017 09}, pages = {934-959}, abstract = {

Spouses often serve as the primary caregivers to their ill or disabled partners. Studies have shown that men receive more care from their wives than vice versa, but few studies have focused on how the gender gap in care varies across the later life course. Drawing on data from the Health and Retirement Study, this study examined the moderating effects of age, gender, and full-time employment on married women{\textquoteright}s and men{\textquoteright}s receipt of spousal care. This study found that among community-dwelling married adults, the gender gap in care was larger among those in middle age (50-65) than it was among those in older age. As women and men aged, the gender gap decreased primarily because men left full-time work and increased the amount of time that they spent caring for their wives. As gender differences in full-time employment narrowed, the gender gap in spousal care narrowed.

}, keywords = {Activities of Daily Living, Aged, Caregivers, Cross-Sectional Studies, Employment, Female, Home Care Services, Humans, Male, Marriage, Middle Aged, Sex Factors, Spouses}, issn = {1552-7573}, doi = {10.1177/0164027516644503}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27193046}, author = {Glauber, Rebecca} } @article {8655, title = {Genome-Wide Association Study of Loneliness Demonstrates a Role for Common Variation.}, journal = {Neuropsychopharmacology}, volume = {42}, year = {2017}, month = {2017 Mar}, pages = {811-821}, abstract = {

Loneliness is a complex biological trait that has been associated with numerous negative health outcomes. The measurement and environmental determinants of loneliness are well understood, but its genetic basis is not. Previous studies have estimated the heritability of loneliness between 37 and 55\% using twins and family-based approaches, and have explored the role of specific candidate genes. We used genotypic and phenotypic data from 10 760 individuals aged ⩾50 years that were collected by the Health and Retirement Study (HRS) to perform the first genome-wide association study of loneliness. No associations reached genome-wide significance (p>5 {\texttimes} 10). Furthermore, none of the previously published associations between variants within candidate genes (BDNF, OXTR, RORA, GRM8, CHRNA4, IL-1A, CRHR1, MTHFR, DRD2, APOE) and loneliness were replicated (p>0.05), despite our much larger sample size. We estimated the chip heritability of loneliness and examined coheritability between loneliness and several personality and psychiatric traits. Our estimates of chip heritability (14-27\%) support a role for common genetic variation. We identified strong genetic correlations between loneliness, neuroticism, and a scale of {\textquoteright}depressive symptoms.{\textquoteright} We also identified weaker evidence for coheritability with extraversion, schizophrenia, bipolar disorder, and major depressive disorder. We conclude that loneliness, as defined in this study, is a modestly heritable trait that has a highly polygenic genetic architecture. The coheritability between loneliness and neuroticism may reflect the role of negative affectivity that is common to both traits. Our results also reflect the value of studies that probe the common genetic basis of salutary social bonds and clinically defined psychiatric disorders.

}, keywords = {Aged, depression, Extraversion, Psychological, Female, Genome-Wide Association Study, Humans, Loneliness, Male, Mental Disorders, Middle Aged, Neuroticism, Phenotype}, issn = {1740-634X}, doi = {10.1038/npp.2016.197}, url = {http://www.nature.com/doifinder/10.1038/npp.2016.197}, author = {Gao, Jianjun and Lea K. Davis and Amy B. Hart and Sanchez-Roige, Sandra and Han, Lide and John T. Cacioppo and Abraham A Palmer} } @article {8823, title = {Genome-wide Association Study of Parental Life Span.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 Oct 01}, pages = {1407-1410}, abstract = {

Background: Having longer lived parents has been shown to be an important predictor of health trajectories and life span. As such, parental life span is an important phenotype that may uncover genes that affect longevity.

Methods: A genome-wide association study of parental life span in participants of European and African ancestry from the Health and Retirement Study was conducted.

Results: A genome-wide significant association was observed for rs35715456 (log10BF = 6.3) on chromosome 18 for the dichotomous trait of having at least one long-lived parent versus not having any long-lived parent. This association was not replicated in an independent sample from the InCHIANTI and Framingham Heart Study. The most significant association among single nucleotide polymorphisms in longevity candidate genes (APOE, MINIPP1, FOXO3, EBF1, CAMKIV, and OTOL1) was observed in the EBF1 gene region (rs17056207, p = .0002).

Conclusions: A promising genetic signal for parental life span was identified but was not replicated in independent samples.

}, keywords = {Aged, Aged, 80 and over, Chromosomes, Human, Pair 18, Female, Genome-Wide Association Study, Humans, Longevity, Male, Middle Aged, Parents, Phenotype, Polymorphism, Single Nucleotide, Trans-Activators}, issn = {1758-535X}, doi = {10.1093/gerona/glw206}, url = {http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw206https://academic.oup.com/biomedgerontology/article/2422264/Genomewide-Association-Study-of-Parental-Life-Span}, author = {Toshiko Tanaka and Ambarish Dutta and Luke C Pilling and Xue, Luting and Kathryn L Lunetta and Joanne M Murabito and Bandinelli, Stefania and Robert B Wallace and David Melzer and Luigi Ferrucci} } @article {12131, title = {Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity.}, journal = {Nature Communications}, volume = {8}, year = {2017}, pages = {910}, abstract = {

Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents{\textquoteright} survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan.Variability in human longevity is genetically influenced. Using genetic data of parental lifespan, the authors identify associations at HLA-DQA/DRB1 and LPA and find that genetic variants that increase educational attainment have a positive effect on lifespan whereas increasing BMI negatively affects lifespan.

}, keywords = {Alleles, Body Mass Index, Coronary Disease, Education, Genetic Predisposition to Disease, Genome-Wide Association Study, HLA-DQ alpha-Chains, HLA-DRB1 Chains, Humans, Insulin Resistance, Life Style, Lipoprotein(a), Lipoproteins, HDL, Longevity, Lung Neoplasms, Obesity, Polymorphism, Single Nucleotide, Smoking, Socioeconomic factors}, issn = {2041-1723}, doi = {10.1038/s41467-017-00934-5}, author = {Joshi, Peter K and Nicola Pirastu and Kentistou, Katherine A and Fischer, Krista and Edith Hofer and Schraut, Katharina E and Clark, David W and Nutile, Teresa and Barnes, Catriona L K and Paul Rhj Timmers and Shen, Xia and Gandin, Ilaria and McDaid, Aaron F and Hansen, Thomas Folkmann and Gordon, Scott D and Giulianini, Franco and Boutin, Thibaud S and Abdellaoui, Abdel and Zhao, Wei and Medina-Gomez, Carolina and Traci M Bartz and Trompet, Stella and Leslie A Lange and Raffield, Laura and van der Spek, Ashley and Galesloot, Tessel E and Proitsi, Petroula and Yanek, Lisa R and Bielak, Lawrence F and Payton, Antony and Murgia, Federico and Concas, Maria Pina and Biino, Ginevra and Tajuddin, Salman M and Sepp{\"a}l{\"a}, Ilkka and Amin, Najaf and Boerwinkle, Eric and B{\o}rglum, Anders D and Campbell, Archie and Ellen W Demerath and Demuth, Ilja and Jessica Faul and Ford, Ian and Gialluisi, Alessandro and G{\"o}gele, Martin and Graff, Mariaelisa and Aroon Hingorani and Jouke-Jan Hottenga and Hougaard, David M and Hurme, Mikko A and Ikram, M Arfan and Jylh{\"a}, Marja and Kuh, Diana and Ligthart, Lannie and Lill, Christina M and Lindenberger, Ulman and Lumley, Thomas and M{\"a}gi, Reedik and Marques-Vidal, Pedro and Sarah E Medland and Lili Milani and Nagy, Reka and William E R Ollier and Peyser, Patricia A and Pramstaller, Peter P and Ridker, Paul M and Fernando Rivadeneira and Ruggiero, Daniela and Saba, Yasaman and Schmidt, Reinhold and Schmidt, Helena and Slagboom, P Eline and Smith, Blair H and Smith, Jennifer A and Sotoodehnia, Nona and Steinhagen-Thiessen, Elisabeth and van Rooij, Frank J A and Verbeek, Andr{\'e} L and Vermeulen, Sita H and Vollenweider, Peter and Wang, Yunpeng and Werge, Thomas and Whitfield, John B and Alan B Zonderman and Lehtim{\"a}ki, Terho and Michele K Evans and Pirastu, Mario and Fuchsberger, Christian and Bertram, Lars and Pendleton, Neil and Sharon L R Kardia and Ciullo, Marina and Becker, Diane M and Wong, Andrew and Psaty, Bruce M and Cornelia M van Duijn and Wilson, James G and Jukema, J Wouter and Lambertus A Kiemeney and Andr{\'e} G Uitterlinden and Franceschini, Nora and Kari E North and David R Weir and Andres Metspalu and Dorret I Boomsma and Caroline Hayward and Daniel I Chasman and Nicholas G Martin and Sattar, Naveed and Campbell, Harry and T{\~o}nu Esko and Kutalik, Zolt{\'a}n and James F Wilson} } @article {8573, title = {Glycated haemoglobin (HbA1c), diabetes and trajectories of change in episodic memory performance.}, journal = {J Epidemiol Community Health}, volume = {71}, year = {2017}, month = {2017 02}, pages = {115-120}, abstract = {

BACKGROUND: As the ageing population grows, it is important to identify strategies to moderate cognitive ageing.

OBJECTIVE: We examined glycated haemoglobin (HbA1c) and diabetes in relation to level and change in episodic memory in older adults with and without diabetes.

METHODS: Data from 4419 older adults with (n=950) and without (n=3469) diabetes participating in a nationally representative longitudinal panel study (the Health and Retirement Study) were examined. Average baseline age was 72.66 years and 58\% were women. HbA1c was measured in 2006 and episodic memory was measured using immediate and delayed list recall over 4 biennial waves between 2006 and 2012. Growth curve models were used to assess trajectories of episodic memory change.

RESULTS: In growth curve models adjusted for age, sex, education, race, depressive symptoms and waist circumference, higher HbA1c levels and having diabetes were associated with poorer baseline episodic memory (p=0.036 and <0.001, respectively) and greater episodic memory decline (p=0.006 and 0.004, respectively). The effect of HbA1c on episodic memory decline was smaller than the effect of age. The results were stronger for women than men and were not modified by age or race. When the main analyses were estimated for those with and without diabetes separately, HbA1c was significantly linked to change in episodic memory only among those with diabetes.

CONCLUSIONS: Higher HbA1c and diabetes were both associated with declines in episodic memory, with this relationship further exacerbated by having diabetes and elevated HbA1c. HbA1c appeared more important for episodic memory performance among women than men.

}, keywords = {Aged, cognitive aging, Demography, Diabetes Mellitus, Female, Glycated Hemoglobin A, Humans, Longitudinal Studies, Male, Memory, Episodic, Risk Factors, Sex Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207588}, author = {Pappas, Colleen and Andel, Ross and Frank J Infurna and Seetharaman, Shyam} } @article {8571, title = {Healthy Aging in the Context of Educational Disadvantage: The Role of "Ordinary Magic".}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 10}, pages = {1214-1234}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Educational Status, Female, Health Behavior, healthy aging, Humans, Logistic Models, Male, Middle Aged, Social Class, United States}, issn = {1552-6887}, doi = {10.1177/0898264316659994}, url = {http://jah.sagepub.com/cgi/doi/10.1177/0898264316659994}, author = {Sara J McLaughlin} } @article {8698, title = {Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 Aug 01}, pages = {1117-1122}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aging, Cross-Cultural Comparison, Disability Evaluation, Female, Geriatric Assessment, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Self Report, Statistics, Nonparametric, United Kingdom, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw209}, author = {Bendayan, Rebecca and Cooper, Rachel and Elizabeth G Wloch and Scott M Hofer and Andrea M Piccinin and Graciela Mu{\~n}iz Terrera} } @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 {8831, title = {Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement?}, journal = {J Occup Environ Med}, volume = {59}, year = {2017}, month = {2017 02}, pages = {184-190}, abstract = {

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Adolescent, Age of Onset, Aged, Aged, 80 and over, Aging, Child, Child Health, Chronic disease, Disabled Persons, Female, health, Health Status, Health Surveys, Humans, Male, Middle Aged, Retirement, Self Report, Work}, issn = {1876-7583}, doi = {10.1016/j.dhjo.2016.12.016}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1}, author = {Caitlin E. Coyle and Putnam, Michelle} } @article {8483, title = {Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.}, journal = {Health Serv Res}, volume = {52}, year = {2017}, month = {2017 02}, pages = {113-131}, abstract = {

OBJECTIVE: To create and test three prospective, increasingly restrictive definitions of serious illness.

DATA SOURCES: Health and Retirement Study, 2000-2012.

STUDY DESIGN: We evaluated subjects{\textquoteright} 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12~months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.

DATA COLLECTION: Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.

PRINCIPAL FINDINGS: One-year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.

CONCLUSIONS: Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Critical Illness, Early Diagnosis, Female, Health Care Costs, Hospitalization, Humans, Male, Medicare, Nursing homes, Prospective Studies, Quality Improvement, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12479}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26990009}, author = {Amy Kelley and Kenneth E Covinsky and Rebecca Jean Gorges and McKendrick, Karen and Bollens-Lund, Evan and R Sean Morrison and Christine S Ritchie} } @article {8697, title = {Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 03}, pages = {276-284}, abstract = {

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Health Behavior, Health Expenditures, Health Status, Humans, Machine learning, Male, Medicare, Retrospective Studies, Self Report, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000660}, author = {Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Avi Dor and Charles W Given and Kurt C Stange and Siran M Koroukian} } @article {8820, title = {The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 01}, pages = {71-80}, abstract = {

BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals.

OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment.

MAIN MEASURES: Outcomes measured were readmissions <=30~days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents >=65~years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race.

KEY RESULTS: For pneumonia, >=3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); {\textquoteright}other{\textquoteright} patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496).

CONCLUSIONS: Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, Comorbidity, Disability Evaluation, Female, Heart Failure, Humans, Logistic Models, Male, Myocardial Infarction, Patient Readmission, Pneumonia, Retrospective Studies, Risk Adjustment, Social determinants of health}, issn = {1525-1497}, doi = {10.1007/s11606-016-3869-x}, url = {http://link.springer.com/10.1007/s11606-016-3869-xhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/article/10.1007/s11606-016-3869-x/fulltext.html}, author = {Meddings, Jennifer and Reichert, Heidi and Shawna N Smith and Theodore J Iwashyna and Kenneth M. Langa and Timothy P Hofer and Laurence F McMahon} } @article {10466, title = {The Impact of Medicare Part D on Emergency Department Visits.}, journal = {Health Economics}, volume = {26}, year = {2017}, month = {2017 04}, pages = {536-544}, abstract = {

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Delivery of Health Care, Emergency Service, Hospital, Female, Humans, Insurance Coverage, Insurance, Health, Male, Medicare Part D, Middle Aged, prescription drugs, Surveys and Questionnaires, United States}, issn = {1099-1050}, doi = {10.1002/hec.3326}, author = {Padmaja Ayyagari and Dan M. Shane and George L Wehby} } @article {8756, title = {Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 02}, pages = {216-222}, abstract = {

BACKGROUND: Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement.

METHODS: Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component.

RESULTS: In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95\% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95\% CI = 1.71-2.59 (excluding pain).

CONCLUSIONS: Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

}, keywords = {Aged, Chronic pain, Female, Frail Elderly, Geriatric Assessment, Humans, Male, Phenotype, Prognosis}, issn = {1758-535X}, doi = {10.1093/gerona/glw212}, url = {http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw212}, author = {Matthew C. Lohman and Karen L Whiteman and Rebecca L. Greenberg and Martha L. Bruce} } @article {8507, title = {The Influence of the Transportation Environment on Driving Reduction and Cessation.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 10 01}, pages = {824-832}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Automobile Driving, environment, Family Characteristics, Female, Geographic Information Systems, Health Status, Humans, Longitudinal Studies, Male, Marital Status, Risk, Survival Analysis, Transportation, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnw088}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27342439}, author = {Jonathon M Vivoda and Steven G Heeringa and Amy J Schulz and Grengs, Joe and Cathleen M. Connell} } @article {6502, title = {Loneliness, depression and cognitive function in older U.S. adults.}, journal = {Int J Geriatr Psychiatry}, volume = {32}, year = {2017}, month = {2017 May}, pages = {564-573}, abstract = {

OBJECTIVE: To examine reciprocal relations of loneliness and cognitive function in older adults.

METHODS: Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression.

RESULTS: Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = -0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95\% CI (1.1-1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time.

CONCLUSION: Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Aged, 80 and over, Cognitive Dysfunction, Demography, Depressive Disorder, Female, Humans, Loneliness, Longitudinal Studies, Male, Middle Aged, Risk Factors}, issn = {1099-1166}, doi = {10.1002/gps.4495}, url = {http://dx.doi.org/10.1002/gps.4495}, author = {Nancy J. Donovan and Bei Wu and Dorene M. Rentz and Reisa A. Sperling and Gad A. Marshall and M. Maria Glymour} } @article {8490, title = {A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {2017 09}, pages = {960-986}, abstract = {

This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34\% died in hospital, and 66\% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43\% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.

}, keywords = {Aged, Aged, 80 and over, Decision making, Fee-for-Service Plans, Female, health policy, Hospices, Hospital Mortality, Humans, Longitudinal Studies, Male, Medicare Part C, Terminal Care, United States}, issn = {1552-7573}, doi = {10.1177/0164027516645843}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27193048}, author = {Elizabeth Edmiston Chen and Edward Alan Miller} } @article {8563, title = {Mental health and breast cancer screening utilization among older Hispanic women.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017 Mar-Apr}, pages = {163-172}, abstract = {

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women{\textquoteright}s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

}, keywords = {Affect, Aged, Anxiety, Breast Neoplasms, Early Detection of Cancer, Female, Hispanic Americans, Humans, Logistic Models, Middle Aged, Motivation, Patient Acceptance of Health Care, United States, Vulnerable Populations}, issn = {1540-7322}, doi = {10.1080/08952841.2015.1113726}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27485158}, author = {Tamara J. Cadet and Berrett-Abebe, Julie and Stewart, Kathleen} } @article {8828, title = {Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S.}, journal = {Soc Sci Med}, volume = {174}, year = {2017}, month = {2017 02}, pages = {149-158}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Health Status, Humans, Interpersonal Relations, Male, Residence Characteristics, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.12.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml}, author = {Esther M Friedman and Regina A Shih and Mary E Slaughter and Margaret M Weden and Kathleen A. Cagney} } @article {12138, title = {New Blood Pressure-Associated Loci Identified in Meta-Analyses of 475 000 Individuals.}, journal = {Circulation: Cardiovascular Genetics}, volume = {10}, year = {2017}, pages = {e001778}, abstract = {

BACKGROUND: Genome-wide association studies have recently identified >400 loci that harbor DNA sequence variants that influence blood pressure (BP). Our earlier studies identified and validated 56 single nucleotide variants (SNVs) associated with BP from meta-analyses of exome chip genotype data. An additional 100 variants yielded suggestive evidence of association.

METHODS AND RESULTS: Here, we augment the sample with 140 886 European individuals from the UK Biobank, in whom 77 of the 100 suggestive SNVs were available for association analysis with systolic BP or diastolic BP or pulse pressure. We performed 2 meta-analyses, one in individuals of European, South Asian, African, and Hispanic descent (pan-ancestry, ≈475 000), and the other in the subset of individuals of European descent (≈423 000). Twenty-one SNVs were genome-wide significant (<5{\texttimes}10) for BP, of which 4 are new BP loci: rs9678851 (missense, ), rs7437940 (), rs13303 (missense, ), and rs1055144 (). In addition, we identified a potentially independent novel BP-associated SNV, rs3416322 (missense, ) at a known locus, uncorrelated with the previously reported SNVs. Two SNVs are associated with expression levels of nearby genes, and SNVs at 3 loci are associated with other traits. One SNV with a minor allele frequency <0.01, (rs3025380 at ) was genome-wide significant.

CONCLUSIONS: We report 4 novel loci associated with BP regulation, and 1 independent variant at an established BP locus. This analysis highlights several candidate genes with variation that alter protein function or gene expression for potential follow-up.

}, keywords = {Antiporters, Blood pressure, Cell Adhesion Molecules, Neuronal, Databases, Factual, Genetic Loci, Genome-Wide Association Study, Genotype, Humans, Microfilament Proteins, Phenotype, Polymorphism, Single Nucleotide, Receptors, Lymphocyte Homing}, issn = {1942-3268}, doi = {10.1161/CIRCGENETICS.117.001778}, author = {Kraja, Aldi T and Cook, James P and Warren, Helen R and Surendran, Praveen and Liu, Chunyu and Evangelou, Evangelos and Alisa Manning and Grarup, Niels and Drenos, Fotios and Sim, Xueling and Smith, Albert Vernon and Amin, Najaf and Alexandra I Blakemore and Bork-Jensen, Jette and Brandslund, Ivan and Farmaki, Aliki-Eleni and Fava, Cristiano and Ferreira, Teresa and Herzig, Karl-Heinz and Giri, Ayush and Giulianini, Franco and Grove, Megan L and Guo, Xiuqing and Sarah E Harris and Have, Christian T and Havulinna, Aki S and Zhang, He and J{\o}rgensen, Marit E and K{\"a}r{\"a}j{\"a}m{\"a}ki, AnneMari and Charles Kooperberg and Linneberg, Allan and Little, Louis and Liu, Yongmei and Bonnycastle, Lori L and Lu, Yingchang and M{\"a}gi, Reedik and Mahajan, Anubha and Malerba, Giovanni and Riccardo E Marioni and Mei, Hao and Menni, Cristina and Alanna C Morrison and Padmanabhan, Sandosh and Walter R Palmas and Poveda, Alaitz and Rauramaa, Rainer and Nigel W Rayner and Riaz, Muhammad and Rice, Ken and Melissa Richard and Smith, Jennifer A and Southam, Lorraine and Stan{\v c}{\'a}kov{\'a}, Alena and Kathleen E Stirrups and Tragante, Vinicius and Tuomi, Tiinamaija and Tzoulaki, Ioanna and Varga, Tibor V and Weiss, Stefan and Yiorkas, Andrianos M and Young, Robin and Zhang, Weihua and Barnes, Michael R and Cabrera, Claudia P and Gao, He and Boehnke, Michael and Boerwinkle, Eric and Chambers, John C and Connell, John M and Cramer Christensen and de Boer, Rudolf A and Ian J Deary and George Dedoussis and Deloukas, Panos and Dominiczak, Anna F and D{\"o}rr, Marcus and Joehanes, Roby and Edwards, Todd L and T{\~o}nu Esko and Myriam Fornage and Franceschini, Nora and Franks, Paul W and Gambaro, Giovanni and Leif C Groop and Hallmans, G{\"o}ran and Hansen, Torben and Caroline Hayward and Heikki, Oksa and Ingelsson, Erik and Tuomilehto, Jaakko and J{\"a}rvelin, Marjo-Riitta and Sharon L R Kardia and Karpe, Fredrik and Kooner, Jaspal S and Lakka, Timo A and Langenberg, Claudia and Lars Lind and Ruth J F Loos and Laakso, Markku and McCarthy, Mark I and Melander, Olle and Mohlke, Karen L and Morris, Andrew P and Palmer, Colin N A and Pedersen, Oluf and Polasek, Ozren and Neil Poulter and Province, Michael A and Psaty, Bruce M and Ridker, Paul M and Rotter, Jerome I and Rudan, Igor and Veikko Salomaa and Nilesh J Samani and Peter Sever and Skaaby, Tea and Stafford, Jeanette M and John M Starr and van der Harst, Pim and van der Meer, Peter and Cornelia M van Duijn and Vergnaud, Anne-Claire and Gudnason, Vilmundur and Wareham, Nicholas J and Wilson, James G and Willer, Cristen J and Daniel Witte and Zeggini, Eleftheria and Saleheen, Danish and Adam S Butterworth and Danesh, John and Asselbergs, Folkert W and Wain, Louise V and Georg B Ehret and Daniel I Chasman and Caulfield, Mark J and Elliott, Paul and Lindgren, Cecilia M and Levy, Daniel and Newton-Cheh, Christopher and Munroe, Patricia B and Howson, Joanna M M} } @article {6516, title = {Older Adults With Three Generations of Kin: Prevalence, Correlates, and Transfers.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Oct 01}, pages = {1067-1072}, abstract = {

OBJECTIVES: We document the prevalence and sociodemographic correlates of older adults with three generations of living kin and examine the patterns of transfers among this group compared with those with fewer generations of kin available.

METHOD: We use the Health and Retirement Study (1998-2010) to estimate kin availability and intergenerational transfers among respondents in their 50s, 60s, and 70s.

RESULTS: It is far more common for older adults to have aging parents, children, and grandchildren than to have just two generations of kin (parents and children). Forty percent of adults in their 50s, 30\% of those in their 60s, and 7.5\% of those in their 70s have three generations of kin available. Hispanics and the least educated are more likely to have this generational configuration. The vast majority provides financial or in-kind transfers to at least one generation, and a large minority provides support to both older and younger generations.

DISCUSSION: Although there has been much concern about the strains among those sandwiched between parents and children, it is far more common among older adults to also have grandchildren, and many of these adults are transferring resources both upward and downward to multiple generations.

}, keywords = {Aged, Black or African American, Family, Family Characteristics, Female, Hispanic or Latino, Humans, Intergenerational Relations, Male, Middle Aged, Resource Allocation, Social Support, Surveys and Questionnaires, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbv158}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/26/geronb.gbv158.abstract}, author = {Rachel Margolis and Wright, Laura} } @article {8814, title = {Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer.}, journal = {JAMA Oncol}, volume = {3}, year = {2017}, month = {2017 Jun 01}, pages = {757-765}, abstract = {

Importance: Medicare beneficiaries with cancer are at risk for financial hardship given increasingly expensive cancer care and significant cost sharing by beneficiaries.

Objectives: To measure out-of-pocket (OOP) costs incurred by Medicare beneficiaries with cancer and identify which factors and services contribute to high OOP costs.

Design, Setting, and Participants: We prospectively collected survey data from 18 166 community-dwelling Medicare beneficiaries, including 1409 individuals who were diagnosed with cancer during the study period, who participated in the January 1, 2002, to December 31, 2012, waves of the Health and Retirement Study, a nationally representative panel study of US residents older than 50 years. Data analysis was performed from July 1, 2014, to June 30, 2015.

Main Outcomes and Measures: Out-of-pocket medical spending and financial burden (OOP expenditures divided by total household income).

Results: Among the 1409 participants (median age, 73 years [interquartile range, 69-79 years]; 46.4\% female and 53.6\% male) diagnosed with cancer during the study period, the type of supplementary insurance was significantly associated with mean annual OOP costs incurred after a cancer diagnosis ($2116 among those insured by Medicaid, $2367 among those insured by the Veterans Health Administration, $5976 among those insured by a Medicare health maintenance organization, $5492 among those with employer-sponsored insurance, $5670 among those with Medigap insurance coverage, and $8115 among those insured by traditional fee-for-service Medicare but without supplemental insurance coverage). A new diagnosis of cancer or common chronic noncancer condition was associated with increased odds of incurring costs in the highest decile of OOP expenditures (cancer: adjusted odds ratio, 1.86; 95\% CI, 1.55-2.23; P < .001; chronic noncancer condition: adjusted odds ratio, 1.82; 95\% CI, 1.69-1.97; P < .001). Beneficiaries with a new cancer diagnosis and Medicare alone incurred OOP expenditures that were a mean of 23.7\% of their household income; 10\% of these beneficiaries incurred OOP expenditures that were 63.1\% of their household income. Among the 10\% of beneficiaries with cancer who incurred the highest OOP costs, hospitalization contributed to 41.6\% of total OOP costs.

Conclusions and Relevance: Medicare beneficiaries without supplemental insurance incur significant OOP costs following a diagnosis of cancer. Costs associated with hospitalization may be a primary contributor to these high OOP costs. Medicare reform proposals that restructure the benefit design for hospital-based services and incorporate an OOP maximum may help alleviate financial burden, as can interventions that reduce hospitalization in this population.

}, keywords = {Aged, Cost of Illness, Female, Financing, Personal, Health Expenditures, Humans, Income, Insurance, Health, Male, Medicare, Neoplasms, Prospective Studies, Social Class, United States}, issn = {2374-2445}, doi = {10.1001/jamaoncol.2016.4865}, url = {http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2016.4865}, author = {Amol K Narang and Lauren Hersch Nicholas} } @article {8700, title = {Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults.}, journal = {Health Psychol}, volume = {36}, year = {2017}, month = {2017 Feb}, pages = {112-121}, abstract = {

OBJECTIVE: Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms.

METHOD: Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults.

RESULTS: Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31\% of the obesity-related increase in depressive symptoms on average across the 3 studies.

CONCLUSION: In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record

}, keywords = {Adult, Aged, Body Weight, depression, Female, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Prejudice, Prospective Studies, United Kingdom, United States, Young Adult}, issn = {1930-7810}, doi = {10.1037/hea0000426}, author = {Robinson, Eric and Angelina R Sutin and Daly, Michael} } @article {6519, title = {Personality and Lung Function in Older Adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Oct 01}, pages = {913-921}, abstract = {

OBJECTIVES: Lung disease is a leading cause of disability and death among older adults. We examine whether personality traits are associated with lung function and shortness of breath (dyspnea) in a national cohort with and without chronic obstructive pulmonary disease (COPD).

METHOD: Participants (N = 12,670) from the Health and Retirement Study were tested for peak expiratory flow (PEF) and completed measures of personality, health behaviors, and a medical history.

RESULTS: High neuroticism and low extraversion, openness, agreeableness, and conscientiousness were associated with lower PEF, and higher likelihood of COPD and dyspnea. Conscientiousness had the strongest and most consistent associations, including lower risk of PEF less than 80\% of the predicted value (OR = 0.67; 0.62-0.73) and dyspnea (OR = 0.52; 0.47-0.57). Although attenuated, the associations remained significant when accounting for smoking, physical activity, and chronic diseases including cardiovascular and psychiatric disorders. The associations between personality and PEF or dyspnea were similar among those with or without COPD, suggesting that psychological links to lung function are not disease dependent. In longitudinal analyses, high neuroticism (β = -0.019) and low conscientiousness (β = 0.027) predicted steeper declines in PEF.

DISCUSSION: A vulnerable personality profile is common among individuals with limited lung function and COPD, predicts shortness of breath and worsening lung function.

}, keywords = {Aged, Aged, 80 and over, Anxiety Disorders, Character, Disease Susceptibility, Dyspnea, Female, Follow-Up Studies, Health Behavior, Humans, Male, Medical History Taking, Middle Aged, Neuroticism, Peak Expiratory Flow Rate, Pulmonary Disease, Chronic Obstructive, Risk Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbv161}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/18/geronb.gbv161.abstract}, author = {Antonio Terracciano and Yannick Stephan and Martina Luchetti and Gonzalez-Rothi, Ricardo and Angelina R Sutin} } @article {8511, title = {Positive Self-Perceptions of Aging and Lower Rate of Overnight Hospitalization in the US Population Over Age 50.}, journal = {Psychosom Med}, volume = {79}, year = {2017}, month = {2017 01}, pages = {81-90}, abstract = {

OBJECTIVE: The aging of the baby boomer generation has led to an unprecedented rise in the number of US adults reaching old age, prompting an urgent call for innovative and cost-effective ways to address the increasing health care needs of the aging population. Studying the role of psychosocial factors on health care use could offer insight into how to minimize hospitalizations among older adults.

METHODS: We use prospective data from a subsample of 4735 participants (mean [standard deviation] age = 69 [8.79] years, 61\% women) from the Health and Retirement Study, a nationally representative study of US adults over age 50, to examine the association between self-perceptions of aging (SPA) and self-reported overnight hospitalizations after adjusting for a comprehensive list of sociodemographic, health-related, and behavioral factors.

RESULTS: Over the 4-year follow-up period, there were a total of 5196 overnight hospitalizations, and 44\% of the sample reported being hospitalized overnight at least once. After adjusting for sociodemographic factors, each standard deviation increase in positive SPA was associated with a lower rate of overnight hospitalization (incidence rate ratio = 0.75; 95\% confidence interval = 0.71-0.80, p < .001). After dividing respondents into quartiles of SPA, we observed a dose-response relationship with individuals in higher quartiles showing increasingly lower rates of overnight hospitalization.

CONCLUSIONS: Positive self-perceptions of aging are associated with a lower rate of hospitalization among older adults over a 4-year period. Future research should examine the factors that contribute to older adults{\textquoteright} SPA and explore the pathways through which attitudes toward aging influence the use of health care resources.

}, keywords = {Aged, Aging, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Self Concept, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000364}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27359184}, author = {Jennifer K Sun and Eric S Kim and Jacqui Smith} } @article {8804, title = {Psychosocial correlates of cervical cancer screening among older Hispanic women.}, journal = {Soc Work Health Care}, volume = {56}, year = {2017}, month = {2017 02}, pages = {124-139}, abstract = {

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women{\textquoteright}s participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Early Detection of Cancer, Female, Hispanic Americans, Humans, Logistic Models, Mass Screening, Middle Aged, Uterine Cervical Neoplasms}, issn = {1541-034X}, doi = {10.1080/00981389.2016.1263268}, url = {https://www.tandfonline.com/doi/full/10.1080/00981389.2016.1263268}, author = {Tamara J. Cadet and Stewart, Kathleen and Howard, Tenial} } @article {6517, title = {Race Differences in Advance Directive Completion.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Mar}, pages = {324-342}, abstract = {

OBJECTIVE: Rates of advance directive completion have increased over the past decade, but significant race differences remain. This study examined how overall increases in advance directive completion have affected disparities between White and African American older adults.

METHOD: Data were taken from the Health and Retirement Study (HRS). Using logistic regression models, the odds of having an advance directive among a sample of older African Americans and Whites who died between 2001 and 2012 were compared ( N = 5,832).

RESULTS: Odds for African Americans were 16\% of the odds for Whites, p < .001, 95\% confidence interval (CI) = [0.11, 0.23]. There were no significant interactions between race and year of death before 2010. During 2010-2012, the increase in the odds for African Americans was greater than for Whites, odds ratio (OR) = 1.95, p = .02, 95\% CI = [1.14, 3.35].

DISCUSSION: Although race disparities remain, the gap between Whites and African Americans has begun to narrow.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Black or African American, Female, Humans, Interviews as Topic, Logistic Models, Male, Qualitative Research, White People}, issn = {1552-6887}, doi = {10.1177/0898264316635568}, url = {http://jah.sagepub.com/content/early/2016/03/03/0898264316635568.abstract}, author = {Catheryn S Koss and Tamara A. Baker} } @article {12137, title = {Rare variants in fox-1 homolog A (RBFOX1) are associated with lower blood pressure.}, journal = {PLoS Genetics}, volume = {13}, year = {2017}, pages = {e1006678}, abstract = {

Many large genome-wide association studies (GWAS) have identified common blood pressure (BP) variants. However, most of the identified BP variants do not overlap with the linkage evidence observed from family studies. We thus hypothesize that multiple rare variants contribute to the observed linkage evidence. We performed linkage analysis using 517 individuals in 130 European families from the Cleveland Family Study (CFS) who have been genotyped on the Illumina OmniExpress Exome array. The largest linkage peak was observed on chromosome 16p13 (MLOD = 2.81) for systolic blood pressure (SBP). Follow-up conditional linkage and association analyses in the linkage region identified multiple rare, coding variants in RBFOX1 associated with reduced SBP. In a 17-member CFS family, carriers of the missense variant rs149974858 are normotensive despite being obese (average BMI = 60 kg/m2). Gene-based association test of rare variants using SKAT-O showed significant association with SBP (p-value = 0.00403) and DBP (p-value = 0.0258) in the CFS participants and the association was replicated in large independent replication studies (N = 57,234, p-value = 0.013 for SBP, 0.0023 for PP). RBFOX1 is expressed in brain tissues, the atrial appendage and left ventricle in the heart, and in skeletal muscle tissues, organs/tissues which are potentially related to blood pressure. Our study showed that associations of rare variants could be efficiently detected using family information.

}, keywords = {Adult, Blood pressure, Body Mass Index, Chromosomes, Human, Pair 16, Family Health, Female, Gene Expression, Gene Frequency, Genetic Linkage, Genetic Predisposition to Disease, Genome-Wide Association Study, Genotype, Humans, Male, Middle Aged, Pedigree, Polymorphism, Single Nucleotide, RNA Splicing Factors, Whites}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006678}, author = {He, Karen Y and Wang, Heming and Brian E Cade and Nandakumar, Priyanka and Giri, Ayush and Erin B Ware and Jeffrey Haessler and Liang, Jingjing and Smith, Jennifer A and Franceschini, Nora and Le, Thu H and Charles Kooperberg and Edwards, Todd L and Sharon L R Kardia and Lin, Xihong and Chakravarti, Aravinda and Redline, Susan and Zhu, Xiaofeng} } @article {8678, title = {Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {153-158}, abstract = {

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one{\textquoteright}s previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2~years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects >=65~years of age sustained a hip fracture (mean age 84 {\textpm} 7~years, 77~\% female). Thirty-one percent returned to pre-fracture ADL function, 34~\% to pre-fracture mobility function, and 41~\% to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36~\% returned to independence, 27~\% survived but needed ADL assistance, and 37~\% died. Return to ADL independence was less likely for those >=85~years old (26~\% vs. 44~\%), with dementia (8~\% vs. 39~\%), and with a Charlson comorbidity score >2 (23~\% vs. 44~\%). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Dementia, Female, Geriatric Assessment, Hip Fractures, Humans, Longitudinal Studies, Male, Mobility Limitation, Recovery of Function, Walking}, issn = {1525-1497}, doi = {10.1007/s11606-016-3848-2}, author = {Victoria L. Tang and Rebecca L. Sudore and Irena Cenzer and W John Boscardin and Alexander K Smith and Christine S Ritchie and Margaret Wallhagen and Finlayson, Emily and Petrillo, Laura and Kenneth E Covinsky} } @article {8816, title = {Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 04}, pages = {371-378}, abstract = {

BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (>=14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (>=3 activities of daily living) or cognitive limitations moderated this relationship.

RESULTS: Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with >=3 activities of daily living, fall risks were reduced by 21\% for those receiving high levels of informal care; additionally, FRIs were reduced by 42\% and 58\% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54\% FRI risk reduction among the cognitively impaired.

CONCLUSIONS: Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Female, Geriatric Assessment, Humans, Independent Living, Longitudinal Studies, Male, Middle Aged, Risk Assessment, Risk Factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000677}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00005650-900000000-98801}, author = {Geoffrey J Hoffman and Hays, Ron D and Steven P Wallace and Martin F Shapiro and Yakusheva, Olga and Susan L Ettner} } @article {8578, title = {The relationship between family support; pain and depression in elderly with arthritis.}, journal = {Psychol Health Med}, volume = {22}, year = {2017}, month = {2017 01}, pages = {75-86}, abstract = {

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0\%) and 1567 females (65.0\%) with arthritic conditions (n~=~2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p~<~.05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

}, keywords = {Aged, Aged, 80 and over, Aging, Arthralgia, Arthritis, depression, Family, Female, Humans, Male, Middle Aged, Social Support, United States}, issn = {1465-3966}, doi = {10.1080/13548506.2016.1211293}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27427504}, author = {Hung, Man and Bounsanga, Jerry and Maren W Voss and Anthony B. Crum and Wei Chen and Wendy Church Birmingham} } @article {6463, title = {Retrospective Reports of Negative Early Life Events Over a 4-Year Period: A Test of Measurement Invariance and Response Consistency.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Sep 01}, pages = {901-912}, abstract = {

OBJECTIVES: The present study examined measurement invariance (i.e., construct validity), response consistency (i.e., test-retest reliability), and potential predictors of response consistency to the Health and Retirement Study (HRS) negative early life events questionnaire over two time points.

METHOD: The study was based on the HRS psychosocial questionnaire, which is a U.S. nationally representative survey of individuals older than 50 years and their spouses of any age. Overall, 4,541 individuals older than 50 years were eligible to complete the questionnaire and responded to all four negative early life events items in 2008 and 2012.

RESULTS: Only partial invariance across the two time points was established (with three of the four loadings and two thresholds remaining constant over time). For 20\% of the sample, at least one item was inconsistently reported across waves. A positive response to a negative early life event item in 2008 was the most consistent predictor of response inconsistency over time.

CONCLUSIONS: The measure of negative early life events has limited construct validity and test-retest reliability. Inconsistency is particularly high among those who had first endorsed an item. The use of this retrospective measure for the understanding of age and aging should be considered with caution. Panel surveys might consider probing about early life events repeatedly to better address inconsistencies over time.

}, keywords = {Aged, Child, Child, Preschool, Female, Humans, Life Change Events, Male, Memory, Episodic, Middle Aged, Models, Statistical, Psychometrics, Reproducibility of Results, Retrospective Studies, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbv087}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/23/geronb.gbv087.abstract}, author = {Liat Ayalon} } @article {12120, title = {Single-trait and multi-trait genome-wide association analyses identify novel loci for blood pressure in African-ancestry populations.}, journal = {PLoS Genetics}, volume = {13}, year = {2017}, pages = {e1006728}, abstract = {

Hypertension is a leading cause of global disease, mortality, and disability. While individuals of African descent suffer a disproportionate burden of hypertension and its complications, they have been underrepresented in genetic studies. To identify novel susceptibility loci for blood pressure and hypertension in people of African ancestry, we performed both single and multiple-trait genome-wide association analyses. We analyzed 21 genome-wide association studies comprised of 31,968 individuals of African ancestry, and validated our results with additional 54,395 individuals from multi-ethnic studies. These analyses identified nine loci with eleven independent variants which reached genome-wide significance (P < 1.25{\texttimes}10-8) for either systolic and diastolic blood pressure, hypertension, or for combined traits. Single-trait analyses identified two loci (TARID/TCF21 and LLPH/TMBIM4) and multiple-trait analyses identified one novel locus (FRMD3) for blood pressure. At these three loci, as well as at GRP20/CDH17, associated variants had alleles common only in African-ancestry populations. Functional annotation showed enrichment for genes expressed in immune and kidney cells, as well as in heart and vascular cells/tissues. Experiments driven by these findings and using angiotensin-II induced hypertension in mice showed altered kidney mRNA expression of six genes, suggesting their potential role in hypertension. Our study provides new evidence for genes related to hypertension susceptibility, and the need to study African-ancestry populations in order to identify biologic factors contributing to hypertension.

}, keywords = {African Americans, Animals, Basic Helix-Loop-Helix Transcription Factors, Blood pressure, Cadherins, Case-Control Studies, Female, Genetic Loci, Genome-Wide Association Study, Humans, Hypertension, Male, Membrane Proteins, Mice, Multifactorial Inheritance, Polymorphism, Single Nucleotide}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006728}, author = {Liang, Jingjing and Le, Thu H and Digna R Velez Edwards and Bamidele O Tayo and Gaulton, Kyle J and Smith, Jennifer A and Lu, Yingchang and Jensen, Richard A and Chen, Guanjie and Yanek, Lisa R and Schwander, Karen and Tajuddin, Salman M and Sofer, Tamar and Kim, Wonji and Kayima, James and McKenzie, Colin A and Fox, Ervin and Michael A Nalls and Young, J Hunter and Yan V Sun and Lane, Jacqueline M and Cechova, Sylvia and Zhou, Jie and Tang, Hua and Myriam Fornage and Musani, Solomon K and Wang, Heming and Lee, Juyoung and Adeyemo, Adebowale and Dreisbach, Albert W and Forrester, Terrence and Chu, Pei-Lun and Anne Cappola and Michele K Evans and Alanna C Morrison and Martin, Lisa W and Kerri Wiggins and Hui, Qin and Zhao, Wei and Jackson, Rebecca D and Erin B Ware and Jessica Faul and Reiner, Alex P and Bray, Michael and Denny, Joshua C and Thomas H Mosley and Walter R Palmas and Guo, Xiuqing and George J Papanicolaou and Alan Penman and Polak, Joseph F and Kenneth Rice and Taylor, Ken D and Boerwinkle, Eric and Erwin P Bottinger and Liu, Kiang and Neil Risch and Hunt, Steven C and Charles Kooperberg and Alan B Zonderman and Laurie, Cathy C and Becker, Diane M and Cai, Jianwen and Ruth J F Loos and Psaty, Bruce M and David R Weir and Sharon L R Kardia and Donna K Arnett and Won, Sungho and Edwards, Todd L and Redline, Susan and Cooper, Richard S and Rao, D C and Rotter, Jerome I and Charles N Rotimi and Levy, Daniel and Chakravarti, Aravinda and Zhu, Xiaofeng and Franceschini, Nora} } @article {6500, title = {Smoking Response to Health and Medical Spending Changes and the Role of Insurance.}, journal = {Health Econ}, volume = {26}, year = {2017}, month = {2017 Mar}, pages = {305-320}, abstract = {

Severe health shocks provide new information about one{\textquoteright}s personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post-shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out-of-pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65~years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults{\textquoteright} medical spending changes separate from health shocks influence their smoking behavior. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Cardiovascular Diseases, Female, Health Behavior, Health Expenditures, Health Surveys, Humans, Insurance, Health, Male, Medically Uninsured, Medicare, Middle Aged, Risk Factors, Smoking, Socioeconomic factors, United States}, issn = {1099-1050}, doi = {10.1002/hec.3309}, url = {http://dx.doi.org/10.1002/hec.3309}, author = {Marti, Joachim and Michael R. Richards} } @article {6491, title = {Social Activities, Incident Cardiovascular Disease, and Mortality.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Mar}, pages = {268-288}, abstract = {

OBJECTIVE: This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States.

METHOD: Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated.

RESULTS: Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality.

DISCUSSION: Social activity is a modifiable behavior that may be considered a potential health intervention.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Incidence, Leisure activities, Logistic Models, Male, Middle Aged, Retirement, United States}, issn = {1552-6887}, doi = {10.1177/0898264316635565}, url = {http://jah.sagepub.com/content/early/2016/03/03/0898264316635565.abstract}, author = {Sae Hwang Han and Jane Tavares and Evans, Molly and Jane S Saczynski and Jeffrey A Burr} } @article {8594, title = {Social Capital and Unretirement: Exploring the Bonding, Bridging, and Linking Aspects of Social Relationships.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {2017 12}, pages = {1100-1117}, abstract = {

Working longer is an important area of research given extended life expectancy, shortfalls of retirement income, desires to remain socially engaged, and solvency concerns of social insurance programs. The purpose of this longitudinal population-based study of older adults is to examine how different types of social resources (social bonding, bridging, and linking) relate to returning to work after retirement. Data were drawn from the Health and Retirement Study of fully retired older adults aged 62+ in 1998 ( N = 8,334) and followed to 2008. After controlling for a comprehensive set of fixed and time-varying covariates, findings suggest that social bridging (informal volunteering) and social linking (formal volunteering, partnered with an employed spouse) were strongly and positively related to returning to work (Hazard Ratio [HR]: 1.49, p < .001; HR: 1.58, p < .0001; and HR: 1.75, p < .0001, respectively). Social bonding resources were not significantly associated with returning to work. Implications for social policy are discussed.

}, keywords = {Aged, Aged, 80 and over, Analysis of Variance, Cross-Sectional Studies, Employment, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Social capital, United States}, issn = {1552-7573}, doi = {10.1177/0164027516664569}, url = {http://roa.sagepub.com/cgi/doi/10.1177/0164027516664569}, author = {Guillermo Ernest Gonzales and Nowell, William Benjamin} } @article {8750, title = {Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer.}, journal = {J Geriatr Oncol}, volume = {8}, year = {2017}, month = {2017 03}, pages = {117-124}, abstract = {

OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care.

METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age >=66years who died from cancer (n=835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders.

RESULTS: While 61.2\% of the patients enrolled in hospice, 24.6\% underwent cancer-directed treatment; 55.1\% were admitted to the hospital and/or ED; and 21.7\% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others.

CONCLUSIONS: To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Health Surveys, Hospices, Hospital Mortality, Humans, Logistic Models, Male, multimorbidity, Neoplasms, Population Surveillance, Quality of Health Care, Risk Factors, Socioeconomic factors, Terminal Care}, issn = {1879-4076}, doi = {10.1016/j.jgo.2016.10.001}, url = {http://linkinghub.elsevier.com/retrieve/pii/S1879406816301229http://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/plain}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Charles W Given and Mark Schluchter and Owusu, Cynthia and Nathan A. Berger} } @article {6493, title = {Social Inequalities in Inflammation: Age Variations in Older Persons.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 Aug}, pages = {769-787}, abstract = {

OBJECTIVE: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons.

METHOD: Data are from the 2006/2008 Health and Retirement Study ( n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics.

RESULTS: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age.

DISCUSSION: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Biomarkers, C-reactive protein, Female, Health Status Disparities, Humans, Inflammation, Male, Middle Aged, Racial Groups, Self Report, Socioeconomic factors}, issn = {1552-6887}, doi = {10.1177/0898264316645546}, url = {http://jah.sagepub.com/content/early/2016/04/24/0898264316645546.abstract}, author = {Uchechi A Mitchell and Carol S Aneshensel} } @article {8854, title = {Sociodemographic disparities in chronic pain, based on 12-year longitudinal data.}, journal = {Pain}, volume = {158}, year = {2017}, pages = {313-322}, abstract = {

Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally-plateauing of pain above age 60, and lower pain among racial/ethnic minorities-are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3\% at baseline, increasing to 36.6\% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-{\`a}-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

}, keywords = {Age Distribution, Age Factors, Aged, Aged, 80 and over, Chronic disease, Ethnic Groups, Female, Healthcare Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Sex Factors, Social Class}, issn = {1872-6623}, doi = {10.1097/j.pain.0000000000000762}, author = {Grol-Prokopczyk, Hanna} } @article {12133, title = {SOS2 and ACP1 Loci Identified through Large-Scale Exome Chip Analysis Regulate Kidney Development and Function.}, journal = {Journal of the American Society of Nephrology }, volume = {28}, year = {2017}, pages = {981-994}, abstract = {

Genome-wide association studies have identified >50 common variants associated with kidney function, but these variants do not fully explain the variation in eGFR. We performed a two-stage meta-analysis of associations between genotypes from the Illumina exome array and eGFR on the basis of serum creatinine (eGFRcrea) among participants of European ancestry from the CKDGen Consortium (: 111,666; : 48,343). In single-variant analyses, we identified single nucleotide polymorphisms at seven new loci associated with eGFRcrea (, , and ; <3.7{\texttimes}10), of which most were common and annotated as nonsynonymous variants. Gene-based analysis identified associations of functional rare variants in three genes with eGFRcrea, including a novel association with the SOS Ras/Rho guanine nucleotide exchange factor 2 gene, (=5.4{\texttimes}10 by sequence kernel association test). Experimental follow-up in zebrafish embryos revealed changes in glomerular gene expression and renal tubule morphology in the embryonic kidney of and -knockdowns. These developmental abnormalities associated with altered blood clearance rate and heightened prevalence of edema. This study expands the number of loci associated with kidney function and identifies novel genes with potential roles in kidney formation.

}, keywords = {Animals, Exome, Genetic Loci, Genome-Wide Association Study, Glomerular Filtration Rate, Humans, kidney, Protein Tyrosine Phosphatases, Proto-Oncogene Proteins, Son of Sevenless Proteins, Zebrafish}, issn = {1533-3450}, doi = {10.1681/ASN.2016020131}, author = {Li, Man and Li, Yong and Weeks, Olivia and Mijatovic, Vladan and Teumer, Alexander and Huffman, Jennifer E and Tromp, Gerard and Fuchsberger, Christian and Gorski, Mathias and Lyytik{\"a}inen, Leo-Pekka and Nutile, Teresa and Sedaghat, Sanaz and Sorice, Rossella and Tin, Adrienne and Yang, Qiong and Ahluwalia, Tarunveer S and Dan E Arking and Bihlmeyer, Nathan A and B{\"o}ger, Carsten A and Carroll, Robert J and Daniel I Chasman and Marilyn C Cornelis and Dehghan, Abbas and Jessica Faul and Feitosa, Mary F and Gambaro, Giovanni and Paolo P. Gasparini and Giulianini, Franco and Iris M Heid and Huang, Jinyan and Imboden, Medea and Jackson, Anne U and Janina Jeff and Jhun, Min A and Katz, Ronit and Kifley, Annette and Kilpel{\"a}inen, Tuomas O and Kumar, Ashish and Laakso, Markku and Li-Gao, Ruifang and Kurt Lohman and Lu, Yingchang and M{\"a}gi, Reedik and Malerba, Giovanni and Mihailov, Evelin and Mohlke, Karen L and Dennis O Mook-Kanamori and Robino, Antonietta and Ruderfer, Douglas and Salvi, Erika and Schick, Ursula M and Schulz, Christina-Alexandra and Smith, Albert V and Smith, Jennifer A and Traglia, Michela and Laura M Yerges-Armstrong and Zhao, Wei and Goodarzi, Mark O and Kraja, Aldi T and Liu, Chunyu and Wessel, Jennifer and Boerwinkle, Eric and Ingrid B Borecki and Bork-Jensen, Jette and Erwin P Bottinger and Braga, Daniele and Brandslund, Ivan and Brody, Jennifer A and Campbell, Archie and Carey, David J and Cramer Christensen and Coresh, Josef and Crook, Errol and Curhan, Gary C and Cusi, Daniele and de Boer, Ian H and de Vries, Aiko P J and Denny, Joshua C and Devuyst, Olivier and Dreisbach, Albert W and Endlich, Karlhans and T{\~o}nu Esko and Franco, Oscar H and Fulop, Tibor and Gerhard, Glenn S and Gl{\"u}mer, Charlotte and Gottesman, Omri and Grarup, Niels and Gudnason, Vilmundur and Hansen, Torben and Tamara B Harris and Caroline Hayward and Lynne J Hocking and Hofman, Albert and Hu, Frank B and Husemoen, Lise Lotte N and Jackson, Rebecca D and J{\o}rgensen, Torben and J{\o}rgensen, Marit E and K{\"a}h{\"o}nen, Mika and Sharon L R Kardia and K{\"o}nig, Wolfgang and Charles Kooperberg and Kriebel, Jennifer and Lenore J Launer and Lauritzen, Torsten and Lehtim{\"a}ki, Terho and Levy, Daniel and Linksted, Pamela and Linneberg, Allan and Liu, Yongmei and Ruth J F Loos and Lupo, Antonio and Meisinger, Christine and Melander, Olle and Andres Metspalu and Mitchell, Paul and Nauck, Matthias and N{\"u}rnberg, Peter and Orho-Melander, Marju and Parsa, Afshin and Pedersen, Oluf and Peters, Annette and Peters, Ulrike and Polasek, Ozren and David J Porteous and Nicole M Probst-Hensch and Psaty, Bruce M and Qi, Lu and Olli T Raitakari and Reiner, Alex P and Rettig, Rainer and Ridker, Paul M and Fernando Rivadeneira and Rossouw, Jacques E and Schmidt, Frank and David S Siscovick and Soranzo, Nicole and Strauch, Konstantin and Toniolo, Daniela and Stephen T Turner and Andr{\'e} G Uitterlinden and Ulivi, Sheila and Velayutham, Dinesh and V{\"o}lker, Uwe and V{\"o}lzke, Henry and Waldenberger, Melanie and Wang, Jie Jin and David R Weir and Daniel Witte and Kuivaniemi, Helena and Caroline S Fox and Franceschini, Nora and Goessling, Wolfram and K{\"o}ttgen, Anna and Chu, Audrey Y} } @article {8856, title = {Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Mar 01}, pages = {279-289}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, environment, Female, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Personal Satisfaction, Social Support, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw148}, url = {http://psychsocgerontology.oxfordjournals.org/cgi/pmidlookup?view=long\&pmid=28077430}, author = {Shannon T. Mejia and Lindsay H Ryan and Gonzalez, Richard and Jacqui Smith} } @article {8492, title = {Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Mar 01}, pages = {340-350}, abstract = {

Objectives : This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement.

Method : The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations.

Results : Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations.

Discussion : This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.

}, keywords = {Aged, Aged, 80 and over, Aging, Disabled Persons, Employment, Female, Humans, Male, United States, Volunteers}, issn = {1758-5368}, doi = {10.1093/geronb/gbw060}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27225973}, author = {Ben Lennox Kail and Dawn C Carr} } @article {8566, title = {Telomere Length Among Older U.S. Adults: Differences by Race/Ethnicity, Gender, and Age.}, journal = {J Aging Health}, volume = {29}, year = {2017}, month = {2017 12}, pages = {1350-1366}, abstract = {

OBJECTIVE: We examine race/ethnic, gender, and age differences in telomere length (TL) within a diverse, nationally representative sample of older adults.

METHOD: Data come from 5,228 White, Black, and Hispanic respondents aged 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative polymerase chain reaction (qPCR) by comparing telomere sequence copy number with a single gene copy number (T/S ratio). Linear regression was used to examine TL by race/ethnicity, gender, and age adjusting for social, economic, and health characteristics.

RESULTS: Women had longer TL than men (p < .05). Blacks ( p < .05) and Hispanics ( p < .10) had longer TL than Whites. Black women and men had the longest TL relative to other groups ( p < .05), while White men had the shortest TL ( p < .05). Black women and Hispanic men showed greater differences in TL with age.

DISCUSSION: Findings indicate social patterns in TL by race/ethnicity, gender, and age among older adults do not reflect differences observed in most population health outcomes.

}, keywords = {Aged, Aging, Biomarkers, Female, Health Status Disparities, Humans, Interviews as Topic, Male, Minority Groups, Qualitative Research, Telomere, United States}, issn = {1552-6887}, doi = {10.1177/0898264316661390}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27469599}, author = {Lauren L Brown and Belinda L Needham and Jennifer A Ailshire} } @article {8703, title = {Timing of Advance Directive Completion and Relationship to Care Preferences.}, journal = {J Pain Symptom Manage}, volume = {53}, year = {2017}, month = {2017 01}, pages = {49-56}, abstract = {

CONTEXT: Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions.

OBJECTIVE: The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care.

METHODS: We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults.

RESULTS: The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71\%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care.

CONCLUSION: Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care.

}, keywords = {Advance care planning, Advance directives, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Patient Participation, Patient Preference, Retrospective Studies}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2016.08.008}, url = {https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(16)30336-0}, author = {Enguidanos, Susan and Jennifer A Ailshire} } @article {8818, title = {The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses.}, journal = {J Pain Symptom Manage}, volume = {53}, year = {2017}, month = {2017 02}, pages = {178-187.e1}, abstract = {

CONTEXT: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression.

OBJECTIVES: The objective of this study was to determine the association between patients{\textquoteright} use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses.

METHODS: We used data from the Health and Retirement Study, a longitudinal survey of U.S. residents, linked to Medicare claims data. We included married Medicare beneficiaries aged 65~years and older who died between 2000 and 2011 (n~=~1258) and their surviving spouses. The use of life-sustaining procedures (i.e., intubation/mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral/parenteral nutrition, and cardiopulmonary resuscitation) in the last month of life was measured via claims data. Using propensity score matching, we compared change in depressive symptoms of surviving spouses.

RESULTS: Eighteen percent of decedents underwent one or more life-sustaining procedures in the last month of life. Those whose spouses underwent life-sustaining procedures had a 0.32-point increase in depressive symptoms after death (scale range~=~0-8) and a greater likelihood of clinically significant depression (odds ratio~=~1.51) compared with a matched sample of spouses of those who did not have procedures (P~<~0.05).

CONCLUSION: Surviving spouses of those who undergo intensive life-sustaining procedures at the end of life experience a greater magnitude of increase in depressive symptoms than those whose spouses do not undergo such procedures. Further study of the circumstances and decision making surrounding these procedures is needed to understand their relationship with survivors{\textquoteright} negative mental health consequences and how best to provide appropriate support.

}, keywords = {Aged, Aged, 80 and over, Caregivers, depression, Female, Humans, Intubation, Longitudinal Studies, Male, Mental Health, Respiration, Artificial, Spouses, Survivors, Terminal Care}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2016.08.023}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0885392416307850http://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/xml}, author = {Katherine A Ornstein and Melissa D. Aldridge and Melissa M Garrido and Rebecca Jean Gorges and Bollens-Lund, Evan and Albert L Siu and Kenneth M. Langa and Amy Kelley} } @article {8386, title = {Accelerated increase and decrease in subjective age as a function of changes in loneliness and objective social indicators over a four-year period: results from the health and retirement study.}, journal = {Aging Ment Health}, volume = {20}, year = {2016}, note = {Export Date: 29 May 2015 Article in Press}, month = {2016 07}, pages = {743-51}, publisher = {20}, abstract = {

OBJECTIVES: The study examined the role of changes in loneliness and objective social indicators in the formation of changes in subjective age over a four-year period.

METHODS: The Health and Retirement Study is a US nationally representative study of older adults over 50 and their spouse of any age. We restricted the sample to individuals, 65 years of age and older (n = 2591). An accelerated increase in subjective age was defined as an increase in subjective age over the two waves greater than five years. An accelerated decrease in subjective age was defined as a difference that was lower than three years. These were examined against a change in subjective age in the range of three to five years (i.e., change consistent with the passage of time).

RESULTS: For 23.4\% of the sample, changes in subjective age were consistent with the passage of time. A total of 38.3\% had an accelerated decrease in subjective age, whereas 38.3\% had an accelerated increase. A decrease in loneliness over the two waves resulted in an accelerated decrease in subjective age, whereas an increase in depressive symptoms resulted in an accelerated increase in subjective age. Changes in objective social indicators, physical difficulties or medical comorbidity did not predict changes in subjective age.

CONCLUSIONS: This is one of very few studies that examined changes in subjective age over time. Changes in subjective age represent an important construct that corresponding to other changes in subjective experiences.

}, keywords = {Aged, Aged, 80 and over, Aging, depression, Female, Humans, Loneliness, Male, Retirement, Social Change}, issn = {1364-6915}, doi = {10.1080/13607863.2015.1035696}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84928654923andpartnerID=40andmd5=dc249d3a4a7b131281c68dbbc5ac5bb7}, author = {Liat Ayalon and Yuval Palgi and Sharon Avidor and Ehud Bodner} } @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 {8357, title = {Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Feb}, pages = {165-79}, publisher = {28}, abstract = {

OBJECTIVE: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period.

METHOD: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above).

RESULTS: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109\% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant.

DISCUSSION: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

}, keywords = {Age Factors, Aged, Body Mass Index, Female, Health Expenditures, Humans, Male, Medicare, Obesity, United States}, issn = {1552-6887}, doi = {10.1177/0898264315589574}, url = {http://jah.sagepub.com/content/28/1/165}, author = {Daniel O. Clark and Kathleen A Lane and Ambuehl, Roberta and Tu, Wanzhu and Chiung-Ju Liu and Kathleen T. Unroe and Christopher M. Callahan} } @article {8399, title = {Allostatic Load and Personality: A 4-Year Longitudinal Study.}, journal = {Psychosom Med}, volume = {78}, year = {2016}, month = {2016 04}, pages = {302-10}, publisher = {78}, abstract = {

OBJECTIVE: Dysregulation across multiple physiological systems, referred to as allostatic load, has pervasive consequences for an individual{\textquoteright}s health. The present study examined whether allostatic load is associated with personality and personality changes during a 4-year follow-up.

METHODS: A total of 5200 participants aged from 50 to 99 years (59.5\% women, mean [standard deviation] age = 66.91 [8.88] years) from the Health and Retirement Study provided data on cardiovascular, metabolic, and immune markers at baseline and personality both at baseline and at 4 years later.

RESULTS: Higher allostatic load was related to higher neuroticism (β = 0.03, p = .042), lower extraversion (β = -0.06, p < .001), and lower conscientiousness (β = -0.06, p < .001) at baseline, and to declines in extraversion (β = -0.03, p = .007), conscientiousness (β = -0.04, p < .001), and agreeableness (β = -0.02, p = .020) over the 4-year period, controlling for demographic covariates. A significant quadratic relation between allostatic load and changes in openness (β = -0.03, p = .002) suggested that openness declines when individuals exceed a high level of cumulative physiological dysregulation. No association was found with changes in neuroticism.

CONCLUSIONS: Allostatic load is associated with personality change across adulthood and old age. The findings indicate that physiological dysregulation across multiple systems challenges personality stability and is associated with accelerated personality traits change.

}, keywords = {Aged, Aged, 80 and over, Aging, Allostasis, Anxiety Disorders, Biomarkers, Conscience, Extraversion, Psychological, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neuroticism, Personality}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000281}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26716813}, author = {Yannick Stephan and Angelina R Sutin and Martina Luchetti and Antonio Terracciano} } @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 {6513, title = {Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment?}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Oct}, pages = {1017-23}, abstract = {

BACKGROUND: Neighbourhood resources may preserve functional independence in older adults, but little is known about whether benefits differ for individuals with normal and impaired memory. We evaluated the extent to which neighbourhood context was related to onset of instrumental and basic activities of daily living (I/ADL) limitations and whether relationships were modified by memory impairment.

METHODS: Health and Retirement Study participants 50+ years of age without baseline I/ADL limitations (n=8726 for IADL and n=8345 for ADL models) were interviewed biennially for up to 8 years. Self-reported neighbourhood characteristics were scaled from 0 (worst) to 1 (best). Memory, assessed by direct and proxy cognitive assessments, was dichotomised at the 20th centile. We used pooled logistic regression models, adjusted for demographics and individual characteristics.

RESULTS: Low neighbourhood physical disorder (OR=0.51 (95\% CI: 0.37 to 0.69)), high social cohesion (OR=0.46 (0.34 to 0.62)), and high safety (OR=0.59 (0.46 to 0.76)) were associated with reduced incidence of IADL limitations. These neighbourhood characteristics were also associated with lower incidence of ADL limitations (disorder OR=0.59 (0.43 to 0.81)); social cohesion OR=0.60 (0.45 to 0.81)); safety OR=0.74 (0.58 to 0.93)). High social ties were not related to ADLs (OR=1.01(0.80 to 1.28)) or IADLs (OR=0.93(0.74 to 1.17)). The benefits of these neighbourhood characteristics for ADLs were similar among those with and without memory impairment but primarily observed among those without memory impairment for IADLs.

CONCLUSIONS: Older adults living in neighbourhoods with low physical disorder, high social cohesion and high safety experience lower incidence of IADL and ADL limitations. Memory status modified the estimated effects of neighbourhood characteristics on IADL but not ADL limitations.

}, keywords = {Activities of Daily Living, Aged, Female, Humans, Independent Living, Interviews as Topic, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Mobility Limitation, Residence Characteristics, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207241}, url = {http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract}, author = {Thu T Nguyen and Rist, Pamela M and M. Maria Glymour} } @article {8548, title = {Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0154203}, abstract = {

BACKGROUND: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated.

METHODS: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother >= 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent{\textquoteright}s educational attainment in a subset of analyses.

RESULTS: Husband{\textquoteright}s Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95\% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28).

CONCLUSIONS: We found no evidence of a relationship between husband{\textquoteright}s Korean War GI Bill eligibility and wives{\textquoteright} mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

}, keywords = {Adult, Aged, depression, Female, Humans, Korean War, Male, Mental Disorders, Mental Health, Middle Aged, Odds Ratio, Population Surveillance, Social Class, Spouses, Veterans, Veterans Health}, issn = {1932-6203}, doi = {10.1371/journal.pone.0154203}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27186983}, author = {Anusha M Vable and Ichiro Kawachi and Canning, David and M. Maria Glymour and Marcia P Jimenez and S. V. Subramanian} } @article {8512, title = {Association of a Genetic Risk Score With Body Mass Index Across Different Birth Cohorts.}, journal = {JAMA}, volume = {316}, year = {2016}, month = {2016 Jul 05}, pages = {63-9}, chapter = {63}, abstract = {

IMPORTANCE: Many genetic variants are associated with body mass index (BMI). Associations may have changed with the 20th century obesity epidemic and may differ for black vs white individuals.

OBJECTIVE: Using birth cohort as an indicator for exposure to obesogenic environment, to evaluate whether genetic predisposition to higher BMI has a larger magnitude of association among adults from more recent birth cohorts, who were exposed to the obesity epidemic at younger ages.

DESIGN, SETTING, AND PARTICIPANTS: Observational study of 8788 adults in the US national Health and Retirement Study who were aged 50 years and older, born between 1900 and 1958, with as many as 12 BMI assessments from 1992 to 2014.

EXPOSURES: A multilocus genetic risk score for BMI (GRS-BMI), calculated as the weighted sum of alleles of 29 single nucleotide polymorphisms associated with BMI, with weights equal to the published per-allele effects. The GRS-BMI represents how much each person{\textquoteright}s BMI is expected to differ, based on genetic background (with respect to these 29 loci), from the BMI of a sample member with median genetic risk. The median-centered GRS-BMI ranged from -1.68 to 2.01.

MAIN OUTCOMES AND MEASURES: BMI based on self-reported height and weight.

RESULTS: GRS-BMI was significantly associated with BMI among white participants (n = 7482; mean age at first assessment, 59 years; 3373 [45\%] were men; P <.001) and among black participants (n = 1306; mean age at first assessment, 57 years; 505 [39\%] were men; P <.001) but accounted for 0.99\% of variation in BMI among white participants and 1.37\% among black participants. In multilevel models accounting for age, the magnitude of associations of GRS-BMI with BMI were larger for more recent birth cohorts. For example, among white participants, each unit higher GRS-BMI was associated with a difference in BMI of 1.37 (95\% CI, 0.93 to 1.80) if born after 1943, and 0.17 (95\% CI, -0.55 to 0.89) if born before 1924 (P = .006). For black participants, each unit higher GRS-BMI was associated with a difference in BMI of 3.70 (95\% CI, 2.42 to 4.97) if born after 1943, and 1.44 (95\% CI, -1.40 to 4.29) if born before 1924.

CONCLUSIONS AND RELEVANCE: For participants born between 1900 and 1958, the magnitude of association between BMI and a genetic risk score for BMI was larger among persons born in later cohorts. This suggests that associations of known genetic variants with BMI may be modified by obesogenic environments.

}, keywords = {African Continental Ancestry Group, Age Factors, Aged, Aged, 80 and over, Alleles, Body Mass Index, Cohort Studies, European Continental Ancestry Group, Female, Genetic Predisposition to Disease, Genetic Variation, Genome-Wide Association Study, Humans, Male, Middle Aged, Multilocus Sequence Typing, Obesity, Polymorphism, Single Nucleotide, Risk Factors, United States}, issn = {1538-3598}, doi = {10.1001/jama.2016.8729}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27380344}, author = {Stefan Walter and Mej{\'\i}a-Guevara, Iv{\'a}n and Estrada, Karol and Sze Y Liu and M. Maria Glymour} } @article {8388, title = {Association of Alcohol Use and Loneliness Frequency Among Middle-Aged and Older Adult Drinkers.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Mar}, pages = {267-84}, publisher = {28}, abstract = {

OBJECTIVES: We examined the association between alcohol use, at-risk drinking, and binge drinking, and loneliness in a sample of middle-aged and older adults.

METHOD: We studied participants aged 50+ years from the 2008 wave of the Health and Retirement Study who reported alcohol use. We ran separate multinomial logistic regressions to assess the association of three alcohol use outcomes (i.e., weekly alcohol consumption, at-risk drinking, and binge drinking) and loneliness.

RESULTS: After adjusting for covariates, being lonely was associated with reduced odds of weekly alcohol consumption 4 to 7 days per week, but not 1 to 3 days per week, compared with average alcohol consumption 0 days per week in the last 3 months. No association was found between at-risk drinking or binge drinking and loneliness.

DISCUSSION: Results suggest that among a sample of community-based adults aged 50+, loneliness was associated with reduced alcohol use frequency, but not with at-risk or binge drinking.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Binge drinking, Cross-Sectional Studies, Female, Humans, Loneliness, Male, Middle Aged, Risk-Taking}, issn = {1552-6887}, doi = {10.1177/0898264315589579}, url = {http://jah.sagepub.com/content/early/2015/06/09/0898264315589579.abstract}, author = {Sarah L. Canham and Pia M Mauro and Christopher N Kaufmann and Sixsmith, Andrew} } @article {6497, title = {Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA.}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Sep}, pages = {917-23}, abstract = {

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

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

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

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

}, keywords = {Adult, Aged, Female, Health Status, Humans, Life Expectancy, Life Style, Longitudinal Studies, Male, Middle Aged, Mortality, Premature, Retirement, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2015-207097}, url = {http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract}, author = {Wu, Chenkai and Michelle C Odden and Gwenith G Fisher and Stawski, Robert S} } @article {8577, title = {Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study.}, journal = {BMC Public Health}, volume = {16}, year = {2016}, month = {2016 07 19}, pages = {596}, abstract = {

BACKGROUND: While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors.

METHODS: We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs.

RESULTS: In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2~years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002).

CONCLUSION: In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.

}, keywords = {Aged, Aged, 80 and over, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Health Literacy, Health Promotion, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Preventive Health Services, Regression Analysis, Retirement, United States}, issn = {1471-2458}, doi = {10.1186/s12889-016-3267-7}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27430477}, author = {Dena M. Fernandez and Janet L. Larson and Brian J Zikmund-Fisher} } @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 {8596, title = {The Benefits of Social Technology Use Among Older Adults Are Mediated by Reduced Loneliness.}, journal = {Cyberpsychol Behav Soc Netw}, volume = {19}, year = {2016}, month = {2016 Sep}, pages = {551-6}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Attitude to Computers, depression, Female, Health Status, Humans, Interpersonal Relations, Loneliness, Male, Middle Aged, Personal Satisfaction, Social Networking, Telecommunications}, issn = {2152-2723}, doi = {10.1089/cyber.2016.0151}, url = {http://online.liebertpub.com/doi/10.1089/cyber.2016.0151}, author = {William J. Chopik} } @article {6446, title = {Better Off Alone Than With a Smoker: The Influence of Partner{\textquoteright}s Smoking Behavior in Later Life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Jul}, pages = {687-97}, abstract = {

OBJECTIVES: We examine how the likelihood of smoking cessation among smokers and patterns of adherence to smoking cessation differ by partnership status, partnership changes, and partners{\textquoteright} smoking behavior. The data are a nationally representative sample of smokers in middle and older age from the Health and Retirement Study (1992-2010).

METHOD: We use multivariate logistic regression models to analyze the likelihood of smoking cessation among smokers and then estimate adherence to smoking cessation using discrete-time event history models.

RESULTS: Those partnered with smokers and those whose partners relapse into smoking are much less likely than the unpartnered to quit smoking and adhere to smoking cessation. Respondents partnered with non-smokers and those whose partners quit smoking are more likely to quit smoking than the unpartnered. Those recently widowed, divorced, and repartnered have similar smoking changes to the consistently unpartnered.

DISCUSSION: Being partnered does not always mean healthier behavior changes. Rather, the association between partnership status and smoking changes depends greatly on the health behavior changes of the partner. The partnership context at the time of smoking cessation sets the stage for longer term patterns of adherence, shaping health in older age.

}, keywords = {Aged, Female, Health Behavior, Humans, Logistic Models, Male, Marital Status, Middle Aged, Motivation, Single Person, Smoking, Smoking cessation, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbu220}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/02/17/geronb.gbu220.abstract}, author = {Rachel Margolis and Wright, Laura} } @article {8400, title = {Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 Feb}, pages = {129-135.e3}, publisher = {26}, abstract = {

PURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.

METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents >= 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.

RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95\% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95\% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95\% CI = (-8.2, -22.6), P = .035].

CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.

}, keywords = {Aged, Aged, 80 and over, depression, Health Status Disparities, Humans, Korean War, Male, Public Policy, Residence Characteristics, Risk Factors, Socioeconomic factors, Veterans}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.12.003}, url = {http://www.sciencedirect.com/science/article/pii/S1047279715300107}, author = {Anusha M Vable and Canning, David and M. Maria Glymour and Ichiro Kawachi and Marcia P Jimenez and S. V. Subramanian} } @article {8827, title = {Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support.}, journal = {Int J Environ Res Public Health}, volume = {14}, year = {2016}, month = {2016 12 26}, abstract = {

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC). Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006-2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults.

}, keywords = {Aged, Aged, 80 and over, Aging, depression, Family, Female, Friends, Humans, Male, Multiple Chronic Conditions, Social Support, United States}, issn = {1660-4601}, doi = {10.3390/ijerph14010016}, url = {http://www.mdpi.com/1660-4601/14/1/16}, author = {Ahn, SangNam and Kim, Seonghoon and Zhang, Hongmei} } @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 {8565, title = {A chapter a day: Association of book reading with longevity.}, journal = {Soc Sci Med}, volume = {164}, year = {2016}, month = {2016 09}, pages = {44-48}, abstract = {

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2~=~0.83, p~<~0.001, HRT3~=~0.77, p~<~0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2~=~90.6, p~<~0.001; tT3~=~67.9, p~<~0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80\% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR~= .80, p < .01), indicating book readers experienced a 20\% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p~=~0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

}, keywords = {Aged, Aged, 80 and over, Books, Chi-Square Distribution, Cohort Studies, Female, Humans, Longevity, Male, Michigan, Middle Aged, Reading, Survival Analysis}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.07.014}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616303689}, author = {Bavishi, Avni and Martin D Slade and Becca R Levy} } @article {8394, title = {Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study.}, journal = {Health Econ}, volume = {25}, year = {2016}, month = {2016 Apr}, pages = {424-38}, publisher = {25}, abstract = {

In this study, we use the Health and Retirement Study to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a $1.00 (131.6\%) tax increase leads to a 3.8-5.2\% reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population.

}, keywords = {Age Factors, Aged, Consumer Behavior, Female, Humans, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Smoking, Taxes, Tobacco Products, United States}, issn = {1099-1050}, doi = {10.1002/hec.3161}, url = {http://onlinelibrary.wiley.com/doi/10.1002/hec.3161/epdf}, author = {Johanna Catherine Maclean and Asia Sikora Kessler and Donald S. Kenkel} } @article {8485, title = {Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults.}, journal = {Med Care}, volume = {54}, year = {2016}, month = {2016 07}, pages = {664-71}, abstract = {

OBJECTIVES: Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.

RESEARCH DESIGN: Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.

SUBJECTS: The analysis included 5497 community-dwelling adults >=65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.

RESULTS: The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95\% confidence interval (CI), $4662-$19,680], $5648 (95\% CI, $3819-$7476), and $9388 (95\% CI, $5969-$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.

CONCLUSIONS: FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Cross-Over Studies, Female, Humans, Insurance Claim Review, Male, Medicare, United States, Wounds and Injuries}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000531}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27057747}, author = {Geoffrey J Hoffman and Hays, Ron D and Martin F Shapiro and Steven P Wallace and Susan L Ettner} } @article {8389, title = {Cohort Effects in the Genetic Influence on Smoking.}, journal = {Behav Genet}, volume = {46}, year = {2016}, note = {Export Date: 9 September 2015 Article in Press}, month = {2016 Jan}, pages = {31-42}, publisher = {46}, abstract = {

We examine the hypothesis that the heritability of smoking has varied over the course of recent history as a function of associated changes in the composition of the smoking and non-smoking populations. Classical twin-based heritability analysis has suggested that genetic basis of smoking has increased as the information about the harms of tobacco has become more prevalent-particularly after the issuance of the 1964 Surgeon General{\textquoteright}s Report. In the present paper we deploy alternative methods to test this claim. We use data from the Health and Retirement Study to estimate cohort differences in the genetic influence on smoking using both genomic-relatedness-matrix restricted maximum likelihood and a modified DeFries-Fulker approach. We perform a similar exercise deploying a polygenic score for smoking using results generated by the Tobacco and Genetics consortium. The results support earlier claims that the genetic influence in smoking behavior has increased over time. Emphasizing historical periods and birth cohorts as environmental factors has benefits over existing GxE research. Our results provide additional support for the idea that anti-smoking policies of the 1980s may not be as effective because of the increasingly important role of genotype as a determinant of smoking status.

}, keywords = {Aged, Cohort Effect, Female, Gene Frequency, Genetic Predisposition to Disease, Genotype, Humans, Male, Middle Aged, Multifactorial Inheritance, Smoking, Twins}, issn = {1573-3297}, doi = {10.1007/s10519-015-9731-9}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84938496073andpartnerID=40andmd5=76a4f2cefad88fc22ebca2e435b4323e}, author = {Benjamin W Domingue and Dalton C Conley and Jason M. Fletcher and Jason D Boardman} } @article {8414, title = {Combat exposure, social relationships, and subjective well-being among middle-aged and older Veterans.}, journal = {Aging Ment Health}, volume = {20}, year = {2016}, month = {2016}, pages = {637-46}, publisher = {20}, abstract = {

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Geriatric Assessment, Health Status, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Prognosis, Risk Factors, Self Report, Sex Distribution, Socioeconomic factors, Syndrome, United States}, issn = {1525-1497}, doi = {10.1007/s11606-016-3590-9}, url = {http://dx.doi.org/10.1007/s11606-016-3590-9}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Kathleen A Smyth and Kurt C Stange and Charles W Given} } @article {8498, title = {Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality.}, journal = {Epidemiology}, volume = {27}, year = {2016}, month = {2016 09}, pages = {670-6}, abstract = {

BACKGROUND: Inverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality.

METHODS: Health and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models.

RESULTS: A 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95\% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95\% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19\% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95\% CI: -1.7, -0.69], representing 18\% of total effect).

CONCLUSION: In a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.

}, keywords = {Aged, Aged, 80 and over, Educational Status, Female, Humans, Literacy, Longitudinal Studies, Male, Middle Aged, Mortality, Odds Ratio, Proportional Hazards Models, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000000517}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27280331}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and M. Maria Glymour} } @article {8682, title = {A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 10}, pages = {1256-78}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Algorithms, Female, Health Status, Humans, Longitudinal Studies, Male, Monte Carlo Method, Probability, Retirement, Smoking}, issn = {1097-0258}, doi = {10.1002/sim.6982}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27222058}, author = {Dimitris Georgarakos and Ralitza Gueorguieva} } @article {8537, title = {Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights.}, journal = {Int Psychogeriatr}, volume = {28}, year = {2016}, month = {2016 Apr}, pages = {557-76}, abstract = {

BACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study.

METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness.

RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear.

CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

}, keywords = {Aged, Aged, 80 and over, Aging, Cross-Sectional Studies, Female, Focus Groups, Humans, Loneliness, Male, Marital Status, Motor Activity, Qualitative Research, Quality of Life, Residence Characteristics, Sex Factors, Social Environment, social isolation, Socioeconomic factors}, issn = {1741-203X}, doi = {10.1017/S1041610215001532}, url = {http://www.journals.cambridge.org/abstract_S1041610215001532}, author = {Cohen-Mansfield, Jiska and Hazan, Haim and Lerman, Yaffa and Shalom, Vera} } @article {8588, title = {C-reactive protein level partially mediates the relationship between moderate alcohol use and frailty: the Health and Retirement Study.}, journal = {Age Ageing}, volume = {45}, year = {2016}, month = {2016 11}, pages = {874-878}, abstract = {

BACKGROUND: frailty is an indicator of late-life decline marked by higher rates of disability and healthcare utilisation. Research has linked health benefits with moderate alcohol use, including frailty risk reduction. Past work suggests inflammation, measured by C-reactive protein (CRP), as one candidate mechanism for this effect.

OBJECTIVE: this study aims to elucidate a possible mechanism - CRP modulation - by which moderate alcohol consumption may protect against frailty.

METHODS: a cross-sectional study using data from the 2008 wave of the Health and Retirement Study (HRS) conducted by the University of Michigan. The HRS is a cohort study on health, retirement and aging on adults aged 50 and older living in the USA. A final sample of 3,229 stroke-free participants, over the age of 65 years and with complete data, was identified from the 2008 wave. Alcohol use was measured via self-report. Frailty was measured using the Paulson-Lichtenberg Frailty Index. CRP was collected through the HRS protocol.

RESULTS: results from structural equation modelling support the hypothesised model that moderate alcohol use is associated with less frailty and lower CRP levels. Furthermore, the indirect relationship from moderate alcohol use to frailty through CRP was statistically significant.

CONCLUSIONS: overall findings suggest that inflammation measured by CRP is one mechanism by which moderate alcohol use may confer protective effects for frailty. These findings inform future research relating alcohol use and frailty, and suggest inflammation as a possible mechanism in the relationship between moderate alcohol use and other beneficial health outcomes.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Alcohol Drinking, Biomarkers, C-reactive protein, Cross-Sectional Studies, Female, Frail Elderly, Frailty, Geriatric Assessment, Humans, Inflammation Mediators, Male, Protective factors, Risk Factors, United States}, issn = {1468-2834}, doi = {10.1093/ageing/afw103}, url = {http://ageing.oxfordjournals.org/content/early/2016/06/30/ageing.afw103.long}, author = {Mona Shah and Daniel Paulson} } @article {8341, title = {A cross-lagged model of the reciprocal associations of loneliness and memory functioning.}, journal = {Psychol Aging}, volume = {31}, year = {2016}, month = {2016 05}, pages = {255-61}, publisher = {31}, abstract = {

The study was designed to evaluate the reciprocal associations of loneliness and memory functioning using a cross-lagged model. The study was based on the psychosocial questionnaire of the Health and Retirement Study, which is a U.S. nationally representative survey of individuals over the age of 50 and their spouses of any age. A total of 1,225 respondents had complete data on the loneliness measure in 2004 and at least in 1 of the subsequent waves (e.g., 2008, 2012) and were maintained for analysis. A cross-lagged model was estimated to examine the reciprocal associations of loneliness and memory functioning, controlling for age, gender, education, depressive symptoms, number of medical conditions, and the number of close social relationships. The model had adequate fit indices: χ2(860, N = 1,225) = 1,401.54, p < .001, Tucker-Lewis index = .957, comparative fit index = .963, and root mean square error of approximation = .023 (90\% confidence interval [.021, .025]). The lagged effect of loneliness on memory functioning was nonsignificant, B(SE) = -.11(.08), p = .15, whereas the lagged effect of memory functioning on loneliness was significant, B(SE) = -.06(.02), p = .01, indicating that lower levels of memory functioning precede higher levels of loneliness 4 years afterward. Further research is required to better understand the mechanisms responsible for the temporal association between reduced memory functioning and increased loneliness. (PsycINFO Database Record

}, keywords = {Aged, Aging, depression, Female, Humans, Loneliness, Male, Memory, Models, Psychological, Social Behavior, Spouses, Surveys and Questionnaires, Time Factors}, issn = {1939-1498}, doi = {10.1037/pag0000075}, url = {http://psycnet.apa.org/journals/pag/31/3/255/}, author = {Liat Ayalon and Sharon Shiovitz-Ezra and Roziner, Ilan} } @article {8364, title = {Depressed Mood in Middle-Aged and Older Adults in Europe and the United States: A Comparative Study Using Anchoring Vignettes.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Feb}, pages = {95-117}, publisher = {28}, abstract = {

OBJECTIVE: To compare self-ratings of depressed mood in middle-aged and older adults in the United States and nine European countries after adjustment by anchoring vignettes.

METHOD: Samples were drawn from three large surveys of middle-aged and older adults: the U.S. Health and Retirement Study, the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Ageing and Retirement in Europe. Self-ratings of depressed mood were compared across countries before and after adjustment by anchoring vignettes depicting cases with different levels of depressed mood.

RESULTS: Compared with Europeans as a group, Americans rated both the cases presented in the vignettes and themselves as more depressed. However, after adjustment by vignette ratings, Americans appeared to be less depressed than their counterparts in all but two European countries.

DISCUSSION: Cultural differences in mental health norms reflected in vignette rating may partly explain between-country differences in self-reported depressive symptoms and perhaps other psychiatric complaints.

}, keywords = {Aged, Cross-Cultural Comparison, depression, Europe, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1552-6887}, doi = {10.1177/0898264315585506}, url = {http://jah.sagepub.com/content/early/2015/04/22/0898264315585506.abstract}, author = {Ramin Mojtabai} } @article {8478, title = {Depression and Frailty in Late Life: Evidence for a Common Vulnerability.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 07}, pages = {630-40}, abstract = {

OBJECTIVES: The study purpose is to estimate the correlation between depression and competing models of frailty, and to determine to what degree the comorbidity of these syndromes is determined by shared symptomology.

METHODS: Data come from the 2010 Health and Retirement Study. Analysis was limited to community-dwelling participants 65 and older (N = 3,453). Depressive symptoms were indexed by the 8-item Centers for Epidemiologic Studies Depression (CESD) scale. Frailty was indexed by 3 alternative conceptual models: (a) biological syndrome, (b) frailty index, and (c) functional domains. Confirmatory factor analysis (CFA) was used to estimate the correlation between depression and each model of frailty.

RESULTS: Each of the 3 frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .68, p < .01), functional domains (ρ = .70, p < .01), and frailty index (ρ = .61, p < .01). Substantial correlation remained when accounting for shared symptoms between depression and the biological syndrome (ρ = .45) and frailty index (ρ = .56) models.

DISCUSSION: Results indicate that the correlation of frailty and depression in late life is substantial. The association between the two constructs cannot be fully explained by symptom overlap, suggesting that psychological vulnerability may be an important component of frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Frail Elderly, Geriatric Assessment, Humans, Independent Living, Interview, Psychological, Male}, issn = {1758-5368}, doi = {10.1093/geronb/gbu180}, url = {http://www.ncbi.nlm.nih.gov/pubmed/25617399}, author = {Matthew C. Lohman and Dumenci, Levent and Briana Mezuk} } @article {8806, title = {Desire for predictive testing for Alzheimer{\textquoteright}s disease and impact on advance care planning: a cross-sectional study.}, journal = {Alzheimers Res Ther}, volume = {8}, year = {2016}, month = {2016 12 13}, pages = {55}, abstract = {

BACKGROUND: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer{\textquoteright}s disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease, and examined how using such a test may impact advance care planning.

METHODS: A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65~years or older asked questions about a test predictive of Alzheimer{\textquoteright}s disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer{\textquoteright}s disease. Then, imagining they knew they would develop Alzheimer{\textquoteright}s disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer{\textquoteright}s disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.

RESULTS: Overall, 75\% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be <=75~years old (odds ratio 0.71 (95\% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer{\textquoteright}s, 81\% would be likely to complete an advance directive, although only 15\% had done so already.

CONCLUSIONS: In this nationally representative sample, 75\% of older adults would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer{\textquoteright}s disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

}, keywords = {Advance care planning, Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Patient Acceptance of Health Care}, issn = {1758-9193}, doi = {10.1186/s13195-016-0223-9}, url = {http://alzres.biomedcentral.com/articles/10.1186/s13195-016-0223-9http://link.springer.com/content/pdf/10.1186/s13195-016-0223-9.pdf}, author = {Sheffrin, Meera and Stijacic-Cenzer, Irena and Michael A Steinman} } @article {8376, title = {The determinants of presenteeism: a comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce.}, journal = {J Occup Health}, volume = {58}, year = {2016}, month = {2016}, pages = {25-35}, publisher = {58}, abstract = {

OBJECTIVES: The aim of this study was to identify the determinants of presenteeism, taking health and individual factors into account.

METHODS: A quantitative analysis applying structural equation modelling analysis was conducted on the basis of secondary data from the Health and Retirement Survey (2008 wave), which measured presenteeism and its determinants.

RESULTS: Stress-related factors at work (β =-0.35, p<0.001), individual factors (α =-0.27, p<0.001), and health (β =0.24, p<0.001) were significantly related to presenteeism. Individual factors were found to be directly correlated with stress-related factors at work (β =0.22, p<0.001). Significant indirect effects between stress-related factors at work and presenteeism (Sobel z=-6.61; p<0.001) and between individual factors and presenteeism (Sobel z=-4.42; p<0.001), which were mediated by health, were also found. Overall, the final model accounted for 37\% (R(2)=0.37) of the variance in presenteeism.

CONCLUSIONS: Our study indicates some important and practical guidelines for employers to avoid the burdens of stress-related presenteeism among their employees. These findings could help select target factors in the design and implementation of effective presenteeism interventions in the aging working population.

}, keywords = {Age Factors, Aged, Aging, Female, Health Surveys, Humans, Male, Middle Aged, Occupational Diseases, Presenteeism, Stress, Psychological, United States, Workplace}, issn = {1348-9585}, doi = {10.1539/joh.15-0114-OA}, url = {https://www.jstage.jst.go.jp/article/joh/58/1/58_15-0114-OA/_article}, author = {Tianan Yang and Zhu, Mingjing and Xiyao Xie} } @article {8367, title = {Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program.}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Apr}, pages = {687-703}, publisher = {51}, abstract = {

OBJECTIVE: To assess three possible determinants of individuals{\textquoteright} response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness.

DATA SOURCES: The health and retirement study (HRS) merged with data on states{\textquoteright} implementation of the PLTC program.

STUDY DESIGN: Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression.

DATA EXTRACTION METHODS: Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations.

PRINCIPAL FINDINGS: We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness.

CONCLUSIONS: Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program{\textquoteright}s existence and increased education about the program{\textquoteright}s benefits, and more generally, about long-term care risks and needs.

}, keywords = {Aged, Awareness, Costs and Cost Analysis, Decision making, Female, Humans, Insurance, Long-Term Care, Male, Middle Aged, Socioeconomic factors}, issn = {1475-6773}, doi = {10.1111/1475-6773.12353}, url = {http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12353/abstract}, author = {Lin, Haizhen and Jeffrey T Prince} } @article {8401, title = {Diabetic Phenotypes and Late-Life Dementia Risk: A Mechanism-specific Mendelian Randomization Study.}, journal = {Alzheimer Dis Assoc Disord}, volume = {30}, year = {2016}, month = {2016 Jan-Mar}, pages = {15-20}, publisher = {30}, abstract = {

BACKGROUND: Mendelian Randomization (MR) studies have reported that type 2 diabetes (T2D) was not associated with Alzheimer disease (AD). We adopted a modified, mechanism-specific MR design to explore this surprising result.

METHODS: Using inverse-variance weighted MR analysis, we evaluated the association between T2D and AD using data from 39 single nucleotide polymorphisms (SNPs) significantly associated with T2D in DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the corresponding associations of each SNP with AD risk obtained from the International Genomics of Alzheimer{\textquoteright}s Project (IGAP, n=17,008 AD cases and n=37,154 controls). We evaluated mechanism-specific genetic subscores, including β-cell function, insulin sensitivity, and adiposity, and repeated analyses in 8501 Health and Retirement Study participants for replication and model validation.

RESULTS: In IGAP, the overall T2D polygenic score did not predict AD [odds ratio (OR) for the T2D polygenic score=1.01; 95\% confidence interval (CI), 0.96, 1.06] but the insulin sensitivity polygenic score predicted higher AD risk (OR=1.17; 95\% CI, 1.02, 1.34). In the Health and Retirement Study, polygenic scores were associated with T2D risk; the associations between insulin sensitivity genetic polygenic score and cognitive phenotypes were not statistically significant.

CONCLUSIONS: Evidence from polygenic scores suggests that insulin sensitivity specifically may affect AD risk, more than T2D overall.

}, keywords = {Alzheimer disease, Diabetes Mellitus, Type 2, Genetic Predisposition to Disease, Humans, Insulin, Mendelian Randomization Analysis, Phenotype, Polymorphism, Single Nucleotide, Risk Factors}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000128}, url = {http://europepmc.org/abstract/MED/26650880}, author = {Stefan Walter and Jessica R Marden and Laura D Kubzansky and Elizabeth R Mayeda and Paul K Crane and Chang, Shun-Chiao and Marilyn C Cornelis and David Rehkopf and Mukherjee, Shubhabrata and M. Maria Glymour} } @article {8499, title = {Differences Among Older Adults in the Types of Dental Services Used in the United States.}, journal = {Inquiry}, volume = {53}, year = {2016}, month = {2016}, abstract = {

The purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6\% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.

}, keywords = {Aged, Dental Care, Female, Humans, Insurance, Dental, Male, Middle Aged, Surveys and Questionnaires, United States}, issn = {1945-7243}, doi = {10.1177/0046958016652523}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27284127}, author = {Richard J. Manski and Jody Schimmel Hyde and Haiyan Chen and John F Moeller} } @article {8377, title = {Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {Int Dent J}, volume = {66}, year = {2016}, month = {2016 Feb}, pages = {36-48}, publisher = {66}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents>=51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

}, keywords = {Aged, Aged, 80 and over, Demography, Dental Care, Europe, Female, Humans, Insurance Coverage, Interviews as Topic, Male, Middle Aged, Oral Health, Patient Acceptance of Health Care, United States}, issn = {0020-6539}, doi = {10.1111/idj.12190}, url = {http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {8500, title = {Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults.}, journal = {Psychosom Med}, volume = {78}, year = {2016}, month = {2016 09}, pages = {819-28}, abstract = {

OBJECTIVE: Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults.

METHODS: Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period.

RESULTS: Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95\% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95\% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95\% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway.

CONCLUSIONS: Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning.

}, keywords = {Aged, Aged, 80 and over, Cognitive Dysfunction, Female, Humans, Incidence, Male, Optimism, Protective factors, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000345}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27284699}, author = {Katerina A B Gawronski and Eric S Kim and Kenneth M. Langa and Laura D Kubzansky} } @article {8530, title = {Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?}, journal = {Gerontologist}, volume = {56}, year = {2016}, month = {2016 06}, pages = {514-24}, abstract = {

PURPOSE OF THE STUDY: In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.

DESIGN AND METHODS: This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.

RESULTS: Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.

IMPLICATIONS: Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Resilience, Psychological, Retirement, Surveys and Questionnaires}, issn = {1758-5341}, doi = {10.1093/geront/gnu068}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25063353}, author = {Lydia K Manning and Dawn C Carr and Ben Lennox Kail} } @article {8824, title = {Do working conditions at older ages shape the health gradient?}, journal = {J Health Econ}, volume = {50}, year = {2016}, month = {2016 12}, pages = {183-197}, abstract = {

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

}, keywords = {Aged, Female, Health Status, Humans, Income, Male, Middle Aged, Occupations, Retirement, Workplace}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2016.10.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S016762961630337Xhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S016762961630337X?httpAccept=text/plain}, author = {Lauren L Schmitz} } @article {8551, title = {Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use?}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Feb}, pages = {314-27}, abstract = {

OBJECTIVES: To compare concordance of survey reports of health service use versus claims data between self respondents and spousal and nonspousal relative proxies.

DATA SOURCES: 1995-2010 data from the Survey on Assets and Health Dynamics among the Oldest Old and 1993-2010 Medicare claims for 3,229 individuals (13,488 person-years).

STUDY DESIGN: Regression models with individual fixed effects were estimated for discordance of any hospitalizations and outpatient surgery and for the numbers of under- and over-reported physician visits.

PRINCIPAL FINDINGS: Spousal proxies were similar to self respondents on discordance. Nonspousal proxies, particularly daughters/daughters-in-law and sons/sons-in-law, had less discordance, mainly due to reduced under-reporting.

CONCLUSIONS: Survey reports of health services use from nonspousal relatives are more consistent with Medicare claims than spousal proxies and self respondents.

}, keywords = {Ambulatory Surgical Procedures, Female, Hospitalization, Humans, Insurance Claim Review, Male, Medicare, Patient Acceptance of Health Care, Proxy, Self Report, Socioeconomic factors, Spouses, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12321}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26059195}, author = {George L Wehby and Michael P Jones and Fred A Ullrich and Yiyue Lou and Frederic D Wolinsky} } @article {8681, title = {Does Volunteering Experience Influence Advance Care Planning in Old Age?}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {423-438}, abstract = {

Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998-2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR~=~1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10~years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP.

}, keywords = {Advance care planning, Aged, Aging, Female, Humans, Income, Logistic Models, Male, Middle Aged, Social Support, Socioeconomic factors, Terminal Care, Volunteers}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1230567}, author = {Shen, Huei-Wern and Khosla, Nidhi} } @article {8384, title = {Effects of Recent Stress and Variation in the Serotonin Transporter Polymorphism (5-HTTLPR) on Depressive Symptoms: A Repeated-Measures Study of Adults Age 50 and Older.}, journal = {Behavior Genetics}, volume = {46}, year = {2016}, pages = {72-88}, publisher = {46}, abstract = {

Depending on genetic sensitivity to it, stress may affect depressive symptomatology differentially. Applying the stress-diathesis hypothesis to older adults, we postulate: (1) recent stress will associate with increased depressive symptom levels and (2) this effect will be greater for individuals with at least one short allele of the serotonin transporter gene promoter region (5-HTTLPR). Further, we employ a design that addresses specific limitations of many prior studies that have examined the 5-HTTLPR {\texttimes} SLE relation, by: (a) using a within-person repeated-measures design to address fluctuations that occur within individuals over time, increase power for detecting G~{\texttimes}~E, and address GE correlation; (b) studying reports of exogenous stressful events (those unlikely to be caused by depression) to help rule out reverse causation and negativity bias, and in order to assess stressors that are more etiologically relevant to depressive symptomatology in older adults. The sample is drawn from the Health and Retirement Study, a U.S. population-based study of older individuals (N~=~28,248; mean age~=~67.5; 57.3~\% female; 80.7~\% Non-Hispanic White, 14.9~\% Hispanic/Latino, 4.5~\% African American; genetic subsample~=~12,332), from whom measures of depressive symptoms and exogenous stressors were collected biannually (1994-2010). Variation in the 5-HTTLPR was characterized via haplotype, using two single nucleotide polymorphisms (SNPs). Ordered logit models were constructed to predict levels of depressive symptoms from 5-HTTLPR and stressors, comparing results of the most commonly applied statistical approaches (i.e., comparing allelic and genotypic models, and continuous and categorical predictors) used in the literature. All models were stratified by race/ethnicity. Overall, results show a main effect of recent stress for all ethnic groups, and mixed results for the variation in 5-HTTLPR~{\texttimes}~stress interaction, contingent upon statistical model used. Findings suggest there may be a differential effect of stressors and 5-HTTLPR on depressive symptoms by ethnicity, but further research is needed, particularly when using a haplotype to characterize variation in 5-HTTLPR in population-based sample with a diverse ethnic composition.

}, keywords = {Aged, Alleles, depression, Depressive Disorder, Ethnic Groups, Female, Gene-Environment Interaction, Genetic Association Studies, Genetic Predisposition to Disease, Haplotypes, Humans, Life Change Events, Male, Middle Aged, Polymorphism, Single Nucleotide, Promoter Regions, Genetic, Serotonin Plasma Membrane Transport Proteins, Stress, Psychological}, issn = {1573-3297}, doi = {10.1007/s10519-015-9740-8}, author = {Thalida E. Arpawong and Jinkook Lee and Drystan F. Phillips and Eileen M. Crimmins and Morgan E. Levine and Carol A Prescott} } @article {6439, title = {The five-factor model of personality and self-reported versus biomarker diabetic control.}, journal = {J Health Psychol}, volume = {21}, year = {2016}, month = {2016 Oct}, pages = {2328-38}, abstract = {

Five-factor personality was examined as an element of self-report diabetic control accuracy versus biomarker control (HbA1c) for 1474 diabetics in the 2006 and 2008 Health and Retirement Study. Correlations of extraversion and self-reported control (r = -.06, p < .01), and extraversion and HbA1c (r = .03, non-significant), were significantly different (t = 2.87, p < .01). Correlations of openness and self-reported control (r = -.05, p < .05), and openness and HbA1c (r = .01, non-significant), were significantly different (t = 1.91, p < .05). Associations were found between self-reported control and conscientiousness (r = -.05, p < .05), neuroticism (r = .04, p < .05), and openness (r = -.05, p < .05). Neuroticism was associated with self-reports that diabetes was worse (r = .07, p < .01). Other correlations and comparisons were non-significant.

}, keywords = {Aged, Aged, 80 and over, Biomarkers, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Personality, Self Report}, issn = {1461-7277}, doi = {10.1177/1359105315576349}, url = {http://hpq.sagepub.com/content/early/2015/03/24/1359105315576349.abstract}, author = {Phillips, Amanda S and Charles A Guarnaccia} } @article {8702, title = {Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {26-34}, chapter = {26-34}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognitive Dysfunction, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Population Dynamics, Residence Characteristics, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv075}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract}, author = {Esther M Friedman and Margaret M Weden and Regina A Shih and Stephanie Kovalchik and Singh, Reema and Jos{\'e} J Escarce} } @article {8879, title = {Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.}, journal = {Nat Commun}, volume = {7}, year = {2016}, month = {2016 Jan 21}, pages = {10023}, abstract = {

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.

}, keywords = {Chronic disease, Genome-Wide Association Study, Genotype, Humans}, issn = {2041-1723}, doi = {10.1038/ncomms10023}, author = {Pattaro, Cristian and Teumer, Alexander and Gorski, Mathias and Chu, Audrey Y and Li, Man and Mijatovic, Vladan and Garnaas, Maija and Tin, Adrienne and Sorice, Rossella and Yong Li and Taliun, Daniel and Olden, Matthias and Foster, Meredith and Qiong Yang and Chen, Ming-Huei and Pers, Tune H and Andrew D Johnson and Ko, Yi-An and Fuchsberger, Christian and Bamidele O Tayo and Michael A Nalls and Feitosa, Mary F and Isaacs, Aaron and Dehghan, Abbas and d{\textquoteright}Adamo, Pio and Adebawole Adeyemo and Dieffenbach, Aida Karina and Alan B Zonderman and Ilja M Nolte and van der Most, Peter J and Alan F Wright and Alan R Shuldiner and Alanna C Morrison and Hofman, Albert and Albert Vernon Smith and Dreisbach, Albert W and Franke, Andre and Andr{\'e} G Uitterlinden and Andres Metspalu and T{\"o}njes, Anke and Lupo, Antonio and Robino, Antonietta and Johansson, {\r A}sa and Demirkan, Ayse and Kollerits, Barbara and Freedman, Barry I and Ponte, Belen and Ben A Oostra and Paulweber, Bernhard and Kr{\"a}mer, Bernhard K and Mitchell, Braxton D and Buckley, Brendan M and Peralta, Carmen A and Caroline Hayward and Helmer, Catherine and Charles N Rotimi and Shaffer, Christian M and M{\"u}ller, Christian and Cinzia Felicita Sala and Cornelia M van Duijn and Saint-Pierre, Aude and Daniel Ackermann and Daniel Shriner and Ruggiero, Daniela and Toniolo, Daniela and Lu, Yingchang and Cusi, Daniele and Czamara, Darina and Ellinghaus, David and David S Siscovick and Ruderfer, Douglas and Gieger, Christian and Grallert, Harald and Rochtchina, Elena and Atkinson, Elizabeth J and Holliday, Elizabeth G and Boerwinkle, Eric and Salvi, Erika and Erwin P Bottinger and Murgia, Federico and Fernando Rivadeneira and Ernst, Florian and Kronenberg, Florian and Hu, Frank B and Navis, Gerjan J and Curhan, Gary C and Georg B Ehret and Homuth, Georg and Coassin, Stefan and Thun, Gian-Andri and Pistis, Giorgio and Gambaro, Giovanni and Malerba, Giovanni and Grant W Montgomery and Gu{\dh}ny Eir{\'\i}ksd{\'o}ttir and Jacobs, Gunnar and Guo Li and Wichmann, H-Erich and Campbell, Harry and Schmidt, Helena and Wallaschofski, Henri and V{\"o}lzke, Henry and Brenner, Hermann and Kroemer, Heyo K and Kramer, Holly and Lin, Honghuang and Irene Mateo Leach and Ford, Ian and Guessous, Idris and Rudan, Igor and Prokopenko, Inga and Ingrid B Borecki and Iris M Heid and Kolcic, Ivana and Persico, Ivana and Jukema, J Wouter and James F Wilson and Felix, Janine F and Divers, Jasmin and Lambert, Jean-Charles and Stafford, Jeanette M and Gaspoz, Jean-Michel and Jennifer A Smith and Jessica Faul and Wang, Jie Jin and Ding, Jingzhong and Joel N Hirschhron and John R. Attia and Whitfield, John B and Chalmers, John and Viikari, Jorma and Coresh, Josef and Denny, Joshua C and Karjalainen, Juha and Fernandes, Jyotika K and Endlich, Karlhans and Butterbach, Katja and Keene, Keith L and Kurt Lohman and Portas, Laura and Lenore J Launer and Lyytik{\"a}inen, Leo-Pekka and Yengo, Loic and Lude L Franke and Luigi Ferrucci and Rose, Lynda M and Kedenko, Lyudmyla and Rao, Madhumathi and Struchalin, Maksim and Kleber, Marcus E and Cavalieri, Margherita and Haun, Margot and Marilyn C Cornelis and Ciullo, Marina and Pirastu, Mario and de Andrade, Mariza and McEvoy, Mark A and Woodward, Mark and Adam, Martin and Cocca, Massimiliano and Nauck, Matthias and Imboden, Medea and Waldenberger, Melanie and Pruijm, Menno and Metzger, Marie and Stumvoll, Michael and Michele K Evans and Sale, Michele M and K{\"a}h{\"o}nen, Mika and Boban, Mladen and Bochud, Murielle and Rheinberger, Myriam and Verweij, Niek and Bouatia-Naji, Nabila and Nicholas G Martin and Nicholas D Hastie and Nicole M Probst-Hensch and Soranzo, Nicole and Devuyst, Olivier and Olli T Raitakari and Gottesman, Omri and Franco, Oscar H and Polasek, Ozren and Paolo P. Gasparini and Munroe, Patricia B and Ridker, Paul M and Mitchell, Paul and Muntner, Paul and Meisinger, Christa and Johannes H Smit and Kovacs, Peter and Wild, Philipp S and Froguel, Philippe and Rettig, Rainer and M{\"a}gi, Reedik and Biffar, Reiner and Schmidt, Reinhold and Middelberg, Rita P S and Carroll, Robert J and Brenda W J H Penninx and Rodney J Scott and Katz, Ronit and Sedaghat, Sanaz and Sarah Wild and Sharon L R Kardia and Ulivi, Sheila and Hwang, Shih-Jen and Enroth, Stefan and Kloiber, Stefan and Trompet, Stella and Stengel, Benedicte and Hancock, Stephen J and Stephen T Turner and Rosas, Sylvia E and Stracke, Sylvia and Tamara B Harris and Zeller, Tanja and Zemunik, Tatijana and Lehtim{\"a}ki, Terho and Illig, Thomas and Aspelund, Thor and Nikopensius, Tiit and T{\~o}nu Esko and Toshiko Tanaka and Gyllensten, Ulf and V{\"o}lker, Uwe and Emilsson, Valur and Vitart, Veronique and Aalto, Ville and Gudnason, Vilmundur and Chouraki, Vincent and Chen, Wei-Min and Igl, Wilmar and M{\"a}rz, Winfried and Koenig, Wolfgang and Lieb, Wolfgang and Ruth J F Loos and Yongmei Liu and Snieder, Harold and Pramstaller, Peter P and Parsa, Afshin and Jeff O{\textquoteright}Connell and Susztak, Katalin and Hamet, Pavel and Tremblay, Johanne and de Boer, Ian H and B{\"o}ger, Carsten A and Goessling, Wolfram and Daniel I Chasman and K{\"o}ttgen, Anna and Kao, W H Linda and Caroline S Fox} } @article {8513, title = {Genetic evidence for natural selection in humans in the contemporary United States.}, journal = {Proc Natl Acad Sci U S A}, volume = {113}, year = {2016}, month = {2016 07 12}, pages = {7774-9}, abstract = {

Recent findings from molecular genetics now make it possible to test directly for natural selection by analyzing whether genetic variants associated with various phenotypes have been under selection. I leverage these findings to construct polygenic scores that use individuals{\textquoteright} genotypes to predict their body mass index, educational attainment (EA), glucose concentration, height, schizophrenia, total cholesterol, and (in females) age at menarche. I then examine associations between these scores and fitness to test whether natural selection has been occurring. My study sample includes individuals of European ancestry born between 1931 and 1953 who participated in the Health and Retirement Study, a representative study of the US population. My results imply that natural selection has been slowly favoring lower EA in both females and males, and are suggestive that natural selection may have favored a higher age at menarche in females. For EA, my estimates imply a rate of selection of about -1.5 mo of education per generation (which pales in comparison with the increases in EA observed in contemporary times). Although they cannot be projected over more than one generation, my results provide additional evidence that humans are still evolving-albeit slowly, especially compared with the rapid changes that have occurred over the past few generations due to cultural and environmental factors.

}, keywords = {Aged, Blood Glucose, Body Height, Body Mass Index, Cholesterol, Educational Status, Female, Humans, Longitudinal Studies, Male, Menarche, Middle Aged, Models, Genetic, Phenotype, Schizophrenia, Selection, Genetic}, issn = {1091-6490}, doi = {10.1073/pnas.1600398113}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27402742}, author = {Jonathan P. Beauchamp} } @article {8662, title = {A Genetic Network Associated With Stress Resistance, Longevity, and Cancer in Humans.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {71}, year = {2016}, month = {2016 06}, pages = {703-12}, abstract = {

Human longevity and diseases are likely influenced by multiple interacting genes within a few biologically conserved pathways. Using long-lived smokers as a phenotype (n = 90)-a group whose survival may signify innate resilience-we conducted a genome-wide association study comparing them to smokers at ages 52-69 (n = 730). These results were used to conduct a functional interaction network and pathway analysis, to identify single nucleotide polymorphisms that collectively related to smokers{\textquoteright} longevity. We identified a set of 215 single nucleotide polymorphisms (all of which had p <5{\texttimes}10(-3) in the genome-wide association study) that were located within genes making-up a functional interaction network. These single nucleotide polymorphisms were then used to create a weighted polygenic risk score that, using an independent validation sample of nonsmokers (N = 6,447), was found to be significantly associated with a 22\% increase in the likelihood of being aged 90-99 (n = 253) and an over threefold increase in the likelihood of being a centenarian (n = 4), compared with being at ages 52-79 (n = 4,900). Additionally, the polygenic risk score was also associated with an 11\% reduction in cancer prevalence over up to 18 years (odds ratio: 0.89, p = .011). Overall, using a unique phenotype and incorporating prior knowledge of biological networks, this study identified a set of single nucleotide polymorphisms that together appear to be important for human aging, stress resistance, cancer, and longevity.

}, keywords = {Aged, Aged, 80 and over, Aging, Alleles, Case-Control Studies, Gene Regulatory Networks, Genome-Wide Association Study, Genotype, Humans, Longevity, Longitudinal Studies, Middle Aged, Neoplasms, Phenotype, Polymorphism, Single Nucleotide, Smoking, Stress, Physiological, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glv141}, author = {Morgan E. Levine and Eileen M. Crimmins} } @article {8618, title = {Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses.}, journal = {Nat Genet}, volume = {48}, year = {2016}, month = {2016 06}, pages = {624-33}, abstract = {

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.

}, keywords = {Anxiety Disorders, Bayes Theorem, depression, Genome-Wide Association Study, Humans, Neuroticism, Phenotype, Polymorphism, Single Nucleotide}, issn = {1546-1718}, doi = {10.1038/ng.3552}, author = {Okbay, Aysu and Baselmans, Bart M L and De Neve, Jan-Emmanuel and Turley, Patrick and Nivard, Michel G and Mark Alan Fontana and Meddens, S Fleur W and Richard Karlsson Linn{\'e}r and Cornelius A Rietveld and Derringer, Jaime and Gratten, Jacob and Lee, James J and Liu, Jimmy Z and de Vlaming, Ronald and Ahluwalia, Tarunveer S and Buchwald, Jadwiga and Cavadino, Alana and Frazier-Wood, Alexis C and Furlotte, Nicholas A and Garfield, Victoria and Geisel, Marie Henrike and Gonzalez, Juan R and Haitjema, Saskia and Karlsson, Robert and van der Laan, Sander W and Ladwig, Karl-Heinz and J. Lahti and Sven J van der Lee and Penelope A Lind and Tian Liu and Lindsay K Matteson and Mihailov, Evelin and Michael B Miller and Minica, Camelia C and Ilja M Nolte and Dennis O Mook-Kanamori and van der Most, Peter J and Christopher J Oldmeadow and Qian, Yong and Olli T Raitakari and Rawal, Rajesh and Realo, Anu and Rueedi, Rico and Schmidt, B{\"o}rge and Albert Vernon Smith and Stergiakouli, Evie and Toshiko Tanaka and Kent D Taylor and Wedenoja, Juho and J{\"u}rgen Wellmann and Westra, Harm-Jan and Willems, Sara M and Wei Zhao and Amin, Najaf and Bakshi, Andrew and Patricia A. Boyle and Cherney, Samantha and Cox, Simon R and Gail Davies and Davis, Oliver S P and Ding, Jun and Nese Direk and Eibich, Peter and Emeny, Rebecca T and Fatemifar, Ghazaleh and Jessica Faul and Luigi Ferrucci and Andreas J Forstner and Gieger, Christian and Gupta, Richa and Tamara B Harris and Harris, Juliette M and Holliday, Elizabeth G and Jouke-Jan Hottenga and Philip L de Jager and Marika A Kaakinen and Kajantie, Eero and Karhunen, Ville and Kolcic, Ivana and Kumari, Meena and Lenore J Launer and Lude L Franke and Li-Gao, Ruifang and Koini, Marisa and Loukola, Anu and Marques-Vidal, Pedro and Grant W Montgomery and Mosing, Miriam A and Paternoster, Lavinia and Pattie, Alison and Katja E Petrovic and Pulkki-Raback, Laura and Quaye, Lydia and Katri R{\"a}ikk{\"o}nen and Rudan, Igor and Rodney J Scott and Jennifer A Smith and Angelina R Sutin and Trzaskowski, Maciej and Anna A E Vinkhuyzen and Lei Yu and Zabaneh, Delilah and John R. Attia and David A Bennett and Klaus Berger and Bertram, Lars and Dorret I Boomsma and Snieder, Harold and Chang, Shun-Chiao and Francesco Cucca and Ian J Deary and Cornelia M van Duijn and Johan G Eriksson and B{\"u}ltmann, Ute and Eco J. C. de Geus and Groenen, Patrick J F and Gudnason, Vilmundur and Hansen, Torben and Catharina A Hartman and Haworth, Claire M A and Caroline Hayward and Andrew C Heath and Hinds, David A and Hypp{\"o}nen, Elina and Iacono, William G and J{\"a}rvelin, Marjo-Riitta and J{\"o}ckel, Karl-Heinz and Kaprio, Jaakko and Sharon L R Kardia and Keltikangas-J{\"a}rvinen, Liisa and Kraft, Peter and Laura D Kubzansky and Lehtim{\"a}ki, Terho and Patrik K E Magnusson and Nicholas G Martin and McGue, Matt and Andres Metspalu and Melinda C Mills and de Mutsert, Ren{\'e}e and Oldehinkel, Albertine J and Pasterkamp, Gerard and Nancy L Pedersen and Plomin, Robert and Polasek, Ozren and Power, Christine and Rich, Stephen S and Rosendaal, Frits R and Hester M. den Ruijter and Schlessinger, David and Schmidt, Helena and Svento, Rauli and Schmidt, Reinhold and Alizadeh, Behrooz Z and Thorkild I. A. S{\o}rensen and Timothy Spector and Andrew Steptoe and Antonio Terracciano and A. Roy Thurik and Nicholas J Timpson and Henning Tiemeier and Andr{\'e} G Uitterlinden and Vollenweider, Peter and Wagner, Gert G and David R Weir and Yang, Jian and Dalton C Conley and Hofman, Albert and Johannesson, Magnus and David I Laibson and Sarah E Medland and Meyer, Michelle N and Pickrell, Joseph K and T{\~o}nu Esko and Krueger, Robert F and Jonathan P. Beauchamp and Philipp D Koellinger and Daniel J. Benjamin and Bartels, Meike and Cesarini, David} } @article {8653, title = {Genetic variants near MLST8 and DHX57 affect the epigenetic age of the cerebellum.}, journal = {Nat Commun}, volume = {7}, year = {2016}, month = {2016 Feb 02}, pages = {10561}, abstract = {

DNA methylation (DNAm) levels lend themselves for defining an epigenetic biomarker of aging known as the {\textquoteright}epigenetic clock{\textquoteright}. Our genome-wide association study (GWAS) of cerebellar epigenetic age acceleration identifies five significant (P<5.0 {\texttimes} 10(-8)) SNPs in two loci: 2p22.1 (inside gene DHX57) and 16p13.3 near gene MLST8 (a subunit of mTOR complex 1 and 2). We find that the SNP in 16p13.3 has a cis-acting effect on the expression levels of MLST8 (P=6.9 {\texttimes} 10(-18)) in most brain regions. In cerebellar samples, the SNP in 2p22.1 has a cis-effect on DHX57 (P=4.4 {\texttimes} 10(-5)). Gene sets found by our GWAS analysis of cerebellar age acceleration exhibit significant overlap with those of Alzheimer{\textquoteright}s disease (P=4.4 {\texttimes} 10(-15)), age-related macular degeneration (P=6.4 {\texttimes} 10(-6)), and Parkinson{\textquoteright}s disease (P=2.6 {\texttimes} 10(-4)). Overall, our results demonstrate the utility of a new paradigm for understanding aging and age-related diseases: it will be fruitful to use epigenetic tissue age as endophenotype in GWAS.

}, keywords = {Adaptor Proteins, Signal Transducing, Aging, Cell Line, Cerebellum, Epigenesis, Genetic, Gene Expression Regulation, Genetic Variation, Genome-Wide Association Study, Humans, Linkage Disequilibrium, mTOR Associated Protein, LST8 Homolog}, issn = {2041-1723}, doi = {10.1038/ncomms10561}, author = {Lu, Ake T and Hannon, Eilis and Morgan E. Levine and Hao, Ke and Eileen M. Crimmins and Lunnon, Katie and Kozlenkov, Alexey and Mill, Jonathan and Dracheva, Stella and Horvath, Steve} } @article {8607, title = {GENOME-WIDE ASSOCIATION STUDY (GWAS) AND GENOME-WIDE BY ENVIRONMENT INTERACTION STUDY (GWEIS) OF DEPRESSIVE SYMPTOMS IN AFRICAN AMERICAN AND HISPANIC/LATINA WOMEN.}, journal = {Depress Anxiety}, volume = {33}, year = {2016}, month = {2016 Apr}, pages = {265-80}, abstract = {

BACKGROUND: Genome-wide association studies (GWAS) have made little progress in identifying variants linked to depression. We hypothesized that examining depressive symptoms and considering gene-environment interaction (GxE) might improve efficiency for gene discovery. We therefore conducted a GWAS and genome-wide by environment interaction study (GWEIS) of depressive symptoms.

METHODS: Using data from the SHARe cohort of the Women{\textquoteright}s Health Initiative, comprising African Americans (n = 7,179) and Hispanics/Latinas (n = 3,138), we examined genetic main effects and GxE with stressful life events and social support. We also conducted a heritability analysis using genome-wide complex trait analysis (GCTA). Replication was attempted in four independent cohorts.

RESULTS: No SNPs achieved genome-wide significance for main effects in either discovery sample. The top signals in African Americans were rs73531535 (located 20 kb from GPR139, P = 5.75 {\texttimes} 10(-8) ) and rs75407252 (intronic to CACNA2D3, P = 6.99 {\texttimes} 10(-7) ). In Hispanics/Latinas, the top signals were rs2532087 (located 27 kb from CD38, P = 2.44 {\texttimes} 10(-7) ) and rs4542757 (intronic to DCC, P = 7.31 {\texttimes} 10(-7) ). In the GEWIS with stressful life events, one interaction signal was genome-wide significant in African Americans (rs4652467; P = 4.10 {\texttimes} 10(-10) ; located 14 kb from CEP350). This interaction was not observed in a smaller replication cohort. Although heritability estimates for depressive symptoms and stressful life events were each less than 10\%, they were strongly genetically correlated (rG = 0.95), suggesting that common variation underlying self-reported depressive symptoms and stressful life event exposure, though modest on their own, were highly overlapping in this sample.

CONCLUSIONS: Our results underscore the need for larger samples, more GEWIS, and greater investigation into genetic and environmental determinants of depressive symptoms in minorities.

}, keywords = {African Americans, Aged, depression, Female, Gene-Environment Interaction, Genome-Wide Association Study, Hispanic Americans, Humans, Life Change Events, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Risk Factors, Self Report}, issn = {1520-6394}, doi = {10.1002/da.22484}, author = {Dunn, Erin C and Wiste, Anna and Radmanesh, Farid and Almli, Lynn M and Gogarten, Stephanie M and Sofer, Tamar and Jessica Faul and Sharon L R Kardia and Jennifer A Smith and David R Weir and Wei Zhao and Soare, Thomas W and Saira S Mirza and Karin Hek and Henning Tiemeier and Goveas, Joseph S and Sarto, Gloria E and Snively, Beverly M and Marilyn C Cornelis and Karestan C Koenen and Kraft, Peter and Shaun M Purcell and Ressler, Kerry J and Rosand, Jonathan and Wassertheil-Smoller, Sylvia and Smoller, Jordan W} } @article {8883, title = {Genome-wide association study identifies 74 loci associated with educational attainment.}, journal = {Nature}, volume = {533}, year = {2016}, month = {2016 05 26}, pages = {539-42}, abstract = {

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20\% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.

}, keywords = {Alzheimer{\textquoteright}s disease, Bipolar Disorder, Cognitive Ability, Education, Fetus, Genome-Wide Association Study, Humans, Molecular Sequence Annotation, Polymorphism, Single Nucleotide, Schizophrenia, United Kingdom}, issn = {1476-4687}, doi = {10.1038/nature17671}, author = {Okbay, Aysu and Jonathan P. Beauchamp and Mark Alan Fontana and Lee, James J and Pers, Tune H and Cornelius A Rietveld and Turley, Patrick and Chen, Guo-Bo and Emilsson, Valur and Meddens, S Fleur W and Oskarsson, Sven and Pickrell, Joseph K and Thom, Kevin and Pascal N Timshel and de Vlaming, Ronald and Abdel Abdellaoui and Ahluwalia, Tarunveer S and Bacelis, Jonas and Baumbach, Clemens and Bjornsdottir, Gyda and Brandsma, Johannes H and Maria Pina Concas and Derringer, Jaime and Furlotte, Nicholas A and Galesloot, Tessel E and Giorgia G Girotto and Gupta, Richa and Hall, Leanne M and Sarah E Harris and Edith Hofer and Horikoshi, Momoko and Huffman, Jennifer E and Kaasik, Kadri and Ioanna Panagiota Kalafati and Karlsson, Robert and Kong, Augustine and Lahti, Jari and Sven J van der Lee and Christiaan de Leeuw and Penelope A Lind and Lindgren, Karl-Oskar and Tian Liu and Mangino, Massimo and Marten, Jonathan and Mihailov, Evelin and Michael B Miller and van der Most, Peter J and Christopher J Oldmeadow and Payton, Antony and Pervjakova, Natalia and Wouter J Peyrot and Qian, Yong and Olli T Raitakari and Rueedi, Rico and Salvi, Erika and Schmidt, B{\"o}rge and Schraut, Katharina E and Jianxin Shi and Albert Vernon Smith and Poot, Raymond A and St Pourcain, Beate and Teumer, Alexander and Thorleifsson, Gudmar and Verweij, Niek and Vuckovic, Dragana and J{\"u}rgen Wellmann and Westra, Harm-Jan and Yang, Jingyun and Wei Zhao and Zhihong Zhu and Alizadeh, Behrooz Z and Amin, Najaf and Bakshi, Andrew and Baumeister, Sebastian E and Biino, Ginevra and B{\o}nnelykke, Klaus and Patricia A. Boyle and Campbell, Harry and Cappuccio, Francesco P and Gail Davies and De Neve, Jan-Emmanuel and Deloukas, Panos and Demuth, Ilja and Ding, Jun and Eibich, Peter and Eisele, Lewin and Eklund, Niina and Jessica Faul and Feitosa, Mary F and Andreas J Forstner and Gandin, Ilaria and Gunnarsson, Bjarni and Halld{\'o}rsson, Bjarni V and Tamara B Harris and Andrew C Heath and Lynne J Hocking and Holliday, Elizabeth G and Homuth, Georg and Horan, Michael A and Jouke-Jan Hottenga and Philip L de Jager and Joshi, Peter K and Jugessur, Astanand and Marika A Kaakinen and K{\"a}h{\"o}nen, Mika and Kanoni, Stavroula and Keltigangas-J{\"a}rvinen, Liisa and Lambertus A Kiemeney and Kolcic, Ivana and Koskinen, Seppo and Kraja, Aldi T and Kroh, Martin and Kutalik, Zolt{\'a}n and Latvala, Antti and Lenore J Launer and Lebreton, Ma{\"e}l P and Douglas F Levinson and Paul Lichtenstein and Lichtner, Peter and David C Liewald and Loukola, Anu and Pamela A F Madden and M{\"a}gi, Reedik and M{\"a}ki-Opas, Tomi and Riccardo E Marioni and Marques-Vidal, Pedro and Meddens, Gerardus A and McMahon, George and Meisinger, Christa and Meitinger, Thomas and Milaneschi, Yusplitri and Lili Milani and Grant W Montgomery and Myhre, Ronny and Nelson, Christopher P and Nyholt, Dale R and William E R Ollier and Aarno Palotie and Paternoster, Lavinia and Nancy L Pedersen and Katja E Petrovic and David J Porteous and Katri R{\"a}ikk{\"o}nen and Ring, Susan M and Robino, Antonietta and Rostapshova, Olga and Rudan, Igor and Rustichini, Aldo and Veikko Salomaa and Sanders, Alan R and Sarin, Antti-Pekka and Schmidt, Helena and Rodney J Scott and Smith, Blair H and Jennifer A Smith and Staessen, Jan A and Steinhagen-Thiessen, Elisabeth and Strauch, Konstantin and Antonio Terracciano and Tobin, Martin D and Ulivi, Sheila and Vaccargiu, Simona and Quaye, Lydia and van Rooij, Frank J A and Venturini, Cristina and Anna A E Vinkhuyzen and V{\"o}lker, Uwe and V{\"o}lzke, Henry and Vonk, Judith M and Vozzi, Diego and Waage, Johannes and Erin B Ware and Gonneke Willemsen and John R. Attia and David A Bennett and Klaus Berger and Bertram, Lars and Bisgaard, Hans and Dorret I Boomsma and Ingrid B Borecki and B{\"u}ltmann, Ute and Chabris, Christopher F and Francesco Cucca and Cusi, Daniele and Ian J Deary and George Dedoussis and Cornelia M van Duijn and Johan G Eriksson and Franke, Barbara and Lude L Franke and Paolo P. Gasparini and Gejman, Pablo V and Gieger, Christian and Hans-J{\"o}rgen Grabe and Gratten, Jacob and Groenen, Patrick J F and Gudnason, Vilmundur and van der Harst, Pim and Caroline Hayward and Hinds, David A and Hoffmann, Wolfgang and Hypp{\"o}nen, Elina and Iacono, William G and Jacobsson, Bo and J{\"a}rvelin, Marjo-Riitta and J{\"o}ckel, Karl-Heinz and Kaprio, Jaakko and Sharon L R Kardia and Lehtim{\"a}ki, Terho and Lehrer, Steven F and Patrik K E Magnusson and Nicholas G Martin and McGue, Matt and Andres Metspalu and Pendleton, Neil and Brenda W J H Penninx and Markus Perola and Nicola Pirastu and Pirastu, Mario and Polasek, Ozren and Posthuma, Danielle and Power, Christine and Province, Michael A and Nilesh J Samani and Schlessinger, David and Schmidt, Reinhold and Thorkild I. A. S{\o}rensen and Timothy Spector and Stefansson, Kari and Thorsteinsdottir, Unnur and A. Roy Thurik and Nicholas J Timpson and Henning Tiemeier and Tung, Joyce Y and Andr{\'e} G Uitterlinden and Vitart, Veronique and Vollenweider, Peter and David R Weir and James F Wilson and Alan F Wright and Dalton C Conley and Krueger, Robert F and George Davey Smith and Hofman, Albert and David I Laibson and Sarah E Medland and Meyer, Michelle N and Yang, Jian and Johannesson, Magnus and Peter M Visscher and T{\~o}nu Esko and Philipp D Koellinger and Cesarini, David and Daniel J. Benjamin} } @article {8484, title = {A Global View on the Effects of Work on Health in Later Life.}, journal = {Gerontologist}, volume = {56 Suppl 2}, year = {2016}, month = {2016 Apr}, pages = {S281-92}, abstract = {

PURPOSE OF THE STUDY: Work is an important environment shaping the aging processes during the adult years. Therefore, the cumulative and acute effects of work characteristics on late-life health deserve great attention. Given that population aging has become a global trend with ensuing changes in labor markets around the world, increased attention is paid to investigating the effects of the timing of retirement around the world and the macroeconomic benefits often associated with delaying retirement. It will be essential for societies with aging populations to maintain productivity given an aging workforce and for individuals it will be crucial to add healthy and meaningful years rather than just years to their lives.

DESIGN AND METHODS: We first describe the available evidence about participation of older workers (65+) in the labor force in high, middle, and low-income countries. Second, we discuss the individual-level and societal influences that might govern labor-force participation of older adults. Thirdly, we review evidence on the association between work on the one and physical, mental, and cognitive health in later life on the other.

RESULTS AND IMPLICATIONS: Globally, both is true: work supports healthy aging and jeopordizes it. We draw implications for policymaking in terms of social protection, HR policies, and older employee employability.

}, keywords = {Aged, Aging, Employment, Humans, Public Policy, Retirement, Socioeconomic factors}, issn = {1758-5341}, doi = {10.1093/geront/gnw032}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26994267}, author = {Ursula M. Staudinger and Finkelstein, Ruth and Calvo, Esteban and Sivaramakrishnan, Kavita} } @article {8614, title = {GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium.}, journal = {Aging Cell}, volume = {15}, year = {2016}, month = {2016 10}, pages = {792-800}, abstract = {

Decline in muscle strength with aging is an important predictor of health trajectory in the elderly. Several factors, including genetics, are proposed contributors to variability in muscle strength. To identify genetic contributors to muscle strength, a meta-analysis of genomewide association studies of handgrip was conducted. Grip strength was measured using a handheld dynamometer in 27~581 individuals of European descent over 65~years of age from 14 cohort studies. Genomewide association analysis was conducted on ~2.7 million imputed and genotyped variants (SNPs). Replication of the most significant findings was conducted using data from 6393 individuals from three cohorts. GWAS of lower body strength was also characterized in a subset of cohorts. Two genomewide significant (P-value< 5~{\texttimes}~10(-8) ) and 39 suggestive (P-value< 5~{\texttimes}~10(-5) ) associations were observed from meta-analysis of the discovery cohorts. After meta-analysis with replication cohorts, genomewide significant association was observed for rs752045 on chromosome 8 (β~=~0.47, SE~=~0.08, P-value~=~5.20~{\texttimes}~10(-10) ). This SNP is mapped to an intergenic region and is located within an accessible chromatin region (DNase hypersensitivity site) in skeletal muscle myotubes differentiated from the human skeletal muscle myoblasts cell line. This locus alters a binding motif of the CCAAT/enhancer-binding protein-β (CEBPB) that is implicated in muscle repair mechanisms. GWAS of lower body strength did not yield significant results. A common genetic variant in a chromosomal region that regulates myotube differentiation and muscle repair may contribute to variability in grip strength in the elderly. Further studies are needed to uncover the mechanisms that link this genetic variant with muscle strength.

}, keywords = {Adult, Aged, Chromatin Immunoprecipitation, Cohort Studies, Epigenesis, Genetic, Genome-Wide Association Study, Hand Strength, Humans, Molecular Sequence Annotation, Muscle Strength, Polymorphism, Single Nucleotide, Quantitative Trait Loci, Reproducibility of Results}, issn = {1474-9726}, doi = {10.1111/acel.12468}, author = {Amy M Matteini and Toshiko Tanaka and Karasik, David and Atzmon, Gil and Chou, Wen-Chi and John D Eicher and Andrew D Johnson and Alice M. Arnold and Michele L Callisaya and Gail Davies and Daniel S Evans and Holtfreter, Birte and Kurt Lohman and Kathryn L Lunetta and Mangino, Massimo and Albert Vernon Smith and Jennifer A Smith and Teumer, Alexander and Lei Yu and Dan E Arking and Aron S Buchman and Chibinik, Lori B and Philip L de Jager and Jessica Faul and Melissa E Garcia and Gillham-Nasenya, Irina and Gudnason, Vilmundur and Hofman, Albert and Hsu, Yi-Hsiang and Ittermann, Till and Lahousse, Lies and David C Liewald and Yongmei Liu and Lopez, Lorna and Fernando Rivadeneira and Rotter, Jerome I and Siggeirsdottir, Kristin and John M Starr and Thomson, Russell and Tranah, Gregory J and Andr{\'e} G Uitterlinden and V{\"o}lker, Uwe and V{\"o}lzke, Henry and David R Weir and Kristine Yaffe and Wei Zhao and Wei Vivian Zhuang and Zmuda, Joseph M and David A Bennett and Steven R Cummings and Ian J Deary and Luigi Ferrucci and Tamara B Harris and Sharon L R Kardia and Kocher, Thomas and Stephen B Kritchevsky and Psaty, Bruce M and Seshadri, Sudha and Timothy Spector and Velandai K Srikanth and Beverly G Windham and Zillikens, M Carola and Anne B Newman and Jeremy D Walston and Douglas P Kiel and Joanne M Murabito} } @article {8817, title = {Health Effects of Short-Term Fluctuations in Macroeconomic Conditions: The Case of Hypertension for Older Americans.}, journal = {Health Econ}, volume = {25 Suppl 2}, year = {2016}, month = {2016 11}, pages = {113-125}, abstract = {

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

}, keywords = {Aged, Commerce, Economic Recession, Female, Health Status, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Socioeconomic factors, Stress, Psychological, Surveys and Questionnaires, Unemployment, United States}, issn = {1099-1050}, doi = {10.1002/hec.3374}, url = {http://doi.wiley.com/10.1002/hec.3374https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002\%2Fhec.3374http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3374/fullpdf}, author = {Marco Angrisani and Jinkook Lee} } @article {8383, title = {Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study.}, journal = {American Journal of Preventive Medicine}, volume = {50}, year = {2016}, pages = {191-198}, publisher = {50}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Ageism, Attitude of Health Personnel, depression, Female, Health Status, Humans, Hypertension, Male, Mental Health, Middle Aged, Overweight, Physician-Patient Relations, Physicians, Prejudice, Racism, Sex Factors, Socioeconomic factors, Stereotyping}, issn = {1873-2607}, doi = {10.1016/j.amepre.2015.07.034}, author = {Cleopatra M Abdou and Adam W. Fingerhut and James S Jackson and Felicia V Wheaton} } @article {8583, title = {High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture.}, journal = {J Pain Symptom Manage}, volume = {52}, year = {2016}, month = {2016 10}, pages = {533-538}, abstract = {

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, 80 and over, Dementia, depression, Female, Hip Fractures, Humans, Interviews as Topic, Male, multimorbidity, pain, Palliative care, Patient Acceptance of Health Care, Prodromal Symptoms, Vulnerable Populations}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2016.07.003}, url = {http://www.sciencedirect.com/science/article/pii/S0885392416302214}, author = {Christine S Ritchie and Amy Kelley and Irena Cenzer and Margaret Wallhagen and Kenneth E Covinsky} } @article {8482, title = {The Impact of Consumer Numeracy on the Purchase of Long-Term Care Insurance.}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 08}, pages = {1612-31}, abstract = {

OBJECTIVE: To determine the effect of consumers{\textquoteright} numeric abilities on the likelihood of owning private long-term care insurance.

DATA SOURCE: The 2010 wave of the Health and Retirement Study, a nationally representative survey of Americans age 50 and older, was used (n~=~12,796).

STUDY DESIGN: Multivariate logistic regression was used to isolate the relationship between numeracy and long-term care insurance ownership.

PRINCIPAL FINDINGS: Each additional question answered correctly on a numeracy scale was associated with a 13 percent increase in the likelihood of holding LTCI, after controlling for predictors of policy demand, education, and cognitive function.

CONCLUSIONS: Poor numeracy may create barriers to long-term care insurance purchase. Policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults{\textquoteright} ability to prepare for future long-term care expenses.

}, keywords = {Consumer Behavior, Financing, Personal, Health Surveys, Humans, Insurance, Long-Term Care, Middle Aged}, issn = {1475-6773}, doi = {10.1111/1475-6773.12439}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26799778}, author = {Brian E McGarry and Temkin-Greener, Helena and Chapman, Benjamin P and David C Grabowski and Li, Yue} } @article {8685, title = {The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning.}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {401-422}, abstract = {

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

}, keywords = {Advance care planning, Advance directives, African Americans, Aged, Aged, 80 and over, Continental Population Groups, European Continental Ancestry Group, Female, Health Status, Hispanic Americans, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Psychology, Social Class}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1229709}, author = {Inoue, Megumi} } @article {8342, title = {Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Jan}, pages = {71-6.e1-3}, publisher = {26}, abstract = {

PURPOSE: Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.

METHODS: IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955).

RESULTS: Using the genetic risk score as an IV, there was a 1.1\% reduction in dementia risk per year of schooling (95\% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5\%; 95\% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education.

CONCLUSIONS: IV analyses suggest education is protective against risk of dementia in older adulthood.

}, keywords = {Aged, Aged, 80 and over, Dementia, Education, Nonprofessional, Educational Status, Female, Genetic Predisposition to Disease, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Polymorphism, Single Nucleotide, Protective factors, Risk Factors, Schools, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.10.006}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and Sze Y Liu and Jennifer J Manly and M. Maria Glymour} } @article {8570, title = {Job Strain as a Risk Factor for Incident Diabetes Mellitus in Middle and Older Age U.S. Workers.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 11}, pages = {1089-1096}, abstract = {

OBJECTIVES: The current study examined the relationship between the 4 quadrants of the job strain model and incident diabetes in U.S. working adults 50 years and older.

METHODS: This study used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n = 1,396). Kaplan-Meier survival curves and Cox proportional hazard regression models were used to examine whether job strain significantly predicted diabetes incidence.

RESULTS: Participants in high strain and passive jobs had significantly higher risk of diabetes relative to those in low strain jobs. In the univariate survival curves, significantly higher risk of diabetes was observed in men working in passive jobs. After adjustment for relevant covariates, participants in high strain (hazard ratio [HR] = 1.73, 95\% confidence interval [CI] = 1.09-2.75) and passive (HR = 1.66, 95\% CI = 1.01-2.73) jobs had a significantly increased risk of diabetes. Among adults 65 years and older, high strain and passive jobs were associated with an approximately fourfold increased risk of incident diabetes.

DISCUSSION: High strain and passive occupations which represent low control over work are associated with increased risk of diabetes incidence among older workers. More research is required to better understand how psychosocial work factors impact health in aging workers. Further, research should continue to explore gender differences in effects of job strain on diabetes.

}, keywords = {Aged, Aging, Diabetes Mellitus, Female, Humans, Kaplan-Meier Estimate, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Stress, Psychological, United States, Work}, issn = {1758-5368}, doi = {10.1093/geronb/gbw091}, author = {Mutambudzi, Miriam and Javed, Zulqarnain} } @article {8542, title = {Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0157327}, abstract = {

PURPOSE: Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function.

METHODS: In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8-20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors.

RESULTS: Higher MSA-level income inequality predicted lower cognitive function 16-18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95\% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods.

CONCLUSIONS: Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.

}, keywords = {Cities, Cognition, Female, health, Humans, Income, Interviews as Topic, Linear Models, Male, Middle Aged, Multivariate Analysis, Residence Characteristics, Retirement, Socioeconomic factors, Statistics as Topic, Telephone, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0157327}, url = {http://dx.doi.org/10.1371/journal.pone.0157327}, author = {Kim, Daniel and Griffin, Beth Ann and Mohammed U Kabeto and Jos{\'e} J Escarce and Kenneth M. Langa and Regina A Shih}, editor = {M. Maria Glymour} } @article {8547, title = {Late mortality after sepsis: propensity matched cohort study.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 May 17}, pages = {i2375}, abstract = {

OBJECTIVES: ~To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN: ~Observational cohort study.

SETTING: ~US Health and Retirement Study.

PARTICIPANTS: ~960 patients aged >=65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES: ~Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS: ~Sepsis was associated with a 22.1\% (95\% confidence interval 17.5\% to 26.7\%) absolute increase in late mortality relative to adults not in hospital, a 10.4\% (5.4\% to 15.4\%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2\% (10.2\% to 22.2\%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS: ~More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Cause of Death, Female, Hospital Mortality, Hospitalization, Humans, Longitudinal Studies, Male, Medicare, Propensity Score, Prospective Studies, Sepsis, Time Factors, United States}, issn = {1756-1833}, doi = {10.1136/bmj.i2375}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27189000}, author = {Hallie C Prescott and Osterholzer, John J and Kenneth M. Langa and Angus, Derek C and Theodore J Iwashyna} } @article {8495, title = {Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans.}, journal = {J Health Soc Behav}, volume = {57}, year = {2016}, month = {2016 06}, pages = {184-99}, abstract = {

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998-2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Aging, Cognitive Dysfunction, European Continental Ancestry Group, Female, Health Status Disparities, Humans, Male, Neuropsychological tests, Risk Factors, Severity of Illness Index, United States}, issn = {2150-6000}, doi = {10.1177/0022146516645925}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27247126}, author = {Zhang, Zhenmei and Mark D Hayward and Yu, Yan-Liang} } @article {6501, title = {Life Expectancy With and Without Pain in the U.S. Elderly Population.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {71}, year = {2016}, month = {2016 Sep}, pages = {1171-6}, abstract = {

BACKGROUND: This study contributes to dialogue on quality versus quantity of life by examining years older persons can expect to live in various states of pain.

METHODS: Data from seven waves of the Health and Retirement Study; N = 26,896; age 55+. Estimations using the Interpolative Markov Chain approach apply probability transitions to multistate life table functions. Two estimates are interpreted: (i) population-based, which provide population averages aggregated across baseline states and (ii) status-based, which provide independent estimates by baseline state. Age- and sex-specific years with no pain, milder nonlimiting, and severe or limiting pain are reported as is percent of life in states of pain.

RESULTS: Females have higher life expectancy than males but similar expectations of pain-free life. Total life expectancy varies only slightly by baseline pain states but pain-free life expectancy varies greatly. For example, an 85-year-old female pain-free at baseline expects 7.04 more years, 5.28 being pain-free. An 85-year-old female with severe pain at baseline expects 6.42 years with only 2.66 pain-free. Percent of life with pain decreases by age for those pain-free at baseline and increases for those with pain at baseline.

CONCLUSION: Pain is moderately associated with quantity of or total life but substantially and importantly associated with quality of or pain-free life.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Health Status Indicators, Humans, Incidence, Life Expectancy, Life Tables, Male, Middle Aged, pain, Quality of Life, Risk Factors, Surveys and Questionnaires, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glw028}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract}, author = {Zachary Zimmer and Rubin, Sara} } @article {8496, title = {Life Satisfaction and Psychological Well-Being of Older Adults With Cancer Experience: The Role of Optimism and Volunteering.}, journal = {Int J Aging Hum Dev}, volume = {83}, year = {2016}, month = {2016 09}, pages = {274-89}, abstract = {

Promoting health and well-being among individuals of advancing age is a significant issue due to increased incidence of cancer among older adults. This study demonstrates the benefits of expecting positive outcomes and participating in volunteer activities among older adults with cancer. We used a nationally representative sample of 2,670 individuals who have experienced cancer from the 2008 wave of the Health and Retirement Study. We constructed a structural equation model to explore the associations of optimism, volunteerism, life satisfaction, and psychological well-being. The level of optimism was a significant predictor of volunteerism, which in turn affected life satisfaction and psychological well-being. The level of engagement in volunteer activities was found to have significant path coefficients toward both life satisfaction and psychological well-being. Our study provides evidence that older adults who have experienced cancer and maintained a positive outlook on their lives and engaged in personally meaningful activities tended to experience psychological well-being and life satisfaction.

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Humans, Male, Middle Aged, Neoplasms, Optimism, Personal Satisfaction, Volunteers}, issn = {1541-3535}, doi = {10.1177/0091415016652406}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27273518}, author = {Jinmoo Heo and Sanghee Chun and Lee, Sunwoo and Kim, Junhyoung} } @article {8704, title = {Lifespan adversity and later adulthood telomere length in the nationally representative US Health and Retirement Study.}, journal = {Proc Natl Acad Sci U S A}, volume = {113}, year = {2016}, month = {2016 10 18}, pages = {E6335-E6342}, abstract = {

Stress over the lifespan is thought to promote accelerated aging and early disease. Telomere length is a marker of cell aging that appears to be one mediator of this relationship. Telomere length is associated with early adversity and with chronic stressors in adulthood in many studies. Although cumulative lifespan adversity should have bigger impacts than single events, it is also possible that adversity in childhood has larger effects on later life health than adult stressors, as suggested by models of biological embedding in early life. No studies have examined the individual vs. cumulative effects of childhood and adulthood adversities on adult telomere length. Here, we examined the relationship between cumulative childhood and adulthood adversity, adding up a range of severe financial, traumatic, and social exposures, as well as comparing them to each other, in relation to salivary telomere length. We examined 4,598 men and women from the US Health and Retirement Study. Single adversities tended to have nonsignificant relations with telomere length. In adjusted models, lifetime cumulative adversity predicted 6\% greater odds of shorter telomere length. This result was mainly due to childhood adversity. In adjusted models for cumulative childhood adversity, the occurrence of each additional childhood event predicted 11\% increased odds of having short telomeres. This result appeared mainly because of social/traumatic exposures rather than financial exposures. This study suggests that the shadow of childhood adversity may reach far into later adulthood in part through cellular aging.

}, keywords = {Aged, Aged, 80 and over, Cellular Senescence, Female, Humans, Longevity, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Public Health Surveillance, Risk Factors, Stress, Psychological, Telomere, Telomere Shortening, United States}, issn = {1091-6490}, doi = {10.1073/pnas.1525602113}, url = {http://www.pnas.org/content/113/42/E6335.long}, author = {Puterman, Eli and Gemmill, Alison and Karasek, Deborah and David R Weir and Nancy E Adler and Aric A Prather and Elissa S Epel} } @article {8567, title = {Longitudinal Relationships Between Productive Activities and Functional Health in Later Years: A Multivariate Latent Growth Curve Modeling Approach.}, journal = {Int J Aging Hum Dev}, volume = {83}, year = {2016}, month = {2016 10}, pages = {418-40}, abstract = {

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

}, keywords = {Activities of Daily Living, Aged, Aging, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Volunteers}, issn = {1541-3535}, doi = {10.1177/0091415016657557}, url = {http://ahd.sagepub.com/content/early/2016/07/21/0091415016657557.long}, author = {Choi, Eunhee and Tang, Fengyan and Turk, Phillip} } @article {8811, title = {The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0166103}, abstract = {

BACKGROUND: The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.

METHODS AND FINDINGS: We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40\% of men and 10\% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95\% CI 0.08-0.50) and would add 900,000 people (95\% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95\% CI 345-975) in net health benefits over that period.

CONCLUSIONS: Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

}, keywords = {Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Cardiovascular Diseases, Female, Humans, Incidence, Life Expectancy, Male, Middle Aged, Nutrition Surveys, Primary Prevention, Quality-Adjusted Life Years, Risk Assessment, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0166103}, url = {http://dx.plos.org/10.1371/journal.pone.0166103}, author = {David B. Agus and Gaudette, {\'E}tienne and Dana P Goldman and Messali, Andrew}, editor = {Song, Qing} } @article {8621, title = {The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health.}, journal = {Behav Genet}, volume = {46}, year = {2016}, month = {2016 Jan}, pages = {43-58}, abstract = {

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

}, keywords = {Adult, Aged, Female, Gene-Environment Interaction, Genetic Predisposition to Disease, Genotype, Humans, Male, Middle Aged, Risk Factors, Smoking, Tobacco Use Disorder, Veterans, Vietnam Conflict}, issn = {1573-3297}, doi = {10.1007/s10519-015-9739-1}, author = {Lauren L Schmitz and Dalton C Conley} } @article {8545, title = {Management of diabetes mellitus in older people with comorbidities.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 06 15}, pages = {i2200}, abstract = {

Diabetes mellitus is a chronic disease of aging that affects more than 20\% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

}, keywords = {Aged, Aging, Blood Glucose, Comorbidity, Diabetes Mellitus, Type 2, Disease Management, Female, Glycemic Index, Guidelines as Topic, Health Services Needs and Demand, Humans, Hypoglycemic Agents, Male, Precision Medicine, Quality of Life}, issn = {1756-1833}, doi = {10.1136/bmj.i2200}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27307175}, author = {Huang, Elbert S} } @article {8373, title = {Marital Histories and Heavy Alcohol Use among Older Adults.}, journal = {J Health Soc Behav}, volume = {57}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Mar}, pages = {77-96}, publisher = {57}, abstract = {

We develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men{\textquoteright}s but increases women{\textquoteright}s drinking relative to being never married and previously married, whereas divorce increases men{\textquoteright}s but decrease women{\textquoteright}s drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men{\textquoteright}s and women{\textquoteright}s heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.

}, keywords = {Adult, Age Factors, Aged, Alcohol Drinking, Divorce, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Models, Psychological, Socioeconomic factors}, issn = {2150-6000}, doi = {10.1177/0022146515628028}, author = {Reczek, Corinne and Tetyana Pudrovska and Deborah Carr and Thomeer, Mieke Beth and Debra Umberson} } @article {8696, title = {Marital history and survival after a heart attack.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {114-123}, abstract = {

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n~=~2197). We found that adults who were never married (odds ratio [OR]~=~1.73), currently divorced (OR~=~1.70), or widowed (OR~=~1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12\% for every additional marital loss and decreased by 7\% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Divorce, Female, Humans, Male, Marital Status, Myocardial Infarction, Prospective Studies, Retrospective Studies, Single Person, Spouses, Survivors, United States, Widowhood}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.10.013}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616305810}, author = {Matthew E Dupre and Nelson, Alicia} } @article {8585, title = {Marital quality, marital dissolution, and mortality risk during the later life course.}, journal = {Soc Sci Med}, volume = {165}, year = {2016}, month = {2016 09}, pages = {119-127}, abstract = {

This study examines the relationship between later-life marital quality, marital dissolution, and mortality using discrete-time event history models with data from nine waves (1992-2008) of the Health and Retirement Study (n~=~7388). Results show marital status is more important for men{\textquoteright}s mortality risk than women{\textquoteright}s, whereas marital quality is more important for women{\textquoteright}s survival than men{\textquoteright}s. Being widowed or divorced more than two years raises mortality risk for men, but later-life marital dissolution is not significantly associated with women{\textquoteright}s mortality risk, regardless of the type of dissolution or length of time since it occurred. Low-quality marital interaction is negatively related to women{\textquoteright}s odds of death, but none of the marital quality measures are significantly associated with mortality for men. Marital satisfaction moderates the relationship between widowhood and mortality for women, but the relationship between marital dissolution and mortality is similar for men regardless of marital quality prior to divorce/widowhood. Results suggest the importance of accounting for both marital status and marital quality when examining older individuals{\textquoteright} mortality risk.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Mortality, Retirement, Sex Factors}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.07.025}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616303860}, author = {Jennifer R. Bulanda and J Scott Brown and Takashi Yamashita} } @article {8497, title = {A method to estimate the contribution of regional genetic associations to complex traits from summary association statistics.}, journal = {Sci Rep}, volume = {6}, year = {2016}, month = {2016 06 08}, pages = {27644}, abstract = {

Despite considerable efforts, known genetic associations only explain a small fraction of predicted heritability. Regional associations combine information from multiple contiguous genetic variants and can improve variance explained at established association loci. However, regional associations are not easily amenable to estimation using summary association statistics because of sensitivity to linkage disequilibrium (LD). We now propose a novel method, LD Adjusted Regional Genetic Variance (LARGV), to estimate phenotypic variance explained by regional associations using summary statistics while accounting for LD. Our method is asymptotically equivalent to a multiple linear regression model when no interaction or haplotype effects are present. It has several applications, such as ranking of genetic regions according to variance explained or comparison of variance explained by two or more regions. Using height and BMI data from the Health Retirement Study (N = 7,776), we show that most genetic variance lies in a small proportion of the genome and that previously identified linkage peaks have higher than expected regional variance.

}, keywords = {Algorithms, Genetic Association Studies, Genetic Linkage, Genetic Variation, Genome-Wide Association Study, Genotype, Humans, Linkage Disequilibrium, Models, Genetic, Models, Statistical, Multifactorial Inheritance, Phenotype, Polymorphism, Single Nucleotide}, issn = {2045-2322}, doi = {10.1038/srep27644}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27273519}, author = {Pare, Guillaume and Mao, Shihong and Wei Q. Deng} } @article {8392, title = {Methodological Aspects of Subjective Life Expectancy: Effects of Culture-Specific Reporting Heterogeneity Among Older Adults in the United States.}, journal = {The Journals of Gerontology: Series B}, volume = {71}, year = {2016}, pages = {558-568}, publisher = {71}, abstract = {

OBJECTIVES: Subjective life expectancy (SLE) has been suggested as a predictor of mortality and mortality-related behaviors. Although critical for culturally diverse societies, these findings do not consider cross-cultural methodological comparability. Culture-specific reporting heterogeneity is a well-known phenomenon introducing biases, and research on this issue with SLE is not established.

METHOD: Using data from the Health and Retirement Study, we examined reporting heterogeneity in SLE focusing on item nonresponse, focal points, and reports over time for five ethnic-cultural groups: non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic other races, English-interviewed Hispanics, and Spanish-interviewed Hispanics.

RESULTS: On item nonresponse, Spanish-interviewed Hispanics said, "I don{\textquoteright}t know," to SLE significantly more than any other groups. Nearly half of the respondents chose 0, 50, or 100, making them focal points. However, the focal points differed: 50 for Whites, 100 for Blacks, and 0 for Spanish-interviewed Hispanics. The relationship of SLE measured at two time points was higher for Whites than minorities. Moreover, those who said "I don{\textquoteright}t know" to SLE showed higher subsequent mortality than those who gave an answer. SLE was not a significant mortality predictor for Hispanics.

DISCUSSION: Overall, SLE is not free from culture-specific reporting heterogeneity. This warrants further research about its culture-relevant measurement mechanisms.

}, keywords = {Aged, Aged, 80 and over, Bias, Cross-Cultural Comparison, Cross-Sectional Studies, Diagnostic Self Evaluation, Ethnic Groups, Female, Frail Elderly, Humans, Language, Life Expectancy, Longitudinal Studies, Male, Middle Aged, Self Report, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv048}, author = {Lee, Sunghee and Jacqui Smith} } @article {8525, title = {Motoric cognitive risk syndrome and risk of mortality in older adults.}, journal = {Alzheimers Dement}, volume = {12}, year = {2016}, month = {2016 05}, pages = {556-64}, abstract = {

INTRODUCTION: Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival.

METHODS: A total of 11,867 nondemented participants aged >65 years from three established cohort studies in the United States and Europe were screened for MCR. Mortality risk of MCR was assessed with Cox and logistic regression models.

RESULTS: At baseline, 836 (7.0\%) participants had MCR. Over a median follow-up of 28~months, 1603 participants died (758 in first 2 years). MCR was associated with increased mortality overall (adjusted hazard ratio, 1.69; 95\% confidence interval [CI], 1.46-1.96) and 2-year mortality (adjusted odds ratio, 1.89; 95\% CI, 1.50-2.38). The association remained after accounting for established mortality risk factors as well as baseline gait speed and memory performance.

DISCUSSION: MCR is associated with increased mortality. Older adults should be screened for MCR to identify at-risk individuals for dementia and death.

}, keywords = {Age Factors, Aged, Cognition Disorders, Cohort Studies, Dementia, Early Diagnosis, Female, Gait, Humans, Male, Mortality, Risk Factors}, issn = {1552-5279}, doi = {10.1016/j.jalz.2015.08.167}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26545790}, author = {Emmeline Ayers and Joe Verghese} } @article {8572, title = {Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study.}, journal = {Int J Geriatr Psychiatry}, volume = {31}, year = {2016}, month = {2016 10}, pages = {1105-15}, abstract = {

OBJECTIVES: The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms.

METHODS: A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models{\textquoteright} outcome was elevated anxiety (>=12 on five-item Beck Anxiety Inventory) or depressive symptoms (>=12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses.

RESULTS: Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95\% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads.

CONCLUSION: Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

}, keywords = {Aged, Aged, 80 and over, Anxiety Disorders, Chronic disease, Depressive Disorder, Female, Humans, Logistic Models, Male, multimorbidity, Retirement, United States}, issn = {1099-1166}, doi = {10.1002/gps.4532}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27441851}, author = {Christine E Gould and Ruth O{\textquoteright}Hara and Mary K. Goldstein and Sherry A. Beaudreau} } @article {8477, title = {Neighborhood Support and Aging-in-Place Preference Among Low-Income Elderly Chinese City-Dwellers.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Jan}, pages = {98-105}, abstract = {

OBJECTIVES: Preferences for aging-in-place are unclear among low-income elderly Chinese city-dwellers, who are more likely to be geographically bound, to have little care support, but possess strong filial values and family cohesiveness. This study investigated the preferences for aging-in-place and its contributing neighborhood factors among low-income Chinese elderly in a metropolitan city.

METHOD: We conducted interviews with 400 older people residing in public housing estates in Hong Kong.

RESULTS: The majority of low-income elderly persons (80.4\%) prefer to age in place even if their health and functioning has deteriorated beyond independent living. Logistic regression showed that (a) having very low income (

DISCUSSION: Low-income elderly Chinese city-dwellers prefer to age in place, given appropriate neighborhood support. These findings can be interpreted in light of Lawton{\textquoteright}s ecological theory of aging and suggest a service model similar to the Naturally Occurring Retirement Community with Supportive Service Programs.

}, keywords = {Aged, Aged, 80 and over, Aging, Asian Continental Ancestry Group, Female, Hong Kong, Humans, Independent Living, Interview, Psychological, Male, Middle Aged, Poverty, Quality of Life, Residence Characteristics, Social Support, Urban Population}, issn = {1758-5368}, doi = {10.1093/geronb/gbu154}, url = {http://www.ncbi.nlm.nih.gov/pubmed/25384636}, author = {Terry Y S Lum and Vivian W Q Lou and Chen, Yanyan and Wong, Gloria and Luo, Hao and Tracy Tong} } @article {8514, title = {Neuroimaging overuse is more common in Medicare compared with the VA.}, journal = {Neurology}, volume = {87}, year = {2016}, month = {2016 Aug 23}, pages = {792-8}, abstract = {

OBJECTIVE: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.

METHODS: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.

RESULTS: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1\% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7\% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0\% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.

CONCLUSIONS: Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Headache Disorders, Primary, Humans, Male, Medicare, Neuroimaging, Peripheral Nervous System Diseases, United States, United States Department of Veterans Affairs, Unnecessary Procedures}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000002963}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27402889}, author = {James F. Burke and Eve A Kerr and Ryan J McCammon and Holleman, Rob and Kenneth M. Langa and Brian C. Callaghan} } @article {8480, title = {Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high.}, journal = {Int J Geriatr Psychiatry}, volume = {31}, year = {2016}, month = {2016 07}, pages = {783-90}, abstract = {

OBJECTIVE: To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory.

METHODS: Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list.

RESULTS: Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196).

CONCLUSION: Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one{\textquoteright}s mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Humans, Male, Memory, Middle Aged, Regression Analysis, Self Efficacy, Surveys and Questionnaires}, issn = {1099-1166}, doi = {10.1002/gps.4392}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26679474}, author = {O{\textquoteright}Shea, Deirdre M and Vonetta M Dotson and Fieo, Robert A and Tsapanou, Angeliki and Laura B Zahodne and Stern, Yaakov} } @article {8501, title = {One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 09}, pages = {1863-8}, abstract = {

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76\% of the participants were women. There were 235 deaths (27\%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10\% risk and 7 to 9 points predicting 66\% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cause of Death, Cohort Studies, Comorbidity, Disability Evaluation, Female, Hip Fractures, Humans, Incidence, Longitudinal Studies, Male, Prognosis, Retrospective Studies, Risk Assessment, Survival Analysis, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14237}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27295578}, author = {Irena Cenzer and Victoria L. Tang and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Espaldon, Roxanne and Kenneth E Covinsky} } @article {8476, title = {The Paradox of Leisure in Later Life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Jan}, pages = {106-11}, abstract = {

OBJECTIVE: Numerous studies have shown that involvement in leisure activity has a significant impact on older adults{\textquoteright} physical, psychological, social, and spiritual well-being. This study explores whether the association between leisure involvement and well-being in later life changes over time.

METHOD: Data were drawn from the first 4 waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE). Growth curve models were applied to examine whether leisure moderated change in quality of life (QoL) over time among 7,875 retirees aged 60 and older.

RESULTS: Findings indicated that the association between leisure and QoL increased with time, as nonactive respondents displayed a decline in QoL over time, whereas those with high levels of leisure involvement showed an increase. Findings remained significant after controlling for sociodemographics, health, and cognitive functioning.

DISCUSSION: Results indicated that the significance of leisure to well-being increases throughout the later life course, and that leisure may act as a resource for resilience in old age. They also pointed out a paradoxical situation in which the older seniors, who may benefit from leisure involvement more than their younger peers, are precisely the ones who face the greater number of constraints to beneficial use of leisure.

}, keywords = {Adaptation, Psychological, Aged, Aging, Cognition, Europe, Female, Health Status Disparities, Humans, Leisure activities, Male, Middle Aged, Quality of Life, Resilience, Psychological, Retirement, Socioeconomic factors, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbu143}, url = {http://www.ncbi.nlm.nih.gov/pubmed/25315158}, author = {Nimrod, Galit and Amit Shrira} } @article {8688, title = {Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories.}, journal = {J Pers Soc Psychol}, volume = {111}, year = {2016}, month = {2016 09}, pages = {411-29}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Aging, Anxiety Disorders, Berlin, Extraversion, Psychological, Female, Health Status, Human Development, Humans, Internal-External Control, Longitudinal Studies, Male, Neuroticism, Personality, Social Support}, issn = {1939-1315}, doi = {10.1037/pspp0000071}, author = {Wagner, Jenny and Ram, Nilam and Jacqui Smith and Denis Gerstorf} } @article {8674, title = {Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults.}, journal = {J Urban Health}, volume = {93}, year = {2016}, month = {2016 10}, pages = {840-850}, abstract = {

While Medicare provides health insurance coverage for those over 65~years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30~\%. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

}, keywords = {Aged, Cognitive Dysfunction, Delivery of Health Care, Disabled Persons, Eligibility Determination, Female, Financing, Personal, Humans, Insurance Coverage, Insurance, Health, Male, Medicaid, Middle Aged, United States}, issn = {1468-2869}, doi = {10.1007/s11524-016-0078-1}, url = {https://link.springer.com/article/10.1007\%2Fs11524-016-0078-1}, author = {Willink, Amber and Davis, Karen and Schoen, Cathy and Jennifer L. Wolff} } @article {6440, title = {Physical, Cognitive, Social, and Emotional Mediators of Activity Involvement and Health in Later Life.}, journal = {Res Aging}, volume = {38}, year = {2016}, month = {2016 Oct}, pages = {791-815}, abstract = {

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Epidemiologic Methods, Female, Health Status, Hospitalization, Humans, Iowa, Male, Medicare, Middle Aged, Patient Acceptance of Health Care, Physicians, Proxy, Spouses, United States}, issn = {1472-6963}, doi = {10.1186/s12913-016-1734-6}, author = {Frederic D Wolinsky and Ayres, Lioness and Michael P Jones and Yiyue Lou and George L Wehby and Fred A Ullrich} } @article {8822, title = {Pleiotropic Associations of Allelic Variants in a 2q22 Region with Risks of Major Human Diseases and Mortality.}, journal = {PLoS Genet}, volume = {12}, year = {2016}, month = {2016 Nov}, pages = {e1006314}, abstract = {

Gaining insights into genetic predisposition to age-related diseases and lifespan is a challenging task complicated by the elusive role of evolution in these phenotypes. To gain more insights, we combined methods of genome-wide and candidate-gene studies. Genome-wide scan in the Atherosclerosis Risk in Communities (ARIC) Study (N = 9,573) was used to pre-select promising loci. Candidate-gene methods were used to comprehensively analyze associations of novel uncommon variants in Caucasians (minor allele frequency~2.5\%) located in band 2q22.3 with risks of coronary heart disease (CHD), heart failure (HF), stroke, diabetes, cancer, neurodegenerative diseases (ND), and mortality in the ARIC study, the Framingham Heart Study (N = 4,434), and the Health and Retirement Study (N = 9,676). We leveraged the analyses of pleiotropy, age-related heterogeneity, and causal inferences. Meta-analysis of the results from these comprehensive analyses shows that the minor allele increases risks of death by about 50\% (p = 4.6{\texttimes}10-9), CHD by 35\% (p = 8.9{\texttimes}10-6), HF by 55\% (p = 9.7{\texttimes}10-5), stroke by 25\% (p = 4.0{\texttimes}10-2), and ND by 100\% (p = 1.3{\texttimes}10-3). This allele also significantly influences each of two diseases, diabetes and cancer, in antagonistic fashion in different populations. Combined significance of the pleiotropic effects was p = 6.6{\texttimes}10-21. Causal mediation analyses show that endophenotypes explained only small fractions of these effects. This locus harbors an evolutionary conserved gene-desert region with non-coding intergenic sequences likely involved in regulation of protein-coding flanking genes ZEB2 and ACVR2A. This region is intensively studied for mutations causing severe developmental/genetic disorders. Our analyses indicate a promising target region for interventions aimed to reduce risks of many major human diseases and mortality.

}, keywords = {Activin Receptors, Type II, Atherosclerosis, Chromosomes, Human, Pair 2, Coronary Disease, Diabetes Mellitus, Female, Genetic Association Studies, Genetic Diseases, Inborn, Genetic Pleiotropy, Genetic Predisposition to Disease, Genome-Wide Association Study, Heart Failure, Homeodomain Proteins, Humans, Male, Repressor Proteins, Risk Factors, Stroke, Zinc Finger E-box Binding Homeobox 2}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006314}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27832070/}, author = {Alexander M Kulminski and He, Liang and Culminskaya, Irina and Loika, Yury and Kernogitski, Yelena and Konstantin G Arbeev and Loiko, Elena and Liubov S Arbeeva and Bagley, Olivia and Duan, Matt and Arseniy P Yashkin and Fang, Fang and Kovtun, Mikhail and Svetlana Ukraintseva and Wu, Deqing and Anatoliy Yashin}, editor = {Barsh, Gregory S.} } @article {8522, title = {Predictors of bone mineral density testing among older women on Medicare.}, journal = {Osteoporos Int}, volume = {27}, year = {2016}, month = {2016 12}, pages = {3577-3586}, abstract = {

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women >=65 and is covered by Medicare, 40~\% of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women >=65~years old. Although Medicare covers DXA every 24~months for women, about 40~\% report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women >=70~years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

}, keywords = {Absorptiometry, Photon, Aged, Bone density, Delivery of Health Care, Female, Humans, Medicare, Osteoporosis, Prospective Studies, United States}, issn = {1433-2965}, doi = {10.1007/s00198-016-3688-2}, url = {http://link.springer.com/10.1007/s00198-016-3688-2}, author = {Yiyue Lou and Edmonds, S. W. and Michael P Jones and Fred A Ullrich and George L Wehby and Cram, P. and Frederic D Wolinsky} } @article {8815, title = {Prescription drug coverage and chronic pain.}, journal = {Int J Health Econ Manag}, volume = {16}, year = {2016}, month = {2016 Jun}, pages = {189-200}, abstract = {

Chronic pain is one of the most common chronic conditions affecting more than 50~\% of older adults. While pain management can be quite complex, prescription drugs are the most commonly used treatment modality. In this study, I examine whether increased access to prescription drugs due to the introduction of the Medicare Part D program in 2006 led to better management of pain among the elderly. While prior work has identified increases in the utilization of analgesics due to the introduction of Medicare Part D, the extent to which this increase in drug use actually improved the well-being of older adults is not known. Using data from the Health and Retirement Study, I employ a difference-in-differences strategy that compares pre versus post 2006 changes in pain related outcomes between Medicare eligible persons and a younger ineligible group. I find that Medicare Part D significantly reduced pain related activity limitations among a sample of older adults who report being troubled by pain.

}, keywords = {Analgesics, Chronic pain, Humans, Insurance Coverage, Medicare Part D, prescription drugs, Retirement, United States}, issn = {2199-9031}, doi = {10.1007/s10754-016-9185-5}, url = {http://link.springer.com/10.1007/s10754-016-9185-5}, author = {Padmaja Ayyagari} } @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 {8494, title = {Prevalence of weakness and its relationship with limitations based on the Foundations for the National Institutes for Health project: data from the Health and Retirement Study.}, journal = {Eur J Clin Nutr}, volume = {70}, year = {2016}, month = {2016 10}, pages = {1168-1173}, abstract = {

BACKGROUND/OBJECTIVES: The objectives of this study were to determine the prevalence of muscle weakness using the two 2014 Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and its relationship with physical limitations, basic activities of daily living (ADL) and instrumental ADL.

SUBJECTS/METHODS: We performed a cross-sectional analysis of community-dwelling adults from the Health and Retirement Study 2006-2008 and identified a subsample of 5092 adults aged ⩾60 years with grip strength (GS) data. Self-reported physical limitations, basic ADL and instrumental ADL were assessed. Criteria for GS (men<26 kg; women <16 kg) and GS adjusted for body mass index (GS/BMI; men <1.0; women <0.56) were applied to the sample. We determined the prevalence of muscle weakness in each sex. Multivariable logistic regression was used to calculate the association of physical limitations, basic ADL and instrument ADL with weakness definitions in each sex.

RESULTS: Mean age was 72.1 years (54.9\% female). Mean GS was 38.3 and 22.9 kg and mean BMI was 29 kg/m, respectively, in men and women. Weakness prevalence using GS and GS:BMI definitions were 7.8 and 15.2 (P<0.001), respectively, in men and 11.4 and 13.3\% (P=0.04) in women. Overall prevalence of physical limitations, basic ADL limitations and instrumental ADL limitations was 52.9, 28.1 and 35.9\%, respectively. In those with weakness, prevalence of physical limitations, basic ADL and instrumental ADL was 78.5, 42.3 and 65.3\%, respectively, using the GS definition, and 79.7, 40.7 and 58.8\%, respectively, using the GS/BMI definition. GS and the GS/BMI definitions of weakness were strongly associated with physical limitations (odds ratio (OR) 2.19 (95\% confidence interval (CI): (1.67-2.87)) and 2.52 (2.01-3.17)), basic ADL (OR 1.59 (1.22-2.07) and 1.66 (1.32-2.07)) and instrumental ADLs (OR 1.98 (1.28-2.54) and 1.78 (1.44-2.20)).

CONCLUSIONS: The new FNIH guidelines for weakness are associated with higher prevalence of physical limitations, basic ADL impairments and instrumental ADL impairments as compared with individuals without weakness.

}, keywords = {Activities of Daily Living, Aged, Aging, Cross-Sectional Studies, Databases, Factual, Female, Humans, Male, Middle Aged, Muscle Weakness, National Institutes of Health (U.S.), Retirement, sarcopenia, Surveys and Questionnaires, United States}, issn = {1476-5640}, doi = {10.1038/ejcn.2016.90}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27245209}, author = {John A. Batsis and Cassandra M Germain and Elizabeth Vasquez and Bartels, S. J.} } @article {8474, title = {Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes.}, journal = {Gerontologist}, volume = {56}, year = {2016}, month = {2016 06}, pages = {535-47}, abstract = {

PURPOSE OF THE STUDY: To determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes.

DESIGN AND METHODS: Ethnographic in-depth interviews were conducted in 5 multilevel settings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma.

RESULTS: Four themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma.

IMPLICATIONS: In no instance were examples or themes identified that suggested the staff intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals{\textquoteright} likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma.

}, keywords = {Aged, Aged, 80 and over, Aging, Anthropology, Cultural, Assisted Living Facilities, Attitude of Health Personnel, Female, Humans, Male, Nursing homes, Prejudice, Social Stigma}, issn = {1758-5341}, doi = {10.1093/geront/gnu058}, url = {http://www.ncbi.nlm.nih.gov/pubmed/24928555}, author = {Zimmerman, Sheryl and Dobbs, Debra and Roth, Erin G and Goldman, Susan and Peeples, Amanda D and Wallace, Brandy} } @article {8531, title = {The Protective Effects of Religiosity on Depression: A 2-Year Prospective Study.}, journal = {Gerontologist}, volume = {56}, year = {2016}, month = {2016 06}, pages = {421-31}, abstract = {

PURPOSE OF THE STUDY: Approximately 20\% of older adults are diagnosed with depression in the United States. Extant research suggests that engagement in religious activity, or religiosity, may serve as a protective factor against depression. This prospective study examines whether religiosity protects against depression and/or aids in recovery.

DESIGN AND METHODS: Study data are drawn from the 2006 and 2008 waves of the Health and Retirement Study. The sample consists of 1,992 depressed and 5,740 nondepressed older adults (mean age = 68.12 years), at baseline (2006), for an overall sample size of 7,732. Logistic regressions analyzed the relationship between organizational (service attendance), nonorganizational (private prayer), and intrinsic measures of religiosity and depression onset (in the baseline nondepressed group) and depression recovery (in the baseline depressed group) at follow-up (2008), controlling for other baseline factors.

RESULTS: Religiosity was found to both protect against and help individuals recover from depression. Individuals not depressed at baseline remained nondepressed 2 years later if they frequently attended religious services, whereas those depressed at baseline were less likely to be depressed at follow-up if they more frequently engaged in private prayer.

IMPLICATIONS: Findings suggest that both organizational and nonorganizational forms of religiosity affect depression outcomes in different circumstances (i.e., onset and recovery, respectively). Important strategies to prevent and relieve depression among older adults may include improving access and transportation to places of worship among those interested in attending services and facilitating discussions about religious activities and beliefs with clinicians.

}, keywords = {Adult, Aged, Aging, depression, Depressive Disorder, Female, Health Surveys, Humans, Male, Middle Aged, Prospective Studies, Religion, Religion and Psychology, Social Support, Spirituality, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnu073}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25063937}, author = {Corina R Ronneberg and Edward Alan Miller and Dugan, Elizabeth and Frank Porell} } @article {8481, title = {Racial and ethnic differences in cognitive function among older adults in the USA.}, journal = {International Journal of Geriatric Psychiatry}, volume = {31}, year = {2016}, pages = {1004-1012}, abstract = {

OBJECTIVE: Examine differences in cognition between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) older adults in the United States.

DATA/METHODS: The final sample includes 18 982 participants aged 51 or older who received a modified version of the Telephone Interview for Cognitive Status during the 2010 Health and Retirement Study follow-up. Ordinary least squares will be used to examine differences in overall cognition according to race/ethnicity.

RESULTS: Hispanics and NHB had lower cognition than NHW for all age groups (51-59, 60-69, 70-79, 80+). Hispanics had higher cognition than NHB for all age groups but these differences were all within one point. The lower cognition among NHB compared to NHW remained significant after controlling for age, gender, and education, whereas the differences in cognition between Hispanics and NHW were no longer significant after controlling for these covariates. Cognitive scores increased with greater educational attainment for all race/ethnic groups, but Hispanics exhibited the least benefit.

DISCUSSION: Our results highlight the role of education in race/ethnic differences in cognitive function during old age. Education seems beneficial for cognition in old age for all race/ethnic groups, but Hispanics appear to receive a lower benefit compared to other race/ethnic groups. Further research is needed on the racial and ethnic differences in the pathways of the benefits of educational attainment for late-life cognitive function. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {African Americans, Aged, Aged, 80 and over, Cognition, Ethnic Groups, European Continental Ancestry Group, Female, Hispanic Americans, Humans, Male, Middle Aged, United States}, issn = {1099-1166}, doi = {10.1002/gps.4410}, author = {D{\'\i}az-Venegas, Carlos and Brian Downer and Kenneth M. Langa and Rebeca Wong} } @article {8684, title = {Racial and Ethnic Differences in End-of-Life Medicare Expenditures.}, journal = {Journal of the American Geriatrics Society}, volume = {64}, year = {2016}, pages = {1789-1797}, abstract = {

OBJECTIVES: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6~months of life.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N~=~7,105).

MEASUREMENTS: Total Medicare expenditures in the last 180~days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

RESULTS: The analysis included 5,548 (78.1\%) non-Hispanic white, 1,030 (14.5\%) non-Hispanic black, and 331 (4.7\%) Hispanic adults and 196 (2.8\%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35\%, P~<~.001) more for black decedents and $16,341 (42\%, P~<~.001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22\%, P~<~.001) more for black and $6,855 (19\%, P~<~.001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

CONCLUSION: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6~months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Cross-Cultural Comparison, Ethnic Groups, European Continental Ancestry Group, Female, Health Care Surveys, Health Expenditures, Hispanic Americans, Humans, Life Support Care, Longitudinal Studies, Male, Medicare, Rate Setting and Review, Social Support, Socioeconomic factors, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14263}, author = {Byhoff, Elena and Tamara B Harris and Kenneth M. Langa and Theodore J Iwashyna} } @article {8593, title = {Racial and Socioeconomic Variation in Genetic Markers of Telomere Length: A Cross-Sectional Study of U.S. Older Adults.}, journal = {EBioMedicine}, volume = {11}, year = {2016}, pages = {296-301}, abstract = {

BACKGROUND: Shorter telomere length (TL) has been associated with stress and adverse socioeconomic conditions, yet U.S. blacks have longer TL than whites. The role of genetic versus environmental factors in explaining TL by race and socioeconomic position (SEP) remains unclear.

METHODS: We used data from the U.S. Health and Retirement Study (N=11,934) to test the hypothesis that there are differences in TL-associated SNPs by race and SEP. We constructed a TL polygenic risk score (PRS) and examined its association with race/ethnicity, educational attainment, assets, gender, and age.

RESULTS: U.S. blacks were more likely to have a lower PRS for TL, as were older individuals and men. Racial differences in TL were statistically accounted for when controlling for population structure using genetic principal components. The GWAS-derived SNPs for TL, however, may not have consistent associations with TL across different racial/ethnic groups.

CONCLUSIONS: This study showed that associations of race/ethnicity with TL differed when accounting for population stratification. The role of race/ethnicity for TL remains uncertain, however, as the genetic determinants of TL may differ by race/ethnicity. Future GWAS samples should include racially diverse participants to allow for better characterization of the determinants of TL in human populations.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alleles, Cross-Sectional Studies, Ethnic Groups, Female, Gene Frequency, Genetic Markers, Genome-Wide Association Study, Geriatric Assessment, Humans, Male, Middle Aged, Polymorphism, Single Nucleotide, Population Surveillance, Socioeconomic factors, Telomere Homeostasis, United States}, issn = {2352-3964}, doi = {10.1016/j.ebiom.2016.08.015}, author = {Hamad, Rita and Tuljapurkar, Shripad and David Rehkopf} } @article {6460, title = {Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Dec}, pages = {1382-1402}, abstract = {

OBJECTIVE: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults.

METHOD: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active.

RESULTS: After adding education, the Hispanic{\textquoteright}s and Black{\textquoteright}s disparities in cognitive performance were slightly attenuated (Hispanics, β = -1.049, p < .001; Blacks, β = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline.

DISCUSSION: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.

}, keywords = {Aged, Aged, 80 and over, Black People, Cognition, Cognition Disorders, Female, Health Behavior, Hispanic or Latino, Humans, Male, White People}, issn = {1552-6887}, doi = {10.1177/0898264315620589}, url = {http://jah.sagepub.com/content/early/2015/12/29/0898264315620589.abstract}, author = {Elizabeth Vasquez and Anda Botoseneanu and Joan M. Bennett and Benjamin A Shaw} } @article {8568, title = {The relationship between childhood poverty, military service, and later life depression among men: Evidence from the Health and Retirement Study.}, journal = {J Affect Disord}, volume = {206}, year = {2016}, month = {2016 Dec}, pages = {1-7}, abstract = {

BACKGROUND: Childhood poverty has been associated with depression in adulthood, but whether this relationship extends to later life major depression (MD) or is modified by military service is unclear.

METHODS: Data come from the Health and Retirement Study (HRS) 2010 wave, a longitudinal, nationally representative study of older adults. Men with data on military service and childhood poverty were included (N=6330). Childhood poverty was assessed by four indicators (i.e., parental unemployment, residential instability) experienced before age 16. Military service was categorized as veteran versus civilian, and during draft versus all-volunteer (after 1973) eras. Past year MD was defined by the Composite International Diagnostic Inventory.

RESULTS: Four in ten men ever served, with 13.7\% in the all-volunteer military. Approximately 12\% of civilians, 8\% draft era and 24\% all-volunteer era veterans had MD. Childhood poverty was associated with higher odds of MD (Odds Ratio (OR): 2.38, 95\% Confidence Interval (CI): 1.32-4.32) and higher odds of military service (OR: 2.58, 95\% CI: 1.58-4.21). Military service was marginally associated with MD (OR: 1.28, 95\% CI: 0.98-1.68) and did not moderate the association between childhood poverty and MD.

LIMITATIONS: Self-report data is subject to recall bias. The HRS did not assess childhood physical and emotional abuse, or military combat exposure.

CONCLUSIONS: Men raised in poverty had greater odds of draft and all-volunteer military service. Early-life experiences, independent of military service, appear associated with greater odds of MD. Assessing childhood poverty in service members may identify risk for depression in later life.

}, keywords = {Adult Survivors of Child Adverse Events, Aged, Depressive Disorder, Major, Female, Health Surveys, Humans, Life Change Events, Male, Middle Aged, Military Personnel, Odds Ratio, Poverty, Self Report, United States, Veterans}, issn = {1573-2517}, doi = {10.1016/j.jad.2016.07.018}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27455351}, author = {Bareis, Natalie and Briana Mezuk} } @article {8532, title = {Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults.}, journal = {Int Psychogeriatr}, volume = {28}, year = {2016}, month = {2016 Apr}, pages = {577-89}, abstract = {

BACKGROUND: Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA.

METHODS: The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts.

RESULTS: Nearly 6\% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95\% CI = 1.17-2.03), 2.75 (95\% CI = 1.75-4.33), and 2.12 (95\% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95\% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE.

CONCLUSIONS: Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

}, keywords = {Age Distribution, Aged, Cannabis, Cross-Sectional Studies, depression, Depressive Disorder, Major, Female, Health Surveys, Humans, Illicit Drugs, Male, Marijuana Abuse, Marijuana Smoking, Middle Aged, Regression Analysis, Self Report, Substance-Related Disorders, Suicidal Ideation, Suicide, Attempted, United States}, issn = {1741-203X}, doi = {10.1017/S1041610215001738}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26542746}, author = {Namkee G Choi and DiNitto, Diana M and Marti, C Nathan and Bryan Y Choi} } @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 {8488, title = {Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care-based studies.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 06}, pages = {441-446.e3}, abstract = {

PURPOSE: To describe self-reported herpes zoster (HZ) and explore factors that could impact interpretation of results from health care-based HZ studies.

METHODS: We performed logistic regression using data from the 2008 Health and Retirement Study (HRS) to evaluate risk factors for having a history of HZ and experiencing severe HZ pain, and predictors for seeking health care for HZ.

RESULTS: Among 14,564 respondents aged >=55~years, women were more likely than men to report a history of HZ (15.7\% vs. 11.6\%, P~<~.01). Blacks (6.4\% vs. 14.7\% in whites, P~<~.01) and respondents with less than a high school diploma (12.2\% vs.14.2\% in respondents with at least a high school diploma, P~= .01) were less likely to report a history of HZ. Women, blacks, Hispanics, and those with less than a high school diploma were more likely to report severe HZ pain. Most (91.1\%) respondents sought health care for HZ; Hispanics (64.2\% vs. 92.1\% in whites, P~<~.001) and those with recurrent HZ were less likely to seek health care for HZ, whereas those with severe pain were more likely (95.4\% vs. 87.9\% in those without severe pain, P~<~.01).

CONCLUSIONS: HRS provides a new platform for studies of HZ, one which allowed us to uncover issues that warrant particular attention when interpreting results of health care-based studies.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Health Surveys, Herpes Zoster, Humans, Independent Living, Logistic Models, Male, Middle Aged, Outcome Assessment, Health Care, pain, Pain Measurement, Patient Acceptance of Health Care, Reproducibility of Results, Retirement, Risk Assessment, Self Report, Severity of Illness Index, Sex Factors, Treatment Outcome, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2016.04.006}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27180114}, author = {Hales, Craig M and Harpaz, Rafael and Bialek, Stephanie R} } @article {8819, title = {Sex-Specific and Time-Varying Associations Between Cigarette Smoking and Telomere Length Among Older Adults.}, journal = {Am J Epidemiol}, volume = {184}, year = {2016}, month = {2016 12 15}, pages = {922-932}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Aging, Biomarkers, DNA, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Oxidative stress, Polymerase Chain Reaction, Prospective Studies, Saliva, Sex Distribution, Smoking, Smoking cessation, Telomere Shortening}, issn = {1476-6256}, doi = {10.1093/aje/kww102}, url = {http://aje.oxfordjournals.org/lookup/doi/10.1093/aje/kww102}, author = {Zhang, Chenan and Diane S. Lauderdale and Brandon L Pierce} } @article {8503, title = {Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 08}, pages = {1610-5}, abstract = {

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED\&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61\%) were treated surgically. Rates of MMS (19\%), excision (42\%), and ED\&C (39\%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19\% of participants with difficulty or dependence in ADLs, 20\% of those with a Charlson comorbidity score greater than 3, and 15\% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Comorbidity, Cost-Benefit Analysis, Cross-Sectional Studies, Curettage, Decision Support Techniques, Disability Evaluation, Electrosurgery, Female, Humans, Keratinocytes, Life Expectancy, Male, Mohs Surgery, Prognosis, Skin Neoplasms}, issn = {1532-5415}, doi = {10.1111/jgs.14202}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27303932}, author = {Linos, Eleni and Chren, Mary-Margaret and Irena Cenzer and Kenneth E Covinsky} } @article {8534, title = {Somatic, positive and negative domains of the Center for Epidemiological Studies Depression (CES-D) scale: a meta-analysis of genome-wide association studies.}, journal = {Psychol Med}, volume = {46}, year = {2016}, month = {2016 06}, pages = {1613-23}, abstract = {

BACKGROUND: Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.

METHOD: We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).

RESULTS: One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (p discovery = 3.82 {\texttimes} 10-8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (p discovery+replication = 1.10 {\texttimes} 10-6) with evidence of heterogeneity.

CONCLUSIONS: Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.

}, keywords = {depression, Depressive Disorder, Major, Genome-Wide Association Study, Humans, Polymorphism, Single Nucleotide, Receptor, Melatonin, MT1, Somatoform Disorders}, issn = {1469-8978}, doi = {10.1017/S0033291715002081}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26997408}, author = {Demirkan, A and J. Lahti and Nese Direk and Viktorin, A. and Kathryn L Lunetta and Antonio Terracciano and Michael A Nalls and Toshiko Tanaka and Karin Hek and Myriam Fornage and J{\"u}rgen Wellmann and Marilyn C Cornelis and Ollila, H. M. and Lei Yu and Luke C Pilling and Isaacs, A and Aarno Palotie and Wei Vivian Zhuang and Alan B Zonderman and Jessica Faul and Angelina R Sutin and Osorio Meirelles and Mulas, A and Hofman, A and Andr{\'e} G Uitterlinden and Fernando Rivadeneira and Markus Perola and Wei Zhao and Veikko Salomaa and Kristine Yaffe and Luik, A I and Yongmei Liu and Ding, J and Paul Lichtenstein and Land{\'e}n, M and Elisabeth Widen and David R Weir and David J Llewellyn and Murray, A and Sharon L R Kardia and Johan G Eriksson and Karestan C Koenen and Patrik K E Magnusson and Luigi Ferrucci and Thomas H Mosley and Francesco Cucca and Ben A Oostra and David A Bennett and Paunio, T. and Klaus Berger and Tamara B Harris and Nancy L Pedersen and Joanne M Murabito and Henning Tiemeier and Cornelia M van Duijn and Katri R{\"a}ikk{\"o}nen} } @article {8408, title = {Spousal Characteristics and Older Adults{\textquoteright} Hospice Use: Understanding Disparities in End-of-Life Care.}, journal = {J Palliat Med}, volume = {19}, year = {2016}, month = {2016 05}, pages = {509-15}, publisher = {19}, abstract = {

BACKGROUND: Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in end-of-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown.

OBJECTIVES: To determine the association between spousal characteristics and hospice use.

DESIGN: We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims.

SETTING: National study of 1567 decedents who were married or partnered at the time of death (2000-2011).

MEASURES: Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey.

RESULTS: In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95\% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models.

IMPLICATIONS: Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.

}, keywords = {Hospice Care, Hospices, Humans, Medicare, Prospective Studies, Quality of Life, Terminal Care, United States}, issn = {1557-7740}, doi = {10.1089/jpm.2015.0399}, url = {http://dx.doi.org/10.1089/jpm.2015.0399}, author = {Katherine A Ornstein and Melissa D. Aldridge and Christine A Mair and Rebecca Jean Gorges and Albert L Siu and Amy Kelley} } @article {8354, title = {Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion.}, journal = {J Health Econ}, volume = {45}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Jan}, pages = {63-76}, publisher = {45}, abstract = {

Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands{\textquoteright} labor supply decreases, wives{\textquoteright} labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act.

}, keywords = {Employment, Female, Government Programs, Humans, Insurance, Health, Male, Middle Aged, Spouses, Surveys and Questionnaires, United States, Veterans}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2015.11.005}, author = {Melissa A. Boyle and Joanna N Lahey} } @article {6443, title = {Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Sep}, pages = {775-85}, abstract = {

OBJECTIVES: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives.

METHOD: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time.

RESULTS: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations.

DISCUSSION: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health.

}, keywords = {Aged, Aging, Blood pressure, Family Relations, Female, Humans, Hypertension, Longitudinal Studies, Male, Marriage, Middle Aged, Stress, Psychological}, issn = {1758-5368}, doi = {10.1093/geronb/gbv023}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/06/geronb.gbv023.abstract}, author = {Kira S. Birditt and Nicky J Newton and James A. Cranford and Lindsay H Ryan} } @article {8505, title = {Telomere length and health outcomes: A two-sample genetic instrumental variables analysis.}, journal = {Exp Gerontol}, volume = {82}, year = {2016}, month = {2016 09}, pages = {88-94}, abstract = {

OBJECTIVE: Previous studies linking telomere length (TL) and health have been largely associational. We apply genetic instrumental variables (IV) analysis, also known as Mendelian randomization, to test the hypothesis that shorter TL leads to poorer health. This method reduces bias from reverse causation or confounding.

METHODS: We used two approaches in this study that rely on two separate data sources: (1) individual-level data from the Health and Retirement Study (HRS) (N=3734), and (2) coefficients from genome-wide association studies (GWAS). We employed two-sample genetic IV analyses, constructing a polygenic risk score (PRS) of TL-associated single nucleotide polymorphisms. The first approach examined the association of the PRS with nine individual health outcomes in HRS. The second approach took advantage of estimates available in GWAS databases to estimate the impact of TL on five health outcomes using an inverse variance-weighted meta-analytic technique.

RESULTS: Using individual-level data, shorter TL was marginally statistically significantly associated with decreased risk of stroke and increased risk of heart disease. Using the meta-analytic approach, shorter TL was associated with increased risk of coronary artery disease (OR 1.02 per 100 base pairs, 95\%CI: 1.00, 1.03).

DISCUSSION: With the exception of a small contribution to heart disease, our findings suggest that TL may be a marker of disease rather than a cause. They also demonstrate the utility of the inverse variance-weighted meta-analytic approach when examining small effect sizes.

}, keywords = {Aged, Aging, Coronary Artery Disease, Databases, Factual, Female, Humans, Longitudinal Studies, Male, Middle Aged, Molecular Epidemiology, Polymorphism, Single Nucleotide, Self Report, Telomere, Telomere Homeostasis, United States}, issn = {1873-6815}, doi = {10.1016/j.exger.2016.06.005}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27321645}, author = {Hamad, Rita and Stefan Walter and David Rehkopf} } @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 {8510, title = {Trajectories of body mass indices and development of frailty: Evidence from the health and retirement study.}, journal = {Obesity (Silver Spring)}, volume = {24}, year = {2016}, month = {2016 08}, pages = {1643-7}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Body Weight, Female, Frail Elderly, Geriatric Assessment, Health Status, Humans, Incidence, Longitudinal Studies, Male, Obesity, Retirement, Risk Factors, Weight Gain}, issn = {1930-739X}, doi = {10.1002/oby.21572}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27355440}, author = {Briana Mezuk and Matthew C. Lohman and Rock, Andrew K and Payne, Martha E} } @article {8340, title = {Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults.}, journal = {Int J Geriatr Psychiatry}, volume = {31}, year = {2016}, note = {Export Date: 9 September 2015 Article in Press}, month = {2016 Jan}, pages = {83-91}, publisher = {31}, abstract = {

OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

METHODS: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.

RESULTS: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43\%), (ii) low but generally stable level of depressive symptoms (41\%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16\%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.

CONCLUSIONS: Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Oral Health, Regression Analysis}, issn = {1099-1166}, doi = {10.1002/gps.4292}, author = {Celia F. Hybel and Joan M. Bennett and Lawrence R Landerman and Jersey Liang and Brenda L Plassman and Bei Wu} } @article {6498, title = {Using an Alzheimer Disease Polygenic Risk Score to Predict Memory Decline in Black and White Americans Over 14 Years of Follow-up.}, journal = {Alzheimer Dis Assoc Disord}, volume = {30}, year = {2016}, month = {2016 Jul-Sep}, pages = {195-202}, abstract = {

Evidence on whether genetic predictors of Alzheimer disease (AD) also predict memory decline is inconsistent, and limited data are available for African ancestry populations. For 8253 non-Hispanic white (NHW) and non-Hispanic black (NHB) Health and Retirement Study participants with memory scores measured 1 to 8 times between 1998 and 2012 (average baseline age=62), we calculated weighted polygenic risk scores [AD Genetic Risk Score (AD-GRS)] using the top 22 AD-associated loci, and an alternative score excluding apolipoprotein E (APOE) (AD-GRSexAPOE). We used generalized linear models with AD-GRS-by-age and AD-GRS-by-age interactions (age centered at 70) to predict memory decline. Average NHB decline was 26\% faster than NHW decline (P<0.001). Among NHW, 10\% higher AD-GRS predicted faster memory decline (linear β=-0.058 unit decrease over 10 y; 95\% confidence interval,-0.074 to -0.043). AD-GRSexAPOE also predicted faster decline for NHW, although less strongly. Among NHB, AD-GRS predicted faster memory decline (linear β=-0.050; 95\% confidence interval, -0.106 to 0.006), but AD-GRSexAPOE did not. Our nonsignificant estimate among NHB may reflect insufficient statistical power or a misspecified AD-GRS among NHB as an overwhelming majority of genome-wide association studies are conducted in NHW. A polygenic score based on previously identified AD loci predicts memory loss in US blacks and whites.

}, keywords = {Alzheimer disease, Black or African American, ethnicity, Female, Follow-Up Studies, Genome-Wide Association Study, Humans, Male, Memory Disorders, Middle Aged, Risk Factors, United States, White People}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000137}, author = {Jessica R Marden and Elizabeth R Mayeda and Stefan Walter and Vivot, Alexandre and Tchetgen Tchetgen, Eric J and Ichiro Kawachi and M. Maria Glymour} } @article {8529, title = {Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age.}, journal = {J Health Soc Behav}, volume = {57}, year = {2016}, month = {2016 06}, pages = {200-22}, abstract = {

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

}, keywords = {Age Factors, Aged, Aging, Continental Population Groups, Female, Health Status Disparities, Health Surveys, Humans, Male, Middle Aged, Sex Factors, Social Class, Socioeconomic factors}, issn = {2150-6000}, doi = {10.1177/0022146516645165}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905600/}, author = {Tyson H Brown and Liana J Richardson and Taylor W. Hargrove and Courtney S Thomas} } @article {8812, title = {Validating a summary measure of weight history for modeling the health consequences of obesity.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 12}, pages = {821-826.e2}, abstract = {

PURPOSE: Data on weight history may enhance the predictive validity of epidemiologic models of the health risks of obesity, but collecting such data is often not feasible. In this study, we investigate the validity of a summary measure of weight history.

METHODS: We evaluated the quality of reporting of maximum weight in a sample of adults aged 50-84~years using data from the Health and Retirement Study. Recalled max body mass index (BMI, measured in kilogram per square meter) based on recalled weight in 2004 was compared with calculated max BMI based on self-reported weight collected biennially between 1992 and 2004. Logistic regression was used to assess similarity between the measures in predicting prevalent conditions.

RESULTS: The correlation coefficient between recalled and calculated max weight in the overall sample was 0.95. Recalled max BMI value was within three BMI units of the calculated value 91.4\% of the time. The proportions of individuals with obese I (BMI: 30.0-34.9), obese II (BMI: 35.0-39.9), and obese III (BMI: 40.0 and above) were 28.8\%, 12.7\%, and 6.6\% using recalled values compared with 27.1\%, 10.5\%, and 4.9\% using calculated values. In multivariate analyses, the two BMI measures similarly predicted disease prevalence across a number of chronic conditions.

CONCLUSIONS: Recalled max BMI was strongly correlated with max BMI calculated over the 12-year period before recall, suggesting that this measure can serve as a reliable summary measure of recent weight status.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Body Weight, Chronic disease, Female, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Obesity, Self Report, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2016.10.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S1047279716304070http://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/plain}, author = {Andrew C. Stokes and Ni, Yu} } @article {8705, title = {Volunteering Is Associated with Lower Risk of Cognitive Impairment.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 11}, pages = {2263-2269}, abstract = {

OBJECTIVES: To examine whether psychosocial factors that can be a target for interventions, such as volunteering, are associated with risk of cognitive impairment.

DESIGN: Health and Retirement Study (HRS) data from 1998 to 2012, a nationally representative longitudinal panel survey of older adults assessed every 2 years, were used.

SETTING: The HRS interviews participants aged 50 and older across the contiguous United States.

PARTICIPANTS: Individuals aged 60 and older in 1998 (N = 13,262).

MEASUREMENTS: Personal interviews were conducted with respondents to assess presence of cognitive impairment, measured using a composite across cognitive measures.

RESULTS: Volunteering at the initial assessment and volunteering regularly over time independently decreased the risk of cognitive impairment over 14 years, and these findings were maintained independent of known risk factors for cognitive impairment. Greater risk of onset of cognitive impairment was associated with being older, being female, being nonwhite, having fewer years of education, and reporting more depressive symptoms.

CONCLUSION: Consistent civic engagement in old age is associated with lower risk of cognitive impairment and provides impetus for interventions to protect against the onset of cognitive impairment. Given the increasing number of baby boomers entering old age, the findings support the public health benefits of volunteering and the potential role of geriatricians, who can promote volunteering by incorporating "prescriptions to volunteer" into their patient care.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Geriatric Assessment, Health Surveys, Humans, Interviews as Topic, Male, Middle Aged, Risk Factors, United States, Volunteers}, issn = {1532-5415}, doi = {10.1111/jgs.14398}, author = {Frank J Infurna and Morris A Okun and Kevin J. Grimm} } @article {8473, title = {What are the experiences of people with dementia in employment?}, journal = {Dementia (London)}, volume = {15}, year = {2016}, month = {2016 Mar}, pages = {147-61}, abstract = {

Statistics show that an increase in the statutory retirement age in the UK will mean that many more people will develop a dementia while still in employment. A review of the literature confirmed that there are no existing studies in the UK which examine this issue in any detail. The aim of this study was to investigate the experiences of people who develop a dementia while still in employment and to understand how they make sense of these experiences; therefore a qualitative explorative inquiry based on an Interpretive Phenomenological Analysis methodology was used. Interviews with five people who had developed a dementia while still in employment were carried out, with ages ranging from 58 to 74 years. Interview transcripts were analysed and four super-ordinate themes were identified: the realization that something is wrong; managing the situation in the workplace; trying to make sense of change; and coming to terms with retirement or unemployment. The results showed that people who develop a dementia while still in employment do not always receive the {\textquoteright}reasonable adjustments{\textquoteright} in the workplace to which they are entitled under the Equality Act (2010). Some of the participants felt that they were poorly treated by their workplace and described some distressing experiences. The study highlights the need for more effective specialized advice and support regarding employment issues and more research into the numbers of people in the UK that are affected by this issue.

}, keywords = {Aged, Alzheimer disease, Dementia, Vascular, Employment, Female, Humans, Interviews as Topic, Male, Middle Aged, Qualitative Research, United Kingdom, Work Performance}, issn = {1741-2684}, doi = {10.1177/1471301213519252}, url = {http://www.ncbi.nlm.nih.gov/pubmed/24419354}, author = {Chaplin, Ruth and Davidson, Ian} } @article {8504, title = {Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries.}, journal = {Am J Public Health}, volume = {106}, year = {2016}, month = {2016 08}, pages = {1449-56}, abstract = {

OBJECTIVES: To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women.

METHODS: We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009).

RESULTS: Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women.

CONCLUSIONS: Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Computer Simulation, Europe, Female, Humans, Middle Aged, Obesity, Single Parent, Smoking, Socioeconomic factors, United States, Women, Working, Young Adult}, issn = {1541-0048}, doi = {10.2105/AJPH.2016.303264}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27310346}, author = {van Hedel, Karen and Mej{\'\i}a-Guevara, Iv{\'a}n and Mauricio Avendano and Erika L. Sabbath and Lisa F Berkman and Johan P Mackenbach and van Lenthe, Frank J} } @article {8268, title = {Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.}, journal = {J Diabetes Complications}, volume = {29}, year = {2015}, month = {2015 Nov-Dec}, pages = {1228-33}, publisher = {29}, abstract = {

AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.

METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).

RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95\% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95\% CI: 0.68-0.94); renal failure (OR=0. 82; 95\% CI: 0.71-0.95); and death (OR=0.86; 95\% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95\% CI: 0.45-0.90), renal failure (OR=0.71; 95\% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95\% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95\% CI: 0.11-0.85), and death (OR=0.56, 95\% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95\% CI: 0.13-0.93).

CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.

}, keywords = {Aged, Aged, 80 and over, Combined Modality Therapy, Diabetes Complications, Diabetes Mellitus, Early Diagnosis, Female, Health Promotion, Health Surveys, Humans, Hypoglycemic Agents, Longitudinal Studies, Male, Mass Screening, Medicare Part A, Medicare Part B, Medication Adherence, Motor Activity, Patient Compliance, Practice Guidelines as Topic, Risk, United States}, issn = {1873-460X}, doi = {10.1016/j.jdiacomp.2015.07.005}, author = {Chen, Yiqun and Frank A Sloan and Arseniy P Yashkin} } @article {8195, title = {Anchoring vignettes in the Health and Retirement Study: how do medical professionals and disability recipients characterize the severity of work limitations?}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0126218}, publisher = {10}, abstract = {

PURPOSE: Recent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data.

METHOD: Nationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics.

RESULTS: We find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale.

CONCLUSIONS: Knowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research.

}, keywords = {Aged, Cardiovascular Diseases, depression, Disabled Persons, Female, Health Personnel, Humans, Male, Middle Aged, pain, Retirement, Self Report}, issn = {1932-6203}, doi = {10.1371/journal.pone.0126218}, url = {http://dx.doi.org/10.1371 2Fjournal.pone.0126218}, author = {Frank Heiland and Yin, Na} } @article {8287, title = {Antidepressant Use and Cognitive Decline: The Health and Retirement Study.}, journal = {Am J Med}, volume = {128}, year = {2015}, month = {2015 Jul}, pages = {739-46}, publisher = {128}, abstract = {

BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years.

METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load.

RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1\%) participants taking antidepressants and those not taking antidepressants (mean, 14.9\%; 95\% confidence interval, 14.3-15.4 vs mean, 15.1\%; 95\% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from -1.4 change in mean score in those with high depressive symptoms and taking antidepressants to -0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term).

CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Antidepressive Agents, Cognition, Cross-Sectional Studies, Depressive Disorder, Female, Follow-Up Studies, Geriatric Assessment, Humans, Incidence, Male, Middle Aged, Reference Values, Risk Assessment, Sex Distribution, Surveys and Questionnaires, United States}, issn = {1555-7162}, doi = {10.1016/j.amjmed.2015.01.007}, author = {Jane S Saczynski and Allison B Rosen and Ryan J McCammon and Zivin, Kara and Susan E. Andrade and Kenneth M. Langa and Sandeep Vijan and Paul A Pirraglia and Becky A. Briesacher} } @article {8212, title = {Are older adults living in more equal counties healthier than older adults living in more unequal counties? A propensity score matching approach.}, journal = {Soc Sci Med}, volume = {141}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Sep}, pages = {82-90}, publisher = {141}, abstract = {

We assessed the potential contextual effect of income inequality on health by: 1) comparing individuals with similar socioeconomic status (SES) but who reside in counties with different levels of income inequality; and 2) examining whether the potential effect of county-level income inequality on health varies across SES groups. We used the Health and Retirement Study, a nationally representative study of Americans over the age of 50. Using propensity score matching, we selected SES-comparable individuals living in high-income inequality counties and in low-income inequality counties. We examined differences in self-rated overall health outcomes and in other specific physical/mental health outcomes between the two groups using logistic regression (n~=~34,994) and imposing different sample restrictions based on residential duration in the area. We then used logistic regression with interactions to assess whether, and if so how, health outcomes differed among participants of different SES groups defined by wealth, income, and education. In bivariate analyses of the unmatched full sample, adults living in high-income inequality counties have worse health outcomes for most health measures. After propensity score matching, adults in high-income inequality counties had worse self-rated health status (AOR~=~1.12; 95\% CI 1.04-1.19) and were more likely to report diagnosed psychiatric problems (AOR~=~1.08; 95\% CI 0.99-1.19) than their matched counterparts in low-income inequality counties. These associations were stronger with longer-term residents in the area. Adverse health outcomes associated with living in high-income inequality counties were significant particularly for individuals in the 30(th) or greater percentiles of income/wealth distribution and those without a college education. In summary, after using more precise matching methods to compare individuals with similar characteristics and addressing measurement error by excluding more recently arrived county residents, adults living in high-income inequality counties had worse reported overall physical and mental health than adults living in low-income inequality counties.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status Indicators, Health Surveys, Healthcare Disparities, Humans, Logistic Models, Male, Middle Aged, Propensity Score, Self Report, Socioeconomic factors}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.07.020}, author = {Choi, Hwajung and Sarah A. Burgard and Irma Elo and Michele M Heisler} } @article {8258, title = {Association Between Hospice Use and Depressive Symptoms in Surviving Spouses.}, journal = {JAMA Intern Med}, volume = {175}, year = {2015}, note = {10.1001/jamainternmed.2015.1722}, month = {2015 Jul}, pages = {1138-46}, publisher = {175}, abstract = {

IMPORTANCE: Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers.

OBJECTIVE: To determine the association between hospice use and depressive symptoms in surviving spouses.

DESIGN, SETTING, AND PARTICIPANTS: We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015.

EXPOSURES: Hospice enrollment for at least 3 days in the year before death.

MAIN OUTCOMES AND MEASURES: Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms).

RESULTS: Of the 1016 decedents in the matched sample, 305 patients (30.0\%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9\% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2\%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7\% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3\% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7\% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse{\textquoteright}s death was 1.63 (95\% CI, 1.00-2.65).

CONCLUSIONS AND RELEVANCE: After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.

}, keywords = {Aged, Aged, 80 and over, Caregivers, depression, Female, Hospice Care, Hospices, Humans, Male, Prospective Studies, Spouses, Survivors}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2015.1722}, url = {http://dx.doi.org/10.1001/jamainternmed.2015.1722}, author = {Katherine A Ornstein and Melissa D. Aldridge and Melissa M Garrido and Rebecca Jean Gorges and Diane E Meier and Amy Kelley} } @article {8619, title = {The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects.}, journal = {Mol Psychiatry}, volume = {20}, year = {2015}, month = {2015 Jun}, pages = {735-43}, abstract = {

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.

}, keywords = {Adult, Aged, Cohort Studies, Depressive Disorder, Major, Educational Status, Estonia, Female, Gene-Environment Interaction, Genetic Association Studies, Genotype, Humans, Likelihood Functions, Male, Middle Aged, Netherlands, Odds Ratio, Polymorphism, Single Nucleotide, Psychiatric Status Rating Scales, Regression Analysis}, issn = {1476-5578}, doi = {10.1038/mp.2015.50}, author = {Wouter J Peyrot and Lee, S H and Milaneschi, Y and Abdel Abdellaoui and Byrne, E M and T{\~o}nu Esko and Eco J. C. de Geus and Hemani, G and Jouke-Jan Hottenga and Kloiber, S and Douglas F Levinson and Lucae, S and Nicholas G Martin and Sarah E Medland and Andres Metspalu and Lili Milani and Markus M N{\"o}then and Potash, J B and Rietschel, M and Cornelius A Rietveld and Ripke, S and Jianxin Shi and Gonneke Willemsen and Zhihong Zhu and Dorret I Boomsma and Naomi R. Wray and Brenda W J H Penninx} } @article {8323, title = {The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study.}, journal = {Psychosom Med}, volume = {77}, year = {2015}, month = {2015 Feb-Mar}, pages = {200-8}, publisher = {77}, abstract = {

OBJECTIVE: To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations.

METHODS: This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses.

RESULTS: After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95\% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95\% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95\% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95\% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95\% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics.

CONCLUSIONS: CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

}, keywords = {Aged, Aged, 80 and over, Cognitive Dysfunction, Cohort Studies, Dementia, depression, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Retrospective Studies, Risk Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000136}, author = {Dimitry S Davydow and Deborah A Levine and Zivin, Kara and Wayne J Katon and Kenneth M. Langa} } @article {8294, title = {Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Feb}, pages = {193-201}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, 80 and over, Aging, Chronic disease, Cognition, Disability Evaluation, Educational Status, Female, Geriatric Assessment, Health Status, Health Surveys, Humans, Longevity, Longitudinal Studies, Male, Marital Status, Prospective Studies, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu124}, url = {http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract}, author = {Jennifer A Ailshire and Hiram Beltr{\'a}n-S{\'a}nchez and Eileen M. Crimmins} } @article {8242, title = {The burden of health care costs for patients with dementia in the last 5 years of life.}, journal = {Ann Intern Med}, volume = {163}, year = {2015}, month = {2015 Nov 17}, pages = {729-36}, publisher = {163}, abstract = {

BACKGROUND: Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.

OBJECTIVE: To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death.

DESIGN: Retrospective cohort.

SETTING: The HRS (Health and Retirement Study).

PARTICIPANTS: Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n~= 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes.

MEASUREMENTS: Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth.

RESULTS: Average total cost per decedent with dementia ($287~038) was significantly greater than that of those who died of heart disease ($175~136), cancer ($173~383), or other causes ($197~286) (P~< 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($61~522) was 81\% higher than that for patients without dementia ($34~068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36~919) represented 32\% of wealth measured 5 years before death compared with 11\% for the nondementia group (P~< 0.001). This proportion was greater for black persons (84\%), persons with less than a high school education (48\%), and unmarried or widowed women (58\%).

LIMITATION: Imputed Medicaid, private insurance, and informal care costs.

CONCLUSION: Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk.

PRIMARY FUNDING SOURCE: National Institute on Aging.

}, keywords = {Aged, Aged, 80 and over, Cost of Illness, Dementia, Female, Health Expenditures, Humans, Insurance, Health, Male, Medicaid, Medicare, Retrospective Studies, Socioeconomic factors, Terminal Care, United States}, issn = {1539-3704}, doi = {10.7326/M15-0381}, author = {Amy Kelley and Kathleen McGarry and Rebecca Jean Gorges and Jonathan S Skinner} } @article {8330, title = {Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.}, journal = {J Am Heart Assoc}, volume = {4}, year = {2015}, month = {2015 May 13}, publisher = {4}, abstract = {

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors{\textquoteright} diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was >=3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (>=65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95\% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95\% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95\% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95\% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95\% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

}, keywords = {Adult, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Stroke, Time Factors}, issn = {2047-9980}, doi = {10.1161/JAHA.115.001923}, author = {Stefan Walter and Eric J. Tchetgen Tchetgen and Kristen K Patton and J Robin Moon and Benjamin D Capistrant and Jessica R Marden and Laura D Kubzansky and Paola Gilsanz and Ichiro Kawachi and M. Maria Glymour} } @article {8314, title = {Childhood and later life stressors and increased inflammatory gene expression at older ages.}, journal = {Soc Sci Med}, volume = {130}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {16-22}, publisher = {130}, abstract = {

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

}, keywords = {Adolescent, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Cyclooxygenase 2, Female, Health Status, Health Surveys, Humans, Interleukin-1beta, Interleukin-8, Life Change Events, Male, Middle Aged, Obesity, RNA, Sex Factors, Smoking, Socioeconomic factors, Stress, Psychological}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.01.030}, author = {Morgan E. Levine and Steven W. Cole and David R Weir and Eileen M. Crimmins} } @article {10276, title = {Cognitive function and the concordance between survey reports and Medicare claims in a nationally representative cohort of older adults.}, journal = {Med Care}, volume = {53}, year = {2015}, month = {2015 May}, pages = {455-62}, abstract = {

BACKGROUND: While age-related cognitive decline may affect all stages in the response process--comprehension, retrieval, judgment, response selection, and response reporting--the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

METHODS: Eight waves of reinterviews (1995-2010) were linked to Medicare claims for 3661 self-respondents yielding 12,313 person-period observations. Cognitive function was measured by 2 episodic memory tests (immediate and delayed recall of 10 words) and 1 mental status test (backward counting, dates, and names). Survey reports on 12 diseases and 4 health services were mapped to Medicare claims to derive counts of concordant reports, underreports, and overreports, as were the numbers of hospital episodes and physician visits. GEE negative binomial and logistic regression models were used.

RESULTS: Better mental status was associated with more concordant reporting and less underreporting on disease history and the number of hospital episodes. Better mental status and delayed word recall were associated with more concordant reporting and less underreporting on health services use. Better delayed recall was significantly associated with less underreporting on the number of physician visits. These associations were not appreciably altered by adjustment for demographic characteristics, socioeconomic status, self-rated health, or secular trends.

CONCLUSION: We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

}, keywords = {Aged, Aging, Cognition Disorders, Data collection, Female, Humans, Insurance Claim Review, Male, Medicare, Mental Health, Psychiatric Status Rating Scales, Self Report, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000338}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25793268}, author = {Frederic D Wolinsky and Michael P Jones and Fred A Ullrich and Yiyue Lou and George L Wehby} } @article {8241, title = {Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Mar}, pages = {332-8}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu113}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract}, author = {Stenholm, Sari and Westerlund, Hugo and Head, Jenny and Hyde, Martin and Ichiro Kawachi and Pentti, Jaana and Mika Kivim{\"a}ki and Vahtera, Jussi} } @article {8238, title = {Comparative genome-wide association studies of a depressive symptom phenotype in a repeated measures setting by race/ethnicity in the Multi-Ethnic Study of Atherosclerosis.}, journal = {BMC Genet}, volume = {16}, year = {2015}, month = {2015 Oct 12}, pages = {118}, publisher = {16}, abstract = {

BACKGROUND: Time-varying phenotypes have been studied less frequently in the context of genome-wide analyses across ethnicities, particularly for mood disorders. This study uses genome-wide association studies of depressive symptoms in a longitudinal framework and across multiple ethnicities to find common variants for depressive symptoms. Ethnicity-specific GWAS for depressive symptoms were conducted using three approaches: a baseline measure, longitudinal measures averaged over time, and a repeated measures analysis. We then used meta-analysis to jointly analyze the results across ethnicities within the Multi-ethnic Study of Atherosclerosis (MESA, n = 6,335), and then within ethnicity, across MESA and a sample from the Health and Retirement Study African- and European-Americans (HRS, n = 10,163).

METHODS: This study uses genome-wide association studies of depressive symptoms in a longitudinal framework and across multiple ethnicities to find common variants for depressive symptoms. Ethnicity-specific GWAS for depressive symptoms were conducted using three approaches: a baseline measure, longitudinal measures averaged over time, and a repeated measures analysis. We then used meta-analysis to jointly analyze the results across ethnicities within the Multi-ethnic Study of Atherosclerosis (MESA, n = 6,335), and then within ethnicity, across MESA and a sample from the Health and Retirement Study African- and European-Americans (HRS, n = 10,163).

RESULTS: Several novel variants were identified at the genome-wide suggestive level (5{\texttimes}10(-8) < p-value <= 5{\texttimes}10(-6)) in each ethnicity for each approach to analyzing depressive symptoms. The repeated measures analyses resulted in typically smaller p-values and an increase in the number of single-nucleotide polymorphisms (SNP) reaching genome-wide suggestive level.

CONCLUSIONS: For phenotypes that vary over time, the detection of genetic predictors may be enhanced by repeated measures analyses.

}, keywords = {Atherosclerosis, Black or African American, depression, ethnicity, Female, Genome-Wide Association Study, Humans, Male, Meta-Analysis as Topic, Middle Aged, Phenotype, Racial Groups, Statistics, Nonparametric, White People}, issn = {1471-2156}, doi = {10.1186/s12863-015-0274-0}, author = {Erin B Ware and Mukherjee, Bhramar and Yan V Sun and Ana V. Diez-Roux and Sharon L R Kardia} } @article {8617, title = {Comprehensive gene- and pathway-based analysis of depressive symptoms in older adults.}, journal = {J Alzheimers Dis}, volume = {45}, year = {2015}, month = {2015}, pages = {1197-206}, abstract = {

Depressive symptoms are common in older adults and are particularly prevalent in those with or at elevated risk for dementia. Although the heritability of depression is estimated to be substantial, single nucleotide polymorphism-based genome-wide association studies of depressive symptoms have had limited success. In this study, we performed genome-wide gene- and pathway-based analyses of depressive symptom burden. Study participants included non-Hispanic Caucasian subjects (n = 6,884) from three independent cohorts, the Alzheimer{\textquoteright}s Disease Neuroimaging Initiative (ADNI), the Health and Retirement Study (HRS), and the Indiana Memory and Aging Study (IMAS). Gene-based meta-analysis identified genome-wide significant associations (ANGPT4 and FAM110A, q-value = 0.026; GRM7-AS3 and LRFN5, q-value = 0.042). Pathway analysis revealed enrichment of association in 105 pathways, including multiple pathways related to ERK/MAPK signaling, GSK3 signaling in bipolar disorder, cell development, and immune activation and inflammation. GRM7, ANGPT4, and LRFN5 have been previously implicated in psychiatric disorders, including the GRM7 region displaying association with major depressive disorder. The ERK/MAPK signaling pathway is a known target of antidepressant drugs and has important roles in neuronal plasticity, and GSK3 signaling has been previously implicated in Alzheimer{\textquoteright}s disease and as a promising therapeutic target for depression. Our results warrant further investigation in independent and larger cohorts and add to the growing understanding of the genetics and pathobiology of depressive symptoms in aging and neurodegenerative disorders. In particular, the genes and pathways demonstrating association with depressive symptoms may be potential therapeutic targets for these symptoms in older adults.

}, keywords = {Aged, Cohort Studies, depression, European Continental Ancestry Group, Female, Genotyping Techniques, Humans, Male, Psychiatric Status Rating Scales}, issn = {1875-8908}, doi = {10.3233/JAD-148009}, author = {Nho, Kwangsik and Vijay K Ramanan and Horgusluoglu, Emrin and Sungeun Kim and Mark H Inlow and Shannon L Risacher and Brenna C McDonald and Martin R Farlow and Tatiana Foroud and Gao, Sujuan and Christopher M. Callahan and Hugh C Hendrie and Alexander B Niculescu and Andrew J Saykin} } @article {12129, title = {Contribution of common non-synonymous variants in PCSK1 to body mass index variation and risk of obesity: a systematic review and meta-analysis with evidence from up to 331 175 individuals.}, journal = {Human Molecular Genetics}, volume = {24}, year = {2015}, pages = {3582-3594}, abstract = {

Polymorphisms rs6232 and rs6234/rs6235 in PCSK1 have been associated with extreme obesity [e.g. body mass index (BMI) >= 40 kg/m(2)], but their contribution to common obesity (BMI >= 30 kg/m(2)) and BMI variation in a multi-ethnic context is unclear. To fill this gap, we collected phenotypic and genetic data in up to 331 175 individuals from diverse ethnic groups. This process involved a systematic review of the literature in PubMed, Web of Science, Embase and the NIH GWAS catalog complemented by data extraction from pre-existing GWAS or custom-arrays in consortia and single studies. We employed recently developed global meta-analytic random-effects methods to calculate summary odds ratios (OR) and 95\% confidence intervals (CIs) or beta estimates and standard errors (SE) for the obesity status and BMI analyses, respectively. Significant associations were found with binary obesity status for rs6232 (OR = 1.15, 95\% CI 1.06-1.24, P = 6.08 {\texttimes} 10(-6)) and rs6234/rs6235 (OR = 1.07, 95\% CI 1.04-1.10, P = 3.00 {\texttimes} 10(-7)). Similarly, significant associations were found with continuous BMI for rs6232 (β = 0.03, 95\% CI 0.00-0.07; P = 0.047) and rs6234/rs6235 (β = 0.02, 95\% CI 0.00-0.03; P = 5.57 {\texttimes} 10(-4)). Ethnicity, age and study ascertainment significantly modulated the association of PCSK1 polymorphisms with obesity. In summary, we demonstrate evidence that common gene variation in PCSK1 contributes to BMI variation and susceptibility to common obesity in the largest known meta-analysis published to date in genetic epidemiology.

}, keywords = {Alleles, Body Mass Index, Genetic Predisposition to Disease, Genetic Variation, Humans, Obesity, Odds Ratio, Polymorphism, Single Nucleotide, Proprotein Convertase 1}, issn = {1460-2083}, doi = {10.1093/hmg/ddv097}, author = {Nead, Kevin T and Li, Aihua and Wehner, Mackenzie R and Neupane, Binod and Gustafsson, Stefan and Adam S Butterworth and Engert, James C and Davis, A Darlene and Hegele, Robert A and Miller, Ruby and den Hoed, Marcel and Khaw, Kay-Tee and Kilpel{\"a}inen, Tuomas O and Wareham, Nick and Edwards, Todd L and Hallmans, G{\"o}ran and Varga, Tibor V and Sharon L R Kardia and Smith, Jennifer A and Zhao, Wei and Jessica Faul and David R Weir and Mi, Jie and Xi, Bo and Quinteros, Samuel Canizales and Cooper, Cyrus and Sayer, Avan Aihie and Jameson, Karen and Gr{\o}ntved, Anders and Myriam Fornage and Stephen Sidney and Hanis, Craig L and Highland, Heather M and H{\"a}ring, Hans-Ulrich and Heni, Martin and Lasky-Su, Jessica and Weiss, Scott T and Gerhard, Glenn S and Still, Christopher and Melka, Melkaey M and Pausova, Zdenka and Paus, Tom{\'a}{\v s} and Grant, Struan F A and Hakonarson, Hakon and Price, R Arlen and Wang, Kai and Scherag, Andre and Hebebrand, Johannes and Hinney, Anke and Franks, Paul W and Timothy M Frayling and McCarthy, Mark I and Hirschhorn, Joel N and Ruth J F Loos and Ingelsson, Erik and Gerstein, Hertzel C and Yusuf, Salim and Beyene, Joseph and Anand, Sonia S and Meyre, David} } @article {8312, title = {Contribution of large region joint associations to complex traits genetics.}, journal = {PLoS Genet}, volume = {11}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {e1005103}, publisher = {11}, abstract = {

A polygenic model of inheritance, whereby hundreds or thousands of weakly associated variants contribute to a trait{\textquoteright}s heritability, has been proposed to underlie the genetic architecture of complex traits. However, relatively few genetic variants have been positively identified so far and they collectively explain only a small fraction of the predicted heritability. We hypothesized that joint association of multiple weakly associated variants over large chromosomal regions contributes to complex traits variance. Confirmation of such regional associations can help identify new loci and lead to a better understanding of known ones. To test this hypothesis, we first characterized the ability of commonly used genetic association models to identify large region joint associations. Through theoretical derivation and simulation, we showed that multivariate linear models where multiple SNPs are included as independent predictors have the most favorable association profile. Based on these results, we tested for large region association with height in 3,740 European participants from the Health and Retirement Study (HRS) study. Adjusting for SNPs with known association with height, we demonstrated clustering of weak associations (p = 2x10-4) in regions extending up to 433.0 Kb from known height loci. The contribution of regional associations to phenotypic variance was estimated at 0.172 (95\% CI 0.063-0.279; p < 0.001), which compared favorably to 0.129 explained by known height variants. Conversely, we showed that suggestively associated regions are enriched for known height loci. To extend our findings to other traits, we also tested BMI, HDLc and CRP for large region associations, with consistent results for CRP. Our results demonstrate the presence of large region joint associations and suggest these can be used to pinpoint weakly associated SNPs.

}, keywords = {Body Mass Index, C-reactive protein, Cholesterol, LDL, Chromosomes, Human, Female, Humans, Male, Models, Genetic, Phenotype, Polymorphism, Single Nucleotide, Quantitative Trait Loci}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1005103}, author = {Pare, Guillaume and Asma, Senay and Wei Q. Deng} } @article {8144, title = {Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Aug}, pages = {1156-63}, publisher = {30}, abstract = {

BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.

OBJECTIVE: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.

MAIN MEASURES: Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents{\textquoteright} family.

KEY RESULTS: Mean baseline age was 66.2 years; 994 (16.7\%) had DM and 3,023 (53.4\%) hypertension. Overall, 173 (3.1\%) suffered incident strokes, 129 (2.3\%) had incident MI, and 465 (8.2\%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 \% CI 1.07-1.67), hypertension (1.31, 95\% CI 1.07-1.61) and perceived constraints in the third (1.55, 95\% CI 1.12-2.15) and fourth quartiles (1.61, 95\% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95\% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95\% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95\% CI 1.41-2.64).

CONCLUSIONS: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

}, keywords = {Aged, Diabetes Mellitus, Female, Health Knowledge, Attitudes, Practice, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Patients, Retrospective Studies, Risk Factors, Stroke, Treatment Outcome}, issn = {1525-1497}, doi = {10.1007/s11606-015-3275-9}, author = {Wei Duan-Porter and Susan Nicole Hastings and Brian Neelon and Courtney Harold Van Houtven} } @article {8247, title = {Cost of informal caregiving for patients with heart failure.}, journal = {Am Heart J}, volume = {169}, year = {2015}, month = {2015 Jan}, pages = {142-48.e2}, publisher = {169}, abstract = {

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged >=50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9\%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Cost of Illness, Heart Failure, Humans, Linear Models, Male, Middle Aged, Models, Econometric}, issn = {1097-6744}, doi = {10.1016/j.ahj.2014.10.010}, url = {http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi}, author = {Heesoo Joo and Fang, Jing and Jan L Losby and Wang, Guijing} } @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 {8192, title = {Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb}, pages = {117-35}, publisher = {50}, abstract = {

OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.

DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).

STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.

DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).

PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.

CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.

}, keywords = {Aged, Dental Health Services, Female, Health Expenditures, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Surveys and Questionnaires, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12205}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and John V Pepper and Patricia A St Clair} } @article {8207, title = {Depressive symptoms, psychiatric medication use, and risk of type 2 diabetes: results from the Health and Retirement Study.}, journal = {Gen Hosp Psychiatry}, volume = {37}, year = {2015}, month = {2015 Sep-Oct}, pages = {420-6}, publisher = {37}, abstract = {

OBJECTIVE: This prospective study investigates the relationships between depressive symptoms, psychiatric medication use, and their interaction on risk of developing type 2 diabetes.

METHOD: Data come from the 1998-2010 waves of the Health and Retirement Study, a US nationally representative cohort of adults aged 51 years and older. Analysis is restricted to participants <65 years old who did not have diabetes in 1998 (N=8704). Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies-Depression Scale. Risk of diabetes over the 12-year follow-up period was assessed using Cox proportional hazard models with time-varying covariates.

RESULTS: After adjusting for covariates, both depressive symptoms [hazard ratio (HR): 1.06, 95\% confidence interval (CI): 1.02-1.09] and psychiatric medication use (HR: 1.57, 95\% CI: 1.25-1.96) were associated with development of diabetes. The interaction between depressive symptoms and medication use was significant (beta=-0.240, P=.049), indicating that the association between elevated depressive symptoms and diabetes was higher among respondents not taking medications. The associations between depressive symptoms and medication use were also attenuated by increasing body mass index.

CONCLUSION: Findings highlight the complex relationship between depressive symptoms and psychiatric medications on diabetes risk and the need for a nuanced understanding of these factors.

}, keywords = {Antidepressive Agents, Cohort Studies, depression, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Risk Assessment, Surveys and Questionnaires}, issn = {1873-7714}, doi = {10.1016/j.genhosppsych.2015.05.008}, url = {http://www.sciencedirect.com/science/article/pii/S0163834315001334}, author = {Scott M Ratliff and Briana Mezuk} } @article {8884, title = {Directional dominance on stature and cognition in~diverse human populations.}, journal = {Nature}, volume = {523}, year = {2015}, month = {2015 Jul 23}, pages = {459-62}, abstract = {

Homozygosity has long been associated with rare, often devastating, Mendelian disorders, and Darwin was one of the first to recognize that inbreeding reduces evolutionary fitness. However, the effect of the more distant parental relatedness that is common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power. Here we use runs of homozygosity to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts, and find statistically significant associations between summed runs~of homozygosity and four complex traits: height, forced expiratory lung volume in one second, general cognitive ability and educational attainment (P < 1 {\texttimes} 10(-300), 2.1 {\texttimes} 10(-6), 2.5 {\texttimes} 10(-10) and 1.8 {\texttimes} 10(-10), respectively). In each case, increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months{\textquoteright} less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing evidence that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been.

}, keywords = {Biological Evolution, Blood pressure, Body Height, Cholesterol, Cognitive Ability, Cohort Studies, Education, Female, Forced Expiratory Volume, Genome, Homozygote, Humans, Lung Volume Measurements, Male, Phenotype}, issn = {1476-4687}, doi = {10.1038/nature14618}, author = {Joshi, Peter K and T{\~o}nu Esko and Mattsson, Hannele and Eklund, Niina and Gandin, Ilaria and Nutile, Teresa and Jackson, Anne U and Schurmann, Claudia and Albert Vernon Smith and Zhang, Weihua and Okada, Yukinori and Stan{\v c}{\'a}kov{\'a}, Alena and Jessica Faul and Wei Zhao and Traci M Bartz and Maria Pina Concas and Franceschini, Nora and Enroth, Stefan and Vitart, Veronique and Trompet, Stella and Guo, Xiuqing and Daniel I Chasman and Jeff O{\textquoteright}Connell and Corre, Tanguy and Nongmaithem, Suraj S and Chen, Yuning and Mangino, Massimo and Ruggiero, Daniela and Traglia, Michela and Farmaki, Aliki-Eleni and Kacprowski, Tim and Bjonnes, Andrew and van der Spek, Ashley and Wu, Ying and Giri, Anil K and Yanek, Lisa R and Wang, Lihua and Edith Hofer and Cornelius A Rietveld and McLeod, Olga and Marilyn C Cornelis and Pattaro, Cristian and Verweij, Niek and Baumbach, Clemens and Abdel Abdellaoui and Warren, Helen R and Vuckovic, Dragana and Mei, Hao and Bouchard, Claude and Perry, John R B and Cappellani, Stefania and Saira S Mirza and Benton, Miles C and Broeckel, Ulrich and Sarah E Medland and Penelope A Lind and Malerba, Giovanni and Alexander W Drong and Yengo, Loic and Bielak, Lawrence F and Zhi, Degui and van der Most, Peter J and Daniel Shriner and M{\"a}gi, Reedik and Hemani, Gibran and Karaderi, Tugce and Wang, Zhaoming and Tian Liu and Demuth, Ilja and Jing Hua Zhao and Meng, Weihua and Lataniotis, Lazaros and van der Laan, Sander W and Bradfield, Jonathan P and Andrew R Wood and Bonnefond, Amelie and Ahluwalia, Tarunveer S and Hall, Leanne M and Salvi, Erika and Yazar, Seyhan and Carstensen, Lisbeth and de Haan, Hugoline G and Abney, Mark and Afzal, Uzma and Matthew A. Allison and Amin, Najaf and Asselbergs, Folkert W and Bakker, Stephan J L and Barr, R Graham and Baumeister, Sebastian E and Daniel J. Benjamin and Bergmann, Sven and Boerwinkle, Eric and Erwin P Bottinger and Campbell, Archie and Chakravarti, Aravinda and Chan, Yingleong and Chanock, Stephen J and Chen, Constance and Yii-Der I Chen and Collins, Francis S and Connell, John and Correa, Adolfo and Cupples, L Adrienne and Gail Davies and D{\"o}rr, Marcus and Georg B Ehret and Ellis, Stephen B and Feenstra, Bjarke and Feitosa, Mary F and Ford, Ian and Caroline S Fox and Timothy M Frayling and Friedrich, Nele and Geller, Frank and Scotland, Generation and Gillham-Nasenya, Irina and Gottesman, Omri and Graff, Misa and Grodstein, Francine and Gu, Charles and Haley, Chris and Hammond, Christopher J and Sarah E Harris and Tamara B Harris and Nicholas D Hastie and Heard-Costa, Nancy L and Heikkil{\"a}, Kauko and Lynne J Hocking and Homuth, Georg and Jouke-Jan Hottenga and Huang, Jinyan and Huffman, Jennifer E and Hysi, Pirro G and Mohammed Arfan Ikram and Ingelsson, Erik and Joensuu, Anni and Johansson, {\r A}sa and Jousilahti, Pekka and Jukema, J Wouter and K{\"a}h{\"o}nen, Mika and Kamatani, Yoichiro and Kanoni, Stavroula and Kerr, Shona M and Khan, Nazir M and Philipp D Koellinger and Koistinen, Heikki A and Kooner, Manraj K and Kubo, Michiaki and Kuusisto, Johanna and Lahti, Jari and Lenore J Launer and Lea, Rodney A and Lehne, Benjamin and Lehtim{\"a}ki, Terho and David C Liewald and Lars Lind and Loh, Marie and Lokki, Marja-Liisa and London, Stephanie J and Loomis, Stephanie J and Loukola, Anu and Lu, Yingchang and Lumley, Thomas and Lundqvist, Annamari and M{\"a}nnist{\"o}, Satu and Marques-Vidal, Pedro and Masciullo, Corrado and Matchan, Angela and Mathias, Rasika A and Matsuda, Koichi and Meigs, James B and Meisinger, Christa and Meitinger, Thomas and Menni, Cristina and Mentch, Frank D and Mihailov, Evelin and Lili Milani and Montasser, May E and Grant W Montgomery and Alanna C Morrison and Myers, Richard H and Nadukuru, Rajiv and Navarro, Pau and Nelis, Mari and Nieminen, Markku S and Ilja M Nolte and O{\textquoteright}Connor, George T and Ogunniyi, Adesola and Padmanabhan, Sandosh and Walter R Palmas and Pankow, James S and Patarcic, Inga and Pavani, Francesca and Peyser, Patricia A and Pietilainen, Kirsi and Neil Poulter and Prokopenko, Inga and Ralhan, Sarju and Redmond, Paul and Rich, Stephen S and Rissanen, Harri and Robino, Antonietta and Rose, Lynda M and Rose, Richard and Cinzia Felicita Sala and Babatunde Salako and Veikko Salomaa and Sarin, Antti-Pekka and Saxena, Richa and Schmidt, Helena and Scott, Laura J and Scott, William R and Sennblad, Bengt and Seshadri, Sudha and Peter Sever and Shrestha, Smeeta and Smith, Blair H and Jennifer A Smith and Soranzo, Nicole and Sotoodehnia, Nona and Southam, Lorraine and Stanton, Alice V and Stathopoulou, Maria G and Strauch, Konstantin and Strawbridge, Rona J and Suderman, Matthew J and Tandon, Nikhil and Tang, Sian-Tsun and Kent D Taylor and Bamidele O Tayo and T{\"o}glhofer, Anna Maria and Tomaszewski, Maciej and T{\v s}ernikova, Natalia and Tuomilehto, Jaakko and Andr{\'e} G Uitterlinden and Vaidya, Dhananjay and van Hylckama Vlieg, Astrid and van Setten, Jessica and Vasankari, Tuula and Vedantam, Sailaja and Vlachopoulou, Efthymia and Vozzi, Diego and Vuoksimaa, Eero and Waldenberger, Melanie and Erin B Ware and Wentworth-Shields, William and Whitfield, John B and Sarah Wild and Gonneke Willemsen and Yajnik, Chittaranjan S and Yao, Jie and Zaza, Gianluigi and Zhu, Xiaofeng and Salem, Rany M and Melbye, Mads and Bisgaard, Hans and Nilesh J Samani and Cusi, Daniele and Mackey, David A and Cooper, Richard S and Froguel, Philippe and Pasterkamp, Gerard and Grant, Struan F A and Hakonarson, Hakon and Luigi Ferrucci and Scott, Robert A and Morris, Andrew D and Palmer, Colin N A and George Dedoussis and Deloukas, Panos and Bertram, Lars and Lindenberger, Ulman and Berndt, Sonja I and Lindgren, Cecilia M and Nicholas J Timpson and T{\"o}njes, Anke and Munroe, Patricia B and Thorkild I. A. S{\o}rensen and Charles N Rotimi and Donna K Arnett and Oldehinkel, Albertine J and Sharon L R Kardia and Balkau, Beverley and Gambaro, Giovanni and Morris, Andrew P and Johan G Eriksson and Margaret J Wright and Nicholas G Martin and Hunt, Steven C and John M Starr and Ian J Deary and Griffiths, Lyn R and Henning Tiemeier and Nicola Pirastu and Kaprio, Jaakko and Wareham, Nicholas J and P{\'e}russe, Louis and Wilson, James G and Giorgia G Girotto and Caulfield, Mark J and Olli T Raitakari and Dorret I Boomsma and Gieger, Christian and van der Harst, Pim and Hicks, Andrew A and Kraft, Peter and Sinisalo, Juha and Knekt, Paul and Johannesson, Magnus and Patrik K E Magnusson and Hamsten, Anders and Schmidt, Reinhold and Ingrid B Borecki and Vartiainen, Erkki and Becker, Diane M and Bharadwaj, Dwaipayan and Mohlke, Karen L and Boehnke, Michael and Cornelia M van Duijn and Sanghera, Dharambir K and Teumer, Alexander and Zeggini, Eleftheria and Andres Metspalu and Paolo P. Gasparini and Ulivi, Sheila and Ober, Carole and Toniolo, Daniela and Rudan, Igor and David J Porteous and Ciullo, Marina and Timothy Spector and Caroline Hayward and Dupuis, Jos{\'e}e and Ruth J F Loos and Alan F Wright and Chandak, Giriraj R and Vollenweider, Peter and Alan R Shuldiner and Ridker, Paul M and Rotter, Jerome I and Sattar, Naveed and Gyllensten, Ulf and Kari E North and Pirastu, Mario and Psaty, Bruce M and David R Weir and Laakso, Markku and Gudnason, Vilmundur and Takahashi, Atsushi and Chambers, John C and Kooner, Jaspal S and David P Strachan and Campbell, Harry and Joel N Hirschhron and Markus Perola and Polasek, Ozren and James F Wilson} } @article {8237, title = {Disability Trajectories at the End of Life: A "Countdown" Model.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {745-52}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Death, Disabled Persons, Female, Humans, Male, Time Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu182}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract}, author = {Douglas A. Wolf and Vicki A Freedman and Jan I Ondrich and Christopher L Seplaki and Brenda C Spillman} } @article {8296, title = {Disaggregating activities of daily living limitations for predicting nursing home admission.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {560-78}, publisher = {50}, abstract = {

OBJECTIVE: To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.

DATA SOURCES: We used panel data from the Health and Retirement Study (HRS) for years 1998-2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801).

STUDY DESIGN: We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables.

PRINCIPAL FINDINGS: Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R(2) s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static.

CONCLUSIONS: Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment, Homes for the Aged, Humans, Male, Middle Aged, Nursing homes, Patient Admission, Residence Characteristics, Risk Factors, Sex Factors, Socioeconomic factors}, issn = {1475-6773}, doi = {10.1111/1475-6773.12235}, author = {Joelle H Fong and Olivia S. Mitchell and Benedict S K Koh} } @article {8224, title = {Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Oct}, pages = {1413-20}, publisher = {30}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Ageism, Aging, Disabled Persons, Female, Follow-Up Studies, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-015-3233-6}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff}, author = {Stephanie E Rogers and Angela D Thrasher and Yinghui Miao and W John Boscardin} } @article {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 {10902, title = {Do Statins Reduce the Health and Health Care Costs of Obesity?}, journal = {Pharmacoeconomics}, volume = {33}, year = {2015}, month = {2015 Jul}, pages = {723-34}, abstract = {

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50~years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6~\% greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and~2 obesity (body mass index [BMI] >=30 and >=35~kg/m(2), respectively) and they increase the costs of class~3 obesity (BMI >=40~kg/m(2)) by 1.2~\%.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

}, keywords = {Aged, Computer Simulation, Cost-Benefit Analysis, Health Care Costs, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Expectancy, Markov chains, Models, Economic, Obesity, Quality-Adjusted Life Years}, issn = {1179-2027}, doi = {10.1007/s40273-014-0234-y}, author = {Gaudette, {\'E}tienne and Dana P Goldman and Messali, Andrew and Sood, Neeraj} } @article {8289, title = {Does Stroke Contribute to Racial Differences in Cognitive Decline?}, journal = {Stroke}, volume = {46}, year = {2015}, month = {2015 Jul}, pages = {1897-902}, publisher = {46}, abstract = {

BACKGROUND AND PURPOSE: It is unknown whether blacks{\textquoteright} elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition.

METHODS: Among 4908 black and white participants aged >=65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time.

RESULTS: We identified 34 of 453 (7.5\%) blacks and 300 of 4455 (6.7\%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95\% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black-white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52).

CONCLUSIONS: In this population-based cohort of older adults, incident stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Cognition Disorders, European Continental Ancestry Group, Female, Humans, Longitudinal Studies, Male, Risk Factors, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.114.008156}, url = {http://stroke.ahajournals.org/content/early/2015/05/20/STROKEAHA.114.008156.abstract}, author = {Deborah A Levine and Mohammed U Kabeto and Kenneth M. Langa and Lynda D Lisabeth and Mary A M Rogers and Andrzej T Galecki} } @article {8219, title = {Effect of APOE and CD33 on Cognitive Decline.}, journal = {PLoS One}, volume = {10}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015}, pages = {e0130419}, publisher = {10}, abstract = {

OBJECTIVE: An Alzheimer{\textquoteright}s disease (AD) diagnosis is preceded by a long period of cognitive decline. We previously demonstrated increased risk of decline among individuals possessing one or more APOE ε4 alleles together with a family history of AD. The objective of this study is to investigate the possibility that such an increased risk might be due to AD risk genes with small effects in combination with APOE.

METHODS: Participants in the Health and Retirement Study (HRS) over the age of 65, who contributed DNA, and had two or more evaluations with an abbreviated version of the modified Telephone Interview for Cognitive Status (TICS-m) were eligible for the study (n = 7451). A genetic risk score (g-score) was derived using AD risk genes{\textquoteright} meta-analyses data, assigning risk according to the number of risk alleles and summed over all the risk genes. Trajectories of cognitive function were modeled in four groups of Caucasian participants with and without one or more APOE ε4 alleles and either a high or low g-score: APOE ε4-/low g-score; APOE ε4-/high g-score; APOE ε4+/low g-score; and APOE ε4+/high g-score. Post hoc analyses evaluated interactions between individual genes and APOE.

RESULTS: Individuals in the APOE ε4+/high g-score group exhibited the greatest cognitive decline over time (p<.0001). This risk appeared to be greater than the sum of the effects of either high g-score or APOE ε4 alone. When gene interactions were individually tested with APOE, a statistically significant interaction with CD33 was discovered (p = 0.04) although the interaction was no longer significant when adjusted for multiple comparisons.

CONCLUSIONS: Individuals with multiple AD risk genes in addition to having one or more APOE ε4 alleles are at greater risk of cognitive decline than individuals with either APOE ε4 or a high genetic risk score. Among those with one or more APOE ε4 alleles, having one or more copies of the CD33 C (risk) allele may further increase the risk of cognitive decline.

}, keywords = {Aged, Apolipoproteins E, Cognition Disorders, Female, Genetic Predisposition to Disease, Humans, Male, Polymorphism, Single Nucleotide, Sialic Acid Binding Ig-like Lectin 3}, issn = {1932-6203}, doi = {10.1371/journal.pone.0130419}, author = {Kathleen M Hayden and Michael W Lutz and Kuchibhatla, Maragatha and Cassandra M Germain and Brenda L Plassman} } @article {8160, title = {The effect of dental insurance on the use of dental care for older adults: a partial identification analysis.}, journal = {Health Econ}, volume = {24}, year = {2015}, note = {Export Date: 6 August 2014 Article in Press}, month = {2015 Jul}, pages = {840-58}, publisher = {24}, abstract = {

We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75\% to around 80\% under universal dental coverage.

}, keywords = {Aged, Dental Care, Female, Humans, Insurance Coverage, Insurance, Dental, Male, Middle Aged, Models, Econometric, Reproducibility of Results}, issn = {1099-1050}, doi = {10.1002/hec.3064}, author = {Kreider, Brent and Richard J. Manski and John F Moeller and John V Pepper} } @article {8175, title = {The effects of constraints and mastery on mental and physical health: Conceptual and methodological considerations.}, journal = {Psychol Aging}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Jun}, pages = {432-448}, publisher = {30}, abstract = {

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

}, keywords = {Aged, Confounding Factors, Epidemiologic, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Motor Activity, Retirement, Self-control}, issn = {1939-1498}, doi = {10.1037/a0039050}, author = {Frank J Infurna and Axel Mayer} } @article {8352, title = {Effects of Co-Worker and Supervisor Support on Job Stress and Presenteeism in an Aging Workforce: A Structural Equation Modelling Approach.}, journal = {Int J Environ Res Public Health}, volume = {13}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Dec 23}, pages = {ijerph13010072}, publisher = {13}, abstract = {

We examined the effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. Structural equation modelling was used to evaluate data from the 2010 wave of the Health and Retirement Survey in the United States (n = 1649). The level of presenteeism was low and the level of job stress was moderate among aging US workers. SEM revealed that co-worker support and supervisor support were strongly correlated (β = 0.67; p < 0.001). Job stress had a significant direct positive effect on presenteeism (β = 0.30; p < 0.001). Co-worker support had a significant direct negative effect on job stress (β = -0.10; p < 0.001) and presenteeism (β = -0.11; p < 0.001). Supervisor support had a significant direct negative effect on job stress (β = -0.40; p < 0.001) but not presenteeism. The findings suggest that presenteeism is reduced by increased respect and concern for employee stress at the workplace, by necessary support at work from colleagues and employers, and by the presence of comfortable interpersonal relationships among colleagues and between employers and employees.

}, keywords = {Aged, Cross-Sectional Studies, Female, Health Surveys, Humans, Interpersonal Relations, Male, Middle Aged, Models, Statistical, Occupational Health, Population Dynamics, Presenteeism, Social Support, Stress, Psychological, United States}, issn = {1660-4601}, doi = {10.3390/ijerph13010072}, author = {Tianan Yang and Shen, Yu-Ming and Zhu, Mingjing and Liu, Yuanling and Deng, Jianwei and Chen, Qian and See, Lai-Chu} } @article {8307, title = {The effects of income on mental health: evidence from the social security notch.}, journal = {J Ment Health Policy Econ}, volume = {18}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Mar}, pages = {27-37}, publisher = {18}, abstract = {

BACKGROUND: Mental health is a key component of overall wellbeing and mental disorders are relatively common, including among older adults. Yet the causal effect of income on mental health status among older adults is poorly understood.

AIMS: This paper considers the effects of a major source of transfer income, Social Security retirement benefits, on the mental health of older adults.

METHODS: The Social Security benefit "Notch" is as a large, permanent, and exogenous shock to Social Security income in retirement. The "Notch" is used to identify the causal effect of Social Security income on mental health among older ages using data from the AHEAD cohort of the Health and Retirement Study.

RESULTS: We find that increases in Social Security income significantly improve mental health status and the likelihood of a psychiatric diagnosis for women, but not for men.

DISCUSSION: The effects of income on mental health for older women are statistically significant and meaningful in magnitude. While this is one of the only studies to use plausibly exogenous variation in household income to identify the effect of income on mental health, a limitation of this work is that the results only directly pertain to lower-education households.

IMPLICATIONS: Public policy proposals that alter retirement benefits for the elderly may have important effects on the mental health of older adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Female, Humans, Income, Male, Mental Health, Models, Econometric, Retirement, Sex Factors, Social Security, Socioeconomic factors, United States}, issn = {1091-4358}, author = {Ezra Golberstein} } @article {8220, title = {Estimating the Effects of Obesity and Weight Change on Mortality Using a Dynamic Causal Model.}, journal = {PLoS One}, volume = {10}, year = {2015}, note = {Times Cited: 0 0}, month = {2015}, pages = {e0129946}, publisher = {10}, abstract = {

BACKGROUND: A well-known challenge in estimating the mortality risks of obesity is reverse causality attributable to illness-associated and smoking-associated weight loss. Given that the likelihood of chronic and acute illnesses rises with age, reverse causality is most threatening to estimates derived from elderly populations.

METHODS: I analyzed data from 12,523 respondents over 50 years old from a nationally representative longitudinal dataset, the Health and Retirement Study (HRS). The effects of both baseline body weight and time-varying weight change on mortality are estimated, adjusting for demographic and socio-economic variables, as well as time-varying confounders including illness and smoking. Body weight is measured by body mass index (BMI). In survival models for mortality, illness and smoking were lagged to minimize bias from reverse causality in estimates of the effect of weight change. Furthermore, because illness both causes and is caused by changes in BMI, I used a marginal structural model (MSM) rather than standard adjustment to control confounding by this and other time-dependent factors.

RESULTS: Overall, relative to normal weight, underweight and Class II/III at baseline are associated with hazard ratios that are 2.07 (95\% confidence interval (CI): 1.28-3.37) and 1.82 (1.54-2.16) respectively, whereas overweight and Class I obesity do not significantly lower or raise the mortality risks. Furthermore, relative to stable weight change, all types of weight change lead to significantly increased risk of mortality. Specifically, large weight loss results in a mortality risk that is nearly 3.86 (3.26-4.58) times of staying in the stable weight range and small weight loss is about 1.81 (1.55-2.11 ) times riskier. In contrast, large weight gain and small weight gain are associated with hazard ratios that are 1.98 (1.67-2.35) and 1.20 (1.02-1.41) respectively.

CONCLUSIONS: Being underweight or severe obese at baseline is associated with excess mortality risk, and weight change tend to raise mortality risk. Both the confounding by illness and by smoking lead to overestimates of the effects of being underweight at baseline and of weight loss, but underestimates the effect of being obese at baseline.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Body Weight, Female, Humans, Male, Middle Aged, Models, Theoretical, Obesity, Overweight, Risk Factors, Thinness, Weight Gain, Weight Loss}, issn = {1932-6203}, doi = {10.1371/journal.pone.0129946}, author = {Cao, Bochen} } @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 {8660, title = {Factors associated with cognitive evaluations in the United States.}, journal = {Neurology}, volume = {84}, year = {2015}, month = {2015 Jan 06}, pages = {64-71}, abstract = {

OBJECTIVE: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.

METHODS: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.

RESULTS: Of the 297 participants with dementia in ADAMS, 55.2\% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95\% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.

CONCLUSIONS: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, Female, Humans, Logistic Models, Male, Marital Status, Multivariate Analysis, Neuropsychological tests, Severity of Illness Index, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000001096}, url = {http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096}, author = {Vikas Kotagal and Kenneth M. Langa and Brenda L Plassman and Gwenith G Fisher and Bruno J Giordani and Robert B Wallace and James F. Burke and David C Steffens and Mohammed U Kabeto and Roger L. Albin and Norman L Foster} } @article {8326, title = {FASTKD2 is associated with memory and hippocampal structure in older adults.}, journal = {Mol Psychiatry}, volume = {20}, year = {2015}, month = {2015 Oct}, pages = {1197-204}, publisher = {20}, abstract = {

Memory impairment is the cardinal early feature of Alzheimer{\textquoteright}s disease, a highly prevalent disorder whose causes remain only partially understood. To identify novel genetic predictors, we used an integrative genomics approach to perform the largest study to date of human memory (n=14 781). Using a genome-wide screen, we discovered a novel association of a polymorphism in the pro-apoptotic gene FASTKD2 (fas-activated serine/threonine kinase domains 2; rs7594645-G) with better memory performance and replicated this finding in independent samples. Consistent with a neuroprotective effect, rs7594645-G carriers exhibited increased hippocampal volume and gray matter density and decreased cerebrospinal fluid levels of apoptotic mediators. The MTOR (mechanistic target of rapamycin) gene and pathways related to endocytosis, cholinergic neurotransmission, epidermal growth factor receptor signaling and immune regulation, among others, also displayed association with memory. These findings nominate FASTKD2 as a target for modulating neurodegeneration and suggest potential mechanisms for therapies to combat memory loss in normal cognitive aging and dementia.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alzheimer disease, Female, Genetic Association Studies, Genome-Wide Association Study, Hippocampus, Humans, Longitudinal Studies, Male, Memory, Memory Disorders, Polymorphism, Single Nucleotide, Protein-Serine-Threonine Kinases, Structure-Activity Relationship}, issn = {1476-5578}, doi = {10.1038/mp.2014.142}, author = {Vijay K Ramanan and Nho, Kwangsik and Shen, Li and Shannon L Risacher and Brenna C McDonald and Martin R Farlow and Tatiana Foroud and Gao, Sujuan and Soininen, Hilkka and Kloszewska, Iwona and Mecocci, Patrizia and Tsolaki, Magda and Vellas, Bruno and Lovestone, Simon and Aisen, Paul S. and Ronald C Petersen and Jack, Clifford R. and Shaw, Leslie M. and Trojanowski, John Q. and Weiner, Michael W. and Green, Robert C. and Arthur W. Toga and Philip L de Jager and Lei Yu and David A Bennett and Andrew J Saykin} } @article {10490, title = {Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending.}, journal = {Health Affairs (Project Hope)}, volume = {34}, year = {2015}, month = {2015 Dec}, pages = {2181-91}, abstract = {

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance{\textquoteright}s role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

}, keywords = {Aged, Financing, Government, Humans, Insurance, Insurance Coverage, Long-term Care, Medicaid, Middle Aged, Policy Making, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2015.1226}, author = {Melissa Favreault and Gleckman, Howard and Richard W. Johnson} } @article {8313, title = {Functional impairment and hospital readmission in Medicare seniors.}, journal = {JAMA Intern Med}, volume = {175}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {559-65}, publisher = {175}, abstract = {

IMPORTANCE: Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

OBJECTIVE: To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

DESIGN, SETTING, AND PARTICIPANTS: We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010.

MAIN OUTCOMES AND MEASURES: Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission.

RESULTS: Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4\% were female, 84.9\% were white, 89.6\% reported 3 or more comorbidities, and 86.0\% had 1 or more hospitalizations in the previous year. Overall, 48.3\% had some level of functional impairment before admission, and 15.5\% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5\% with no functional impairment, 14.3\% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95\% CI, 0.94-1.20), 14.4\% with difficulty with 1 or more ADL (OR, 1.08; 95\% CI, 0.96-1.21), 16.5\% with dependency in 1 to 2 ADLs (OR, 1.26; 95\% CI, 1.11-1.44), and 18.2\% with dependency in 3 or more ADLs (OR, 1.42; 95\% CI, 1.20-1.69). Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9\% readmission rate for no impairment vs 25.7\% for dependency in 3 or more ADLs [OR, 1.70; 95\% CI, 1.04-2.78]).

CONCLUSIONS AND RELEVANCE: Functional impairment is associated with increased risk of 30-day all-cause hospital readmission in Medicare seniors, especially those admitted for heart failure, myocardial infarction, or pneumonia. Functional impairment may be an important but underaddressed factor in preventing readmissions for Medicare seniors.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Female, Heart Failure, Humans, Income, Logistic Models, Male, Medicare, Myocardial Infarction, Patient Readmission, Pneumonia, Risk Assessment, Risk Factors, Sex Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2014.7756}, author = {S. Ryan Greysen and Irena Cenzer and Andrew D. Auerbach and Kenneth E Covinsky} } @article {8233, title = {Gender Differences in Institutional Long-Term Care Transitions.}, journal = {Womens Health Issues}, volume = {25}, year = {2015}, month = {2015 Sep-Oct}, pages = {441-9}, publisher = {25}, abstract = {

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n~=~3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Family Characteristics, Female, Geriatric Assessment, Home Care Services, Humans, Length of Stay, Logistic Models, Long-term Care, Male, Marital Status, Middle Aged, Nursing homes, Patient Discharge, Residence Characteristics, Sex Characteristics, United States}, issn = {1878-4321}, doi = {10.1016/j.whi.2015.04.010}, url = {http://www.sciencedirect.com/science/article/pii/S1049386715000638}, author = {Mudrazija, Stipica and Thomeer, Mieke Beth and Jacqueline L. Angel} } @article {8297, title = {Genetic contributions to variation in general cognitive function: a meta-analysis of genome-wide association studies in the CHARGE consortium (N=53949).}, journal = {Mol Psychiatry}, volume = {20}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb}, pages = {183-92}, publisher = {20}, abstract = {

General cognitive function is substantially heritable across the human life course from adolescence to old age. We investigated the genetic contribution to variation in this important, health- and well-being-related trait in middle-aged and older adults. We conducted a meta-analysis of genome-wide association studies of 31 cohorts (N=53,949) in which the participants had undertaken multiple, diverse cognitive tests. A general cognitive function phenotype was tested for, and created in each cohort by principal component analysis. We report 13 genome-wide significant single-nucleotide polymorphism (SNP) associations in three genomic regions, 6q16.1, 14q12 and 19q13.32 (best SNP and closest gene, respectively: rs10457441, P=3.93 {\texttimes} 10(-9), MIR2113; rs17522122, P=2.55 {\texttimes} 10(-8), AKAP6; rs10119, P=5.67 {\texttimes} 10(-9), APOE/TOMM40). We report one gene-based significant association with the HMGN1 gene located on chromosome 21 (P=1 {\texttimes} 10(-6)). These genes have previously been associated with neuropsychiatric phenotypes. Meta-analysis results are consistent with a polygenic model of inheritance. To estimate SNP-based heritability, the genome-wide complex trait analysis procedure was applied to two large cohorts, the Atherosclerosis Risk in Communities Study (N=6617) and the Health and Retirement Study (N=5976). The proportion of phenotypic variation accounted for by all genotyped common SNPs was 29\% (s.e.=5\%) and 28\% (s.e.=7\%), respectively. Using polygenic prediction analysis, ~1.2\% of the variance in general cognitive function was predicted in the Generation Scotland cohort (N=5487; P=1.5 {\texttimes} 10(-17)). In hypothesis-driven tests, there was significant association between general cognitive function and four genes previously associated with Alzheimer{\textquoteright}s disease: TOMM40, APOE, ABCG1 and MEF2C.

}, keywords = {Aged, Aged, 80 and over, Atherosclerosis, Cognition, Cognition Disorders, Cohort Studies, Female, Genetic Predisposition to Disease, Genome-Wide Association Study, HMGN1 Protein, Humans, Male, Middle Aged, Neuropsychological tests, Phenotype, Polymorphism, Single Nucleotide, Scotland}, issn = {1476-5578}, doi = {10.1038/mp.2014.188}, author = {Gail Davies and Armstrong, N. and Joshua C. Bis and Bressler, J. and Chouraki, V. and Giddaluru, S. and Edith Hofer and Carla A Ibrahim-Verbaas and Kirin, M. and J. Lahti and Sven J van der Lee and Stephanie Le Hellard and Tian Liu and Riccardo E Marioni and Christopher J Oldmeadow and Postmus, I. and Albert Vernon Smith} } @article {8882, title = {Genetic studies of body mass index yield new insights for obesity biology.}, journal = {Nature}, volume = {518}, year = {2015}, month = {2015 Feb 12}, pages = {197-206}, abstract = {

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P~<~5~{\texttimes}~10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for \~{}2.7\% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20\% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

}, keywords = {Age Factors, BMI, Continental Population Groups, Energy Metabolism, Europe, Female, Genome-Wide Association Study, Glutamic Acid, Humans, Insulin, Male, Obesity, Polymorphism, Single Nucleotide, Quantitative Trait Loci, Synapses}, issn = {1476-4687}, doi = {10.1038/nature14177}, author = {Locke, Adam E and Kahali, Bratati and Berndt, Sonja I and Justice, Anne E and Pers, Tune H and Day, Felix R and Powell, Corey and Vedantam, Sailaja and Buchkovich, Martin L and Yang, Jian and Croteau-Chonka, Damien C and T{\~o}nu Esko and Fall, Tove and Ferreira, Teresa and Gustafsson, Stefan and Kutalik, Zolt{\'a}n and Luan, Jian{\textquoteright}an and M{\"a}gi, Reedik and Randall, Joshua C and Thomas W Winkler and Andrew R Wood and Workalemahu, Tsegaselassie and Jessica Faul and Jennifer A Smith and Jing Hua Zhao and Wei Zhao and Chen, Jin and Rudolf Ferhmann and Hedman, {\r A}sa K and Karjalainen, Juha and Schmidt, Ellen M and Absher, Devin and Amin, Najaf and Anderson, Denise and Beekman, Marian and Bolton, Jennifer L and Bragg-Gresham, Jennifer L and Buyske, Steven and Demirkan, Ayse and Deng, Guohong and Georg B Ehret and Feenstra, Bjarke and Feitosa, Mary F and Fischer, Krista and Goel, Anuj and Gong, Jian and Jackson, Anne U and Kanoni, Stavroula and Kleber, Marcus E and Kristiansson, Kati and Lim, Unhee and Lotay, Vaneet and Mangino, Massimo and Irene Mateo Leach and Medina-Gomez, Carolina and Sarah E Medland and Michael A Nalls and Palmer, Cameron D and Pasko, Dorota and Pechlivanis, Sonali and Peters, Marjolein J and Prokopenko, Inga and Shungin, Dmitry and Stan{\v c}{\'a}kov{\'a}, Alena and Strawbridge, Rona J and Yun Ju Sung and Toshiko Tanaka and Teumer, Alexander and Trompet, Stella and van der Laan, Sander W and van Setten, Jessica and Jana V. van Vliet-Ostaptchouk and Wang, Zhaoming and Yengo, Loic and Zhang, Weihua and Isaacs, Aaron and Albrecht, Eva and {\"A}rnl{\"o}v, Johan and Arscott, Gillian M and Attwood, Antony P and Bandinelli, Stefania and Barrett, Amy and Bas, Isabelita N and Bellis, Claire and Bennett, Amanda J and Berne, Christian and Blagieva, Roza and Bl{\"u}her, Matthias and B{\"o}hringer, Stefan and Bonnycastle, Lori L and B{\"o}ttcher, Yvonne and Boyd, Heather A and Bruinenberg, Marcel and Caspersen, Ida H and Yii-Der I Chen and Robert Clark and Daw, E Warwick and de Craen, Anton J M and Delgado, Graciela and Dimitriou, Maria and Doney, Alex S F and Eklund, Niina and Estrada, Karol and Eury, Elodie and Folkersen, Lasse and Fraser, Ross M and Melissa E Garcia and Geller, Frank and Giedraitis, Vilmantas and Gigante, Bruna and Alan S Go and Golay, Alain and Goodall, Alison H and Gordon, Scott D and Gorski, Mathias and Hans-J{\"o}rgen Grabe and Grallert, Harald and Grammer, Tanja B and Gr{\"a}{\ss}ler, J{\"u}rgen and Gr{\"o}nberg, Henrik and Groves, Christopher J and Gusto, Ga{\"e}lle and Jeffrey Haessler and Hall, Per and Haller, Toomas and Hallmans, G{\"o}ran and Catharina A Hartman and Hassinen, Maija and Caroline Hayward and Heard-Costa, Nancy L and Helmer, Quinta and Hengstenberg, Christian and Oddgeir L Holmen and Jouke-Jan Hottenga and James, Alan L and Janina Jeff and Johansson, {\r A}sa and Jolley, Jennifer and Juliusdottir, Thorhildur and Kinnunen, Leena and Koenig, Wolfgang and Koskenvuo, Markku and Kratzer, Wolfgang and Laitinen, Jaana and Lamina, Claudia and Leander, Karin and Lee, Nanette R and Lichtner, Peter and Lars Lind and Lindstr{\"o}m, Jaana and Ken Sin Lo and Lobbens, St{\'e}phane and Lorbeer, Roberto and Lu, Yingchang and Mach, Fran{\c c}ois and Patrik K E Magnusson and Mahajan, Anubha and McArdle, Wendy L and McLachlan, Stela and Menni, Cristina and Merger, Sigrun and Mihailov, Evelin and Lili Milani and Moayyeri, Alireza and Monda, Keri L and Morken, Mario A and Mulas, Antonella and M{\"u}ller, Gabriele and M{\"u}ller-Nurasyid, Martina and Musk, Arthur W and Nagaraja, Ramaiah and Markus M N{\"o}then and Ilja M Nolte and Pilz, Stefan and Nigel W Rayner and Renstrom, Frida and Rettig, Rainer and Ried, Janina S and Ripke, Stephan and Neil R Robertson and Rose, Lynda M and Sanna, Serena and Scharnagl, Hubert and Scholtens, Salome and Schumacher, Fredrick R and Scott, William R and Seufferlein, Thomas and Jianxin Shi and Albert Vernon Smith and Smolonska, Joanna and Stanton, Alice V and Steinthorsdottir, Valgerdur and Kathleen E Stirrups and Heather M Stringham and Sundstr{\"o}m, Johan and Swertz, Morris A and Swift, Amy J and Syv{\"a}nen, Ann-Christine and Tan, Sian-Tsung and Bamidele O Tayo and Thorand, Barbara and Thorleifsson, Gudmar and Tyrer, Jonathan P and Uh, Hae-Won and Vandenput, Liesbeth and Verhulst, Frank C and Vermeulen, Sita H and Verweij, Niek and Vonk, Judith M and Lindsay L Waite and Warren, Helen R and Dawn M Waterworth and Michael N Weedon and Wilkens, Lynne R and Willenborg, Christina and Wilsgaard, Tom and Wojczynski, Mary K and Wong, Andrew and Alan F Wright and Zhang, Qunyuan and Brennan, Eoin P and Murim Choi and Dastani, Zari and Alexander W Drong and Eriksson, Per and Franco-Cereceda, Anders and G{\r a}din, Jesper R and Gharavi, Ali G and Goddard, Michael E and Handsaker, Robert E and Huang, Jinyan and Karpe, Fredrik and Kathiresan, Sekar and Keildson, Sarah and Kiryluk, Krzysztof and Kubo, Michiaki and Lee, Jong-Young and Liang, Liming and Lifton, Richard P and Ma, Baoshan and McCarroll, Steven A and McKnight, Amy J and Min, Josine L and Moffatt, Miriam F and Grant W Montgomery and Joanne M Murabito and Nicholson, George and Nyholt, Dale R and Okada, Yukinori and Perry, John R B and Dorajoo, Rajkumar and Reinmaa, Eva and Salem, Rany M and Sandholm, Niina and Scott, Robert A and Stolk, Lisette and Takahashi, Atsushi and Tanaka, Toshihiro and Ferdinand M van {\textquoteright}t Hooft and Anna A E Vinkhuyzen and Westra, Harm-Jan and Wei Zhang and Krina T Zondervan and Andrew C Heath and Arveiler, Dominique and Bakker, Stephan J L and Beilby, John and Bergman, Richard N and Blangero, John and Bovet, Pascal and Campbell, Harry and Caulfield, Mark J and Cesana, Giancarlo and Chakravarti, Aravinda and Daniel I Chasman and Chines, Peter S and Collins, Francis S and Crawford, Dana C and Cupples, L Adrienne and Cusi, Daniele and Danesh, John and de Faire, Ulf and Hester M den Ruijter and Dominiczak, Anna F and Erbel, Raimund and Erdmann, Jeanette and Johan G Eriksson and Farrall, Martin and Felix, Stephan B and Ferrannini, Ele and Ferri{\`e}res, Jean and Ford, Ian and Forouhi, Nita G and Forrester, Terrence and Franco, Oscar H and Gansevoort, Ron T and Gejman, Pablo V and Gieger, Christian and Gottesman, Omri and Gudnason, Vilmundur and Gyllensten, Ulf and Hall, Alistair S and Tamara B Harris and Andrew T Hattersley and Hicks, Andrew A and Hindorff, Lucia A and Aroon Hingorani and Hofman, Albert and Homuth, Georg and Hovingh, G Kees and Humphries, Steve E and Hunt, Steven C and Hypp{\"o}nen, Elina and Illig, Thomas and Jacobs, Kevin B and J{\"a}rvelin, Marjo-Riitta and J{\"o}ckel, Karl-Heinz and Johansen, Berit and Jousilahti, Pekka and Jukema, J Wouter and Jula, Antti M and Kaprio, Jaakko and Kastelein, John J P and Keinanen-Kiukaanniemi, Sirkka M and Lambertus A Kiemeney and Knekt, Paul and Kooner, Jaspal S and Charles Kooperberg and Kovacs, Peter and Kraja, Aldi T and Kumari, Meena and Kuusisto, Johanna and Lakka, Timo A and Langenberg, Claudia and Loic Le Marchand and Lehtim{\"a}ki, Terho and Lyssenko, Valeriya and M{\"a}nnist{\"o}, Satu and Marette, Andr{\'e} and Matise, Tara C and McKenzie, Colin A and McKnight, Barbara and Moll, Frans L and Morris, Andrew D and Morris, Andrew P and Murray, Jeffrey C and Nelis, Mari and Ohlsson, Claes and Oldehinkel, Albertine J and Ong, Ken K and Pamela A F Madden and Pasterkamp, Gerard and Peden, John F and Peters, Annette and Postma, Dirkje S and Pramstaller, Peter P and Price, Jackie F and Qi, Lu and Olli T Raitakari and Rankinen, Tuomo and Rao, D C and Rice, Treva K and Ridker, Paul M and Rioux, John D and Ritchie, Marylyn D and Rudan, Igor and Veikko Salomaa and Nilesh J Samani and Saramies, Jouko and Sarzynski, Mark A and Schunkert, Heribert and Schwarz, Peter E H and Peter Sever and Alan R Shuldiner and Sinisalo, Juha and Stolk, Ronald P and Strauch, Konstantin and T{\"o}njes, Anke and Tr{\'e}gou{\"e}t, David-Alexandre and Tremblay, Angelo and Tremoli, Elena and Virtamo, Jarmo and Vohl, Marie-Claude and V{\"o}lker, Uwe and Waeber, G{\'e}rard and Gonneke Willemsen and Witteman, Jacqueline C and Zillikens, M Carola and Adair, Linda S and Amouyel, Philippe and Asselbergs, Folkert W and Assimes, Themistocles L and Bochud, Murielle and Boehm, Bernhard O and Boerwinkle, Eric and Bornstein, Stefan R and Erwin P Bottinger and Bouchard, Claude and Cauchi, St{\'e}phane and Chambers, John C and Chanock, Stephen J and Cooper, Richard S and de Bakker, Paul I W and George Dedoussis and Luigi Ferrucci and Franks, Paul W and Froguel, Philippe and Leif C Groop and Christopher A Haiman and Hamsten, Anders and Hui, Jennie and Hunter, David J and Hveem, Kristian and Kaplan, Robert C and Mika Kivim{\"a}ki and Kuh, Diana and Laakso, Markku and Yongmei Liu and Nicholas G Martin and M{\"a}rz, Winfried and Melbye, Mads and Andres Metspalu and Moebus, Susanne and Munroe, Patricia B and Nj{\o}lstad, Inger and Ben A Oostra and Palmer, Colin N A and Nancy L Pedersen and Markus Perola and P{\'e}russe, Louis and Peters, Ulrike and Power, Chris and Quertermous, Thomas and Rauramaa, Rainer and Fernando Rivadeneira and Saaristo, Timo E and Saleheen, Danish and Sattar, Naveed and Eric E Schadt and Schlessinger, David and Eline P Slagboom and Snieder, Harold and Timothy Spector and Thorsteinsdottir, Unnur and Stumvoll, Michael and Tuomilehto, Jaakko and Andr{\'e} G Uitterlinden and Uusitupa, Matti and van der Harst, Pim and Walker, Mark and Wallaschofski, Henri and Wareham, Nicholas J and Watkins, Hugh and David R Weir and Wichmann, H-Erich and James F Wilson and Zanen, Pieter and Ingrid B Borecki and Deloukas, Panos and Caroline S Fox and Iris M Heid and Jeff O{\textquoteright}Connell and David P Strachan and Stefansson, Kari and Cornelia M van Duijn and Gon{\c c}alo R Abecasis and Lude L Franke and Timothy M Frayling and McCarthy, Mark I and Peter M Visscher and Scherag, Andre and Willer, Cristen J and Boehnke, Michael and Mohlke, Karen L and Lindgren, Cecilia M and Beckmann, Jacques S and Barroso, In{\^e}s and Kari E North and Ingelsson, Erik and Joel N Hirschhron and Ruth J F Loos and Elizabeth K Speliotes} } @article {8612, title = {Genetic vulnerability to diabetes and obesity: does education offset the risk?}, journal = {Soc Sci Med}, volume = {127}, year = {2015}, month = {2015 Feb}, pages = {150-8}, abstract = {

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n~=~8398), we tested whether education modifies genetic risk for obesity and T2D, offsetting genetic effects; whether this effect is larger for individuals who have high risk for other (unobserved) reasons, i.e., at higher quantiles of HbA1c and BMI; and whether effects differ by gender. We measured T2D risk using Hemoglobin A1c (HbA1c) level, and obesity risk using body-mass index (BMI). We constructed separate genetic risk scores (GRS) for obesity and diabetes respectively based on the most current available information on the single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs). Linear regression models with years of schooling indicate that the effect of genetic risk on HbA1c is smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders. Quantile regression models show that the GRS~{\texttimes}~education effect systematically increased along the HbA1c outcome distribution; for example the GRS~{\texttimes}~years of education interaction coefficient was~-0.01 (95\% CI~=~-0.03, 0.00) at the 10th percentile compared to~-0.03 (95\% CI~=~-0.07, 0.00) at the 90th percentile. These results suggest that education may be an important socioeconomic source of heterogeneity in responses to genetic vulnerability to T2D.

}, keywords = {Aged, Body Mass Index, Diabetes Mellitus, Type 2, Educational Status, European Continental Ancestry Group, Female, Genetic Predisposition to Disease, Genotype, Glycated Hemoglobin A, Health Status Disparities, Humans, Male, Middle Aged, Obesity, Risk Factors, Social determinants of health}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.09.009}, url = {http://www.sciencedirect.com/science/article/pii/S0277953614005760}, author = {Sze Y Liu and Stefan Walter and Jessica R Marden and David Rehkopf and Laura D Kubzansky and Thu T Nguyen and M. Maria Glymour} } @article {10640, title = {Genetically predicted body mass index and Alzheimer{\textquoteright}s disease-related phenotypes in three large samples: Mendelian randomization analyses.}, journal = {Alzheimers Dement}, volume = {11}, year = {2015}, month = {2015 Dec}, pages = {1439-1451}, abstract = {

Observational research shows that higher body mass index (BMI) increases Alzheimer{\textquoteright}s disease (AD) risk, but it is unclear whether this association is causal. We applied genetic variants that predict BMI in Mendelian randomization analyses, an approach that is not biased by reverse causation or confounding, to evaluate whether higher BMI increases AD risk. We evaluated individual-level data from the AD Genetics Consortium (ADGC: 10,079 AD cases and 9613 controls), the Health and Retirement Study (HRS: 8403 participants with algorithm-predicted dementia status), and published associations from the Genetic and Environmental Risk for AD consortium (GERAD1: 3177 AD cases and 7277 controls). No evidence from individual single-nucleotide polymorphisms or polygenic scores indicated BMI increased AD risk. Mendelian randomization effect estimates per BMI point (95\% confidence intervals) were as follows: ADGC, odds ratio (OR) = 0.95 (0.90-1.01); HRS, OR = 1.00 (0.75-1.32); GERAD1, OR = 0.96 (0.87-1.07). One subscore (cellular processes not otherwise specified) unexpectedly predicted lower AD risk.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Body Mass Index, Female, Genotype, Humans, Linear Models, Male, Mendelian Randomization Analysis, Obesity, Phenotype, Polymorphism, Single Nucleotide, Risk Factors}, issn = {1552-5279}, doi = {10.1016/j.jalz.2015.05.015}, author = {Mukherjee, Shubhabrata and Stefan Walter and Kauwe, John S K and Andrew J Saykin and David A Bennett and Eric B Larson and Paul K Crane and M. Maria Glymour} } @article {8225, title = {Greater Perceived Age Discrimination in England than the United States: Results from HRS and ELSA.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Nov}, pages = {925-33}, publisher = {70}, abstract = {

OBJECTIVES: We examined cross-national differences in perceptions of age discrimination in England and the United States. Under the premise that the United States has had age discrimination legislation in place for considerably longer than England, we hypothesized that perceptions of age discrimination would be lower in the United States.

METHODS: We analyzed data from two nationally representative studies of aging, the U.S. Health and Retirement Study (n = 4,818) and the English Longitudinal Study of Ageing (n = 7,478). Respondents aged 52 years and older who attributed any experiences of discrimination to their age were treated as cases of perceived age discrimination. We used multivariable logistic regression to estimate the odds ratios of experiencing perceived age discrimination in relation to selected sociodemographic factors.

RESULTS: Perceptions of age discrimination were significantly higher in England than the United States, with 34.8\% of men and women in England reporting age discrimination compared with 29.1\% in the United States. Associations between perceived age discrimination and older age and lower levels of household wealth were observed in both countries, but we found differences between England and the United States in the relationship between perceived age discrimination and education.

DISCUSSION: Our study revealed that levels of perceived age discrimination are lower in the United States than England and are less socially patterned. This suggests that differing social and political circumstances in the two countries may have an important role to play.

}, keywords = {Aged, Aged, 80 and over, Ageism, England, Female, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv040}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/07/28/geronb.gbv040.abstract}, author = {Rippon, Isla and Zaninotto, Paola and Andrew Steptoe} } @article {8606, title = {GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Jan}, pages = {110-8}, abstract = {

BACKGROUND: The genetic contribution to longevity in humans has been estimated to range from 15\% to 25\%. Only two genes, APOE and FOXO3, have shown association with longevity in multiple independent studies.

METHODS: We conducted a meta-analysis of genome-wide association studies including 6,036 longevity cases, age >=90 years, and 3,757 controls that died between ages 55 and 80 years. We additionally attempted to replicate earlier identified single nucleotide polymorphism (SNP) associations with longevity.

RESULTS: In our meta-analysis, we found suggestive evidence for the association of SNPs near CADM2 (odds ratio [OR] = 0.81; p value = 9.66 {\texttimes} 10(-7)) and GRIK2 (odds ratio = 1.24; p value = 5.09 {\texttimes} 10(-8)) with longevity. When attempting to replicate findings earlier identified in genome-wide association studies, only the APOE locus consistently replicated. In an additional look-up of the candidate gene FOXO3, we found that an earlier identified variant shows a highly significant association with longevity when including published data with our meta-analysis (odds ratio = 1.17; p value = 1.85{\texttimes}10(-10)).

CONCLUSIONS: We did not identify new genome-wide significant associations with longevity and did not replicate earlier findings except for APOE and FOXO3. Our inability to find new associations with survival to ages >=90 years because longevity represents multiple complex traits with heterogeneous genetic underpinnings, or alternatively, that longevity may be regulated by rare variants that are not captured by standard genome-wide genotyping and imputation of common variants.

}, keywords = {Aged, Aged, 80 and over, Apolipoproteins E, Cell Adhesion Molecules, Cohort Studies, Female, Forkhead Box Protein O3, Forkhead Transcription Factors, Genome-Wide Association Study, Humans, Longevity, Male, Middle Aged, Polymorphism, Single Nucleotide, Receptors, Kainic Acid}, issn = {1758-535X}, doi = {10.1093/gerona/glu166}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/}, author = {Broer, Linda and Aron S Buchman and Deelen, Joris and Daniel S Evans and Jessica Faul and Kathryn L Lunetta and Sebastiani, Paola and Jennifer A Smith and Albert Vernon Smith and Toshiko Tanaka and Lei Yu and Alice M. Arnold and Aspelund, Thor and Emelia J Benjamin and Philip L de Jager and Gu{\dh}ny Eir{\'\i}ksd{\'o}ttir and Melissa E Garcia and Hofman, Albert and Kaplan, Robert C and Sharon L R Kardia and Douglas P Kiel and Ben A Oostra and Orwoll, Eric S and Parimi, Neeta and Psaty, Bruce M and Fernando Rivadeneira and Rotter, Jerome I and Seshadri, Sudha and Andrew B Singleton and Henning Tiemeier and Andr{\'e} G Uitterlinden and Wei Zhao and Bandinelli, Stefania and David A Bennett and Luigi Ferrucci and Gudnason, Vilmundur and Tamara B Harris and Karasik, David and Lenore J Launer and Thomas T Perls and Eline P Slagboom and Tranah, Gregory J and David R Weir and Anne B Newman and Cornelia M van Duijn and Joanne M Murabito} } @article {8277, title = {Harmonizing Measures of Cognitive Performance Across International Surveys of Aging Using Item Response Theory.}, journal = {J Aging Health}, volume = {27}, year = {2015}, month = {2015 Dec}, pages = {1392-414}, publisher = {27}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Humans, Internationality, Longitudinal Studies, Male, Psychological Theory, Reproducibility of Results, Surveys and Questionnaires, United Kingdom, United States}, issn = {1552-6887}, doi = {10.1177/0898264315583054}, author = {Kitty S. Chan and Alden L Gross and Liliana E Pezzin and Jason Brandt and Judith D Kasper} } @article {6472, title = {Health literacy and the digital divide among older Americans.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015 Mar}, pages = {284-9}, chapter = {284}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cohort Studies, Digital Divide, Female, Health Literacy, Humans, Internet, Male, Prospective Studies, Retrospective Studies, Surveys and Questionnaires, United States}, issn = {1525-1497}, doi = {10.1007/s11606-014-3069-5}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a}, author = {Helen G Levy and Alexander T Janke and Kenneth M. Langa} } @article {8205, title = {Historical improvements in well-being do not hold in late life: Birth- and death-year cohorts in the United States and Germany.}, journal = {Dev Psychol}, volume = {51}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Jul}, pages = {998-1012}, publisher = {51}, abstract = {

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

}, keywords = {Aged, Aging, Cohort Effect, depression, Epidemiologic Research Design, Female, Germany, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Propensity Score, United States}, issn = {1939-0599}, doi = {10.1037/a0039349}, author = {H{\"u}l{\"u}r, Gizem and Ram, Nilam and Denis Gerstorf} } @article {8260, title = {Hospitalization Type and Subsequent Severe Sepsis.}, journal = {Am J Respir Crit Care Med}, volume = {192}, year = {2015}, month = {2015 Sep 01}, pages = {581-8}, publisher = {192}, abstract = {

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Anti-Bacterial Agents, Clostridioides difficile, Dysbiosis, Enterocolitis, Pseudomembranous, Female, Hospitalization, Humans, Incidence, Information Storage and Retrieval, Longitudinal Studies, Male, Medicare, Patient Readmission, Retrospective Studies, Risk Factors, Sepsis, United States}, issn = {1535-4970}, doi = {10.1164/rccm.201503-0483OC}, author = {Hallie C Prescott and Dickson, R. P. and Mary A M Rogers and Kenneth M. Langa and Lwashyna, T. J.} } @article {8251, title = {How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {628-38}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, African Continental Ancestry Group, Disability Evaluation, European Continental Ancestry Group, Hispanic Americans, Homes for the Aged, Humans, Nursing homes, Proportional Hazards Models, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu114}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/09/08/geronb.gbu114.abstract}, author = {Thomeer, Mieke Beth and Mudrazija, Stipica and Jacqueline L. Angel} } @article {8308, title = {How old do you feel? The role of age discrimination and biological aging in subjective age.}, journal = {PLoS One}, volume = {10}, year = {2015}, note = {Times Cited: 0 0}, month = {2015}, pages = {e0119293}, publisher = {10}, abstract = {

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

}, keywords = {Aerobiosis, Aged, Aged, 80 and over, Aging, Cardiovascular Physiological Phenomena, Cellular Senescence, Discrimination, Psychological, Emotions, Female, Humans, Male, Middle Aged, Muscle Strength, Perception}, issn = {1932-6203}, doi = {10.1371/journal.pone.0119293}, author = {Yannick Stephan and Angelina R Sutin and Antonio Terracciano} } @article {8316, title = {Improving the validity of activity of daily living dependency risk assessment.}, journal = {J Appl Gerontol}, volume = {34}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Apr}, pages = {329-42}, publisher = {34}, abstract = {

OBJECTIVES: Efforts to prevent activity of daily living (ADL) dependency may be improved through models that assess older adults{\textquoteright} dependency risk. We evaluated whether cognition and gait speed measures improve the predictive validity of interview-based models.

METHOD: Participants were 8,095 self-respondents in the 2006 Health and Retirement Survey who were aged 65 years or over and independent in five ADLs. Incident ADL dependency was determined from the 2008 interview. Models were developed using random 2/3rd cohorts and validated in the remaining 1/3rd.

RESULTS: Compared to a c-statistic of 0.79 in the best interview model, the model including cognitive measures had c-statistics of 0.82 and 0.80 while the best fitting gait speed model had c-statistics of 0.83 and 0.79 in the development and validation cohorts, respectively.

CONCLUSION: Two relatively brief models, one that requires an in-person assessment and one that does not, had excellent validity for predicting incident ADL dependency but did not significantly improve the predictive validity of the best fitting interview-based models.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Female, Gait, Geriatric Assessment, Humans, Independent Living, Interviews as Topic, Male, Quality Improvement, Reproducibility of Results, Risk Assessment}, issn = {1552-4523}, doi = {10.1177/0733464812471894}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {8156, title = {Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {860-5}, publisher = {70}, abstract = {

BACKGROUND: Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages. Previous studies have examined the association between prevalent diabetes and various impairments and disabilities. Methods considering incident, rather than prevalent, diabetes as the exposure of interest can reduce bias in estimates of these associations.

METHODS: Risk-set matching, a type of propensity score matching meant to handle time-varying exposures, was used to estimate the relationship between incident diabetes and mobility limitations among adults in the Health and Retirement Study. This approach ensures that covariates precede diabetes onset rather than follow it.

RESULTS: Individuals who were diagnosed with diabetes during the study period accumulated more subsequent mobility limitations than were accumulated by matched controls. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 24.9\% more mobility limitations at study exit than those who did not.

CONCLUSIONS: The magnitude of the relationship between diabetes and limitations estimated in this article is smaller than that presented in previous studies, but the method presented here is likely to provide a less-biased estimate of the association between diabetes and accumulation of mobility limitations.

}, keywords = {Bias, Diabetes Mellitus, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Propensity Score, Risk Assessment, Risk Factors, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu212}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/11/19/gerona.glu212.abstract}, author = {Ezra I. Fishman} } @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 {8889, title = {Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair.}, journal = {Nat Genet}, volume = {47}, year = {2015}, month = {2015 Nov}, pages = {1294-303}, abstract = {

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in \~{}70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (\~{}6\% increase in risk per year; P = 3 {\texttimes} 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

}, keywords = {Age Factors, Aging, BRCA1 Protein, Breast Neoplasms, DNA Repair, Female, Genome, Genome-Wide Association Study, Genotype, Humans, Hypothalamus, Menopause, Middle Aged, Models, Genetic, Older Adults, Phenotype, Reproduction, Signal Transduction}, issn = {1546-1718}, doi = {10.1038/ng.3412}, author = {Day, Felix R and Ruth, Katherine S and Thompson, Deborah J and Kathryn L Lunetta and Pervjakova, Natalia and Daniel I Chasman and Stolk, Lisette and Finucane, Hilary K and Sulem, Patrick and Bulik-Sullivan, Brendan and T{\~o}nu Esko and Andrew D Johnson and Elks, Cathy E and Franceschini, Nora and He, Chunyan and Altmaier, Elisabeth and Brody, Jennifer A and Lude L Franke and Huffman, Jennifer E and Keller, Margaux F and McArdle, Patrick F and Nutile, Teresa and Porcu, Eleonora and Robino, Antonietta and Rose, Lynda M and Schick, Ursula M and Jennifer A Smith and Teumer, Alexander and Traglia, Michela and Vuckovic, Dragana and Yao, Jie and Wei Zhao and Albrecht, Eva and Amin, Najaf and Corre, Tanguy and Jouke-Jan Hottenga and Mangino, Massimo and Albert Vernon Smith and Toshiko Tanaka and Gon{\c c}alo R Abecasis and Andrulis, Irene L and Anton-Culver, Hoda and Antoniou, Antonis C and Arndt, Volker and Alice M. Arnold and Barbieri, Caterina and Beckmann, Matthias W and Beeghly-Fadiel, Alicia and Benitez, Javier and Bernstein, Leslie and Bielinski, Suzette J and Blomqvist, Carl and Boerwinkle, Eric and Bogdanova, Natalia V and Bojesen, Stig E and Manjeet K. Bolla and Borresen-Dale, Anne-Lise and Boutin, Thibaud S and Brauch, Hiltrud and Brenner, Hermann and Br{\"u}ning, Thomas and Burwinkel, Barbara and Campbell, Archie and Campbell, Harry and Chanock, Stephen J and Chapman, J Ross and Yii-Der I Chen and Chenevix-Trench, Georgia and Couch, Fergus J and Coviello, Andrea D and Cox, Angela and Czene, Kamila and Darabi, Hatef and De Vivo, Immaculata and Ellen W Demerath and Joe G Dennis and Devilee, Peter and D{\"o}rk, Thilo and Dos-Santos-Silva, Isabel and Dunning, Alison M and John D Eicher and Fasching, Peter A and Jessica Faul and Figueroa, Jonine and Flesch-Janys, Dieter and Gandin, Ilaria and Melissa E Garcia and Garc{\'\i}a-Closas, Montserrat and Giles, Graham G and Giorgia G Girotto and Goldberg, Mark S and Gonz{\'a}lez-Neira, Anna and Goodarzi, Mark O and Grove, Megan L and Gudbjartsson, Daniel F and Gu{\'e}nel, Pascal and Guo, Xiuqing and Christopher A Haiman and Hall, Per and Hamann, Ute and Henderson, Brian E and Lynne J Hocking and Hofman, Albert and Homuth, Georg and Hooning, Maartje J and John L Hopper and Hu, Frank B and Huang, Jinyan and Humphreys, Keith and Hunter, David J and Jakubowska, Anna and Jones, Samuel E and Kabisch, Maria and Karasik, David and Knight, Julia A and Kolcic, Ivana and Charles Kooperberg and Kosma, Veli-Matti and Kriebel, Jennifer and Kristensen, Vessela and Lambrechts, Diether and Langenberg, Claudia and Li, Jingmei and Li, Xin and Lindstr{\"o}m, Sara and Yongmei Liu and Luan, Jian{\textquoteright}an and Lubinski, Jan and M{\"a}gi, Reedik and Mannermaa, Arto and Manz, Judith and Margolin, Sara and Marten, Jonathan and Nicholas G Martin and Masciullo, Corrado and Meindl, Alfons and Michailidou, Kyriaki and Mihailov, Evelin and Lili Milani and Milne, Roger L and M{\"u}ller-Nurasyid, Martina and Michael A Nalls and Neale, Benjamin M and Nevanlinna, Heli and Neven, Patrick and Anne B Newman and B{\o}rge G Nordestgaard and Olson, Janet E and Padmanabhan, Sandosh and Peterlongo, Paolo and Peters, Ulrike and Petersmann, Astrid and Peto, Julian and Pharoah, Paul D P and Nicola Pirastu and Pirie, Ailith and Pistis, Giorgio and Polasek, Ozren and David J Porteous and Psaty, Bruce M and Pylk{\"a}s, Katri and Radice, Paolo and Raffel, Leslie J and Fernando Rivadeneira and Rudan, Igor and Rudolph, Anja and Ruggiero, Daniela and Cinzia Felicita Sala and Sanna, Serena and Sawyer, Elinor J and Schlessinger, David and Schmidt, Marjanka K and Schmidt, Frank and Schmutzler, Rita K and Schoemaker, Minouk J and Scott, Robert A and Seynaeve, Caroline M and Simard, Jacques and Sorice, Rossella and Southey, Melissa C and St{\"o}ckl, Doris and Strauch, Konstantin and Swerdlow, Anthony and Kent D Taylor and Thorsteinsdottir, Unnur and Toland, Amanda E and Tomlinson, Ian and Truong, Th{\'e}r{\`e}se and Tryggvadottir, Laufey and Stephen T Turner and Vozzi, Diego and Wang, Qin and Wellons, Melissa and Gonneke Willemsen and James F Wilson and Winqvist, Robert and Wolffenbuttel, Bruce B H R and Alan F Wright and Yannoukakos, Drakoulis and Zemunik, Tatijana and Wei Zhang and Zygmunt, Marek and Bergmann, Sven and Dorret I Boomsma and Buring, Julie E and Luigi Ferrucci and Grant W Montgomery and Gudnason, Vilmundur and Timothy Spector and Cornelia M van Duijn and Alizadeh, Behrooz Z and Ciullo, Marina and Crisponi, Laura and Easton, Douglas F and Paolo P. Gasparini and Gieger, Christian and Tamara B Harris and Caroline Hayward and Sharon L R Kardia and Kraft, Peter and McKnight, Barbara and Andres Metspalu and Alanna C Morrison and Reiner, Alex P and Ridker, Paul M and Rotter, Jerome I and Toniolo, Daniela and Andr{\'e} G Uitterlinden and Ulivi, Sheila and V{\"o}lzke, Henry and Wareham, Nicholas J and David R Weir and Laura M Yerges-Armstrong and Price, Alkes L and Stefansson, Kari and Visser, Jenny A and Ong, Ken K and Chang-Claude, Jenny and Joanne M Murabito and Perry, John R B and Murray, Anna} } @article {8244, title = {A Life Course Approach to Inequality: Examining Racial/Ethnic Differences in the Relationship between Early Life Socioeconomic Conditions and Adult Health Among Men.}, journal = {Ethn Dis}, volume = {25}, year = {2015}, month = {2015 Aug 07}, pages = {313-20}, publisher = {25}, abstract = {

OBJECTIVE: Previous research has documented a relationship between childhood socioeconomic conditions and adult health, but less is known about racial/ethnic differences in this relationship, particularly among men. This study utilizes a life course approach to investigate racial/ethnic differences in the relationships among early and later life socioeconomic circumstances and health in adulthood among men.

DESIGN: Panel data from the Health and Retirement Study and growth curve models are used to examine group differences in the relationships among childhood and adult socioeconomic factors and age-trajectories of self-rated health among White, Black and Mexican American men aged 51-77 years (N=4147).

RESULTS: Multiple measures of childhood socioeconomic status (SES) predict health in adulthood for White men, while significantly fewer measures of childhood SES predict health for Black and Mexican American men. Moreover, the health consequences of childhood SES diminish with age for Black and Mexican American men. The childhood SES-adult health relationship is largely explained by measures of adult SES for White men.

CONCLUSIONS: The life course pathways linking childhood SES and adult health differ by race/ethnicity among men. Similar to arguments that the universality of the adult SES-health relationship should not be assumed, results from our study suggest that scholars should not assume that the significance and nature of the association between childhood SES and health in adulthood is similar across race/ethnicity among men.

}, keywords = {Adult, Aged, ethnicity, Humans, Life Change Events, Male, Men{\textquoteright}s health, Middle Aged, Racial Groups, Socioeconomic factors, United States}, issn = {1049-510X}, doi = {10.18865/ed.25.3.313}, author = {Taylor W. Hargrove and Tyson H Brown} } @article {8178, title = {Life satisfaction and use of preventive health care services.}, journal = {Health Psychol}, volume = {34}, year = {2015}, month = {2015 Jul}, pages = {779-82}, publisher = {779-782}, abstract = {

OBJECTIVE: Although a growing body of research shows that life satisfaction is linked with enhanced health behaviors and physical health, no study has examined life satisfaction{\textquoteright}s association with use of preventive health care services. From prior research the authors hypothesized that people with higher life satisfaction would be more proactive in taking care of their health, hence more likely to use preventive health care services.

METHOD: Multiple logistic regression models were used to examine the association between life satisfaction and preventive services. Participants were drawn from the Health and Retirement Study, a prospective and nationally representative panel study of adults (age >50). Participants{\textquoteright} use of preventive services was collected over 2 years of follow-up.

RESULTS: In models adjusting for sociodemographic factors, each standard deviation increase in life satisfaction was associated with a higher likelihood that people would obtain a cholesterol test. Further, women with higher life satisfaction were more likely to obtain a mammogram-x-ray or pap smear and also regularly check their breasts for lumps, whereas men were more likely to obtain a prostate exam.

CONCLUSION: Higher life satisfaction was associated with higher use of several preventive services. A growing body of randomized controlled trials targeting life satisfaction has shown that levels of life satisfaction are modifiable. Thus, if these findings are replicated, life satisfaction may provide an important target for interventions aimed at enhancing preventive behaviors and health.

}, keywords = {Aged, Aged, 80 and over, Female, Health Behavior, Humans, Male, Mammography, Middle Aged, Personal Satisfaction, Preventive Health Services, Prospective Studies}, issn = {1930-7810}, doi = {10.1037/hea0000174}, author = {Eric S Kim and Laura D Kubzansky and Jacqui Smith} } @article {8663, title = {Lifespan and Healthspan: Past, Present, and Promise.}, journal = {Gerontologist}, volume = {55}, year = {2015}, month = {2015 Dec}, pages = {901-11}, abstract = {

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

}, keywords = {Aged, Aged, 80 and over, Aging, Disabled Persons, Humans, Life Expectancy, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnv130}, author = {Eileen M. Crimmins} } @article {8214, title = {Loneliness, eudaimonia, and the human conserved transcriptional response to adversity.}, journal = {Psychoneuroendocrinology}, volume = {62}, year = {2015}, month = {2015 Dec}, pages = {11-7}, publisher = {62}, abstract = {

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56\% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

}, keywords = {Aged, Aged, 80 and over, Down-Regulation, Female, Humans, Inflammation, Loneliness, Longitudinal Studies, Male, Mental Health, Middle Aged, social isolation, Social Support, Stress, Psychological, Transcriptome}, issn = {1873-3360}, doi = {10.1016/j.psyneuen.2015.07.001}, url = {http://www.sciencedirect.com/science/article/pii/S0306453015002358}, author = {Steven W. Cole and Morgan E. Levine and Jesusa M. G. Arevalo and Ma, Jeffrey and David R Weir and Eileen M. Crimmins} } @article {8176, title = {The "long arm" of childhood health: linking childhood disability to late midlife mental health.}, journal = {Res Aging}, volume = {37}, year = {2015}, month = {2015 Jan}, pages = {82-102}, publisher = {37}, abstract = {

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

}, keywords = {Child, depression, Female, Health Status, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires, Time Factors, United States}, issn = {1552-7573}, doi = {10.1177/0164027514522276}, url = {http://roa.sagepub.com/content/early/2014/02/23/0164027514522276.abstract}, author = {Kenzie Latham} } @article {8332, title = {Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls.}, journal = {Neurology}, volume = {85}, year = {2015}, month = {2015 Jul 07}, pages = {71-9}, publisher = {85}, abstract = {

OBJECTIVE: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.

METHODS: The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients >=65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.

RESULTS: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1\% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32\% vs 25\%, p = 0.008), 5.0 years for pain (36\% vs 27\%, p = 0.002), and 5.0 years for good to excellent self-rated health (61\% vs 74\%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.

CONCLUSIONS: In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Early Diagnosis, Female, Humans, International Classification of Diseases, Longitudinal Studies, Male, Medicare, Patient-Centered Care, Peripheral Nervous System Diseases, Treatment Outcome, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000001714}, author = {Brian C. Callaghan and Kevin Kerber and Kenneth M. Langa and Banerjee, Mousumi and Rodgers, Ann and Ryan J McCammon and James F. Burke and Eva L Feldman} } @article {8163, title = {Measurement Invariance of Cognitive Abilities Across Ethnicity, Gender, and Time Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {386-97}, publisher = {70}, abstract = {

OBJECTIVES: The aim of this research was to test the invariance of the cognitive variables in the Health and Retirement Study/Asset Health Dynamics Among the Oldest Old studies (HRS/AHEAD) across ethnicity, gender, and time.

METHOD: Analyses were conducted using a selected subsample of the HRS/AHEAD data set. The cognitive performance tests measuring episodic memory and mental status were used, and invariance of a two-factor structure was tested using confirmatory factor analyses and multilevel modeling for longitudinal data.

RESULTS: Results provided some support for "strict" factorial invariance of the episodic memory and mental status measures across ethnicity and gender. Further support of weak ("metric") measurement invariance was found across time.

DISCUSSION: Results of the research further our understanding of invariance of the HRS/AHEAD cognitive ability measures. Further implications are discussed.

}, keywords = {Aged, Aged, 80 and over, Black People, Female, Hispanic or Latino, Humans, Male, Memory, Episodic, Mental Processes, Middle Aged, Neuropsychological tests, Psychometrics, Psychomotor Performance, Reproducibility of Results, Sex Factors, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbt106}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2013/10/25/geronb.gbt106.abstract}, author = {A Nayena Blankson and John J McArdle} } @article {8299, title = {Mixture SNPs effect on phenotype in genome-wide association studies.}, journal = {BMC Genomics}, volume = {16}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb 03}, pages = {3}, publisher = {16}, abstract = {

BACKGROUND: Recently mixed linear models are used to address the issue of "missing" heritability in traditional Genome-wide association studies (GWAS). The models assume that all single-nucleotide polymorphisms (SNPs) are associated with the phenotypes of interest. However, it is more common that only a small proportion of SNPs have significant effects on the phenotypes, while most SNPs have no or very small effects. To incorporate this feature, we propose an efficient Hierarchical Bayesian Model (HBM) that extends the existing mixed models to enforce automatic selection of significant SNPs. The HBM models the SNP effects using a mixture distribution of a point mass at zero and a normal distribution, where the point mass corresponds to those non-associative SNPs.

RESULTS: We estimate the HBM using Gibbs sampling. The estimation performance of our method is first demonstrated through two simulation studies. We make the simulation setups realistic by using parameters fitted on the Framingham Heart Study (FHS) data. The simulation studies show that our method can accurately estimate the proportion of SNPs associated with the simulated phenotype and identify these SNPs, as well as adapt to certain model mis-specification than the standard mixed models. In addition, we analyze data from the FHS and the Health and Retirement Study (HRS) to study the association between Body Mass Index (BMI) and SNPs on Chromosome 16, and replicate the identified genetic associations. The analysis of the FHS data identifies 0.3\% SNPs on Chromosome 16 that affect BMI, including rs9939609 and rs9939973 on the FTO gene. These two SNPs are in strong linkage disequilibrium with rs1558902 (Rsq =0.901 for rs9939609 and Rsq =0.905 for rs9939973), which has been reported to be linked with obesity in previous GWAS. We then replicate the findings using the HRS data: the analysis finds 0.4\% of SNPs associated with BMI on Chromosome 16. Furthermore, around 25\% of the genes that are identified to be associated with BMI are common between the two studies.

CONCLUSIONS: The results demonstrate that the HBM and the associated estimation algorithm offer a powerful tool for identifying significant genetic associations with phenotypes of interest, among a large number of SNPs that are common in modern genetics studies.

}, keywords = {Algorithms, Alleles, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, Bayes Theorem, Body Mass Index, Chromosomes, Human, Pair 16, Genome-Wide Association Study, Humans, Linkage Disequilibrium, Phenotype, Polymorphism, Single Nucleotide, Principal Component Analysis, Proteins}, issn = {1471-2164}, doi = {10.1186/1471-2164-16-3}, author = {Wang, Ling and Shen, Haipeng and Hexuan Liu and Guo, Guang} } @article {8154, title = {Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions.}, journal = {Prev Chronic Dis}, volume = {12}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr 23}, pages = {E55}, publisher = {12}, abstract = {

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95\% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Data Interpretation, Statistical, ethnicity, Female, Health Status Indicators, Humans, Interviews as Topic, Male, Middle Aged, Mobility Limitation, Outcome Assessment, Health Care, Prospective Studies, Recurrence, Retirement, Self Report, Smoking, Social Class, Syndrome, United States, Vulnerable Populations}, issn = {1545-1151}, doi = {10.5888/pcd12.140478}, author = {Siran M Koroukian and David F Warner and Owusu, Cynthia and Charles W Given} } @article {8257, title = {The Paulson-Lichtenberg Frailty Index: evidence for a self-report measure of frailty.}, journal = {Aging Ment Health}, volume = {19}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, month = {2015}, pages = {892-901}, publisher = {19}, abstract = {

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

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

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

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

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

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

DESIGN: Longitudinal.

SETTING: Health and Retirement Study (HRS).

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

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

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

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

}, keywords = {Aged, Cognition, Female, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Prejudice, Social Perception}, issn = {1545-7214}, doi = {10.1016/j.jagp.2014.03.007}, author = {Angelina R Sutin and Yannick Stephan and Carretta, H. and Antonio Terracciano} } @article {8615, title = {Polygenic risk, stressful life events and depressive symptoms in older adults: a polygenic score analysis.}, journal = {Psychol Med}, volume = {45}, year = {2015}, month = {2015 Jun}, pages = {1709-20}, abstract = {

BACKGROUND: Previous studies suggest that the relationship between genetic risk and depression may be moderated by stressful life events (SLEs). The goal of this study was to assess whether SLEs moderate the association between polygenic risk of major depressive disorder (MDD) and depressive symptoms in older adults.

METHOD: We used logistic and negative binomial regressions to assess the associations between polygenic risk, SLEs and depressive symptoms in a sample of 8761 participants from the Health and Retirement Study. Polygenic scores were derived from the Psychiatric Genomics Consortium genome-wide association study of MDD. SLEs were operationalized as a dichotomous variable indicating whether participants had experienced at least one stressful event during the previous 2 years. Depressive symptoms were measured using an eight-item Center for Epidemiologic Studies Depression Scale subscale and operationalized as both a dichotomous and a count variable.

RESULTS: The odds of reporting four or more depressive symptoms were over twice as high among individuals who experienced at least one SLE (odds ratio 2.19, 95\% confidence interval 1.86-2.58). Polygenic scores were significantly associated with depressive symptoms (β = 0.21, p ⩽ 0.0001), although the variance explained was modest (pseudo r 2 = 0.0095). None of the interaction terms for polygenic scores and SLEs was statistically significant.

CONCLUSIONS: Polygenic risk and SLEs are robust, independent predictors of depressive symptoms in older adults. Consistent with an additive model, we found no evidence that SLEs moderated the association between common variant polygenic risk and depressive symptoms.

}, keywords = {depression, Depressive Disorder, Major, Female, Genetic Predisposition to Disease, Humans, Life Change Events, Male, Middle Aged, Multifactorial Inheritance, Odds Ratio, Risk Factors, United States}, issn = {1469-8978}, doi = {10.1017/S0033291714002839}, author = {Musliner, Katherine L. and Seiffudin, Fayaz and Judy, J. A. and Pirooznia, Mehdi and Goes, Fernando S. and Zandi, Peter P.} } @article {8245, title = {Population-level impact of loss on survivor mortality risk.}, journal = {Qual Life Res}, volume = {24}, year = {2015}, month = {2015 Dec}, pages = {2959-61}, publisher = {24}, abstract = {

INTRODUCTION: The loss of a loved one adversely affects the bereaved.

MATERIALS AND METHODS: Using data from the 2010 and 2012 waves of Health and Retirement Study (HRS), we estimate the risk for death in a 2-year span after the loss of a parent, spouse, or child for adults aged 50 to 70 years.

CONCLUSION: A respondent with a loss was twice as likely to die when compared similarly aged persons with no loss (OR 2.32; 95 \% CI 1.14, 5.30). Loss of either a parent (OR 1.93; 95 \% CI 1.01, 4.07), or a child (OR 1.77; 95 \% CI 1.08, 2.96) also increased respondent mortality. This elevated risk persists after adjustment for gender and other high-risk health conditions. Any physical activity reduces survivor death rates during this critical period by more than 85 \%.

}, keywords = {Bereavement, Female, Humans, Longevity, Male, Quality of Life, Risk, Survivors}, issn = {1573-2649}, doi = {10.1007/s11136-015-1048-x}, url = {https://link.springer.com/article/10.1007\%2Fs11136-015-1048-x}, author = {Joseph C. Allegra and Amara E. Ezeamama and Simpson, Cherie and Toni Miles} } @article {8250, title = {The prevalence of older couples with ADL limitations and factors associated with ADL help receipt.}, journal = {J Gerontol Soc Work}, volume = {58}, year = {2015}, month = {2015}, pages = {171-89}, publisher = {58}, abstract = {

Using the Andersen-Newman model, we investigated the prevalence of activities of daily living (ADLs) limitations in married couples, and couple characteristics associated with ADL help-receipt. In this sample of 3,235 couples age 65+ in the 2004 Health and Retirement Study, 74.3\%, 22.1\%, and 3.6\% were couples in which neither partner, one partner, or both partners had limitations, respectively. Logistic regression results indicate that help-receipt was associated with certain health needs in the couple, but not with their predisposing characteristics or enabling resources. Social workers could target couples most in need of assistance by assessing both partners{\textquoteright} health problems.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Male, Social Support, Socioeconomic factors}, issn = {1540-4048}, doi = {10.1080/01634372.2014.944248}, url = {http://dx.doi.org/10.1080/01634372.2014.944248}, author = {Shen, Huei-Wern and Sheila Feld and Ruth E Dunkle and Tracy Schroepfer and Amanda J Lehning} } @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 {8157, title = {Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {793-803}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Aged, Black People, Female, Frail Elderly, Health Status, Health Status Disparities, Hispanic or Latino, Humans, Intergenerational Relations, Longitudinal Studies, Male, Middle Aged, Parenting, Residence Characteristics, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu160}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/12/06/geronb.gbu160.abstract}, author = {Chen, Feinian and Christine A Mair and Bao, Luoman and Yang Claire Yang} } @article {8188, title = {Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions.}, journal = {JAMA}, volume = {313}, year = {2015}, note = {10.1001/jama.2015.1410}, month = {2015 Mar 10}, pages = {1055-7}, publisher = {313}, keywords = {Acute Disease, Hospitalization, Humans, Patient Readmission, Sepsis}, issn = {1538-3598}, doi = {10.1001/jama.2015.1410}, url = {http://dx.doi.org/10.1001/jama.2015.1410}, author = {Hallie C Prescott and Kenneth M. Langa and Theodore J Iwashyna} } @article {8153, title = {A Research Note on Transitions in Out-of-Pocket Spending on Dental Services.}, journal = {Res Aging}, volume = {37}, year = {2015}, month = {2015 Aug}, pages = {646-66}, publisher = {37}, abstract = {

OBJECTIVE: We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period.

METHODS: We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods.

RESULTS: Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors.

DISCUSSION: Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated.

}, keywords = {Aged, Aged, 80 and over, Dental Care, Female, Health Expenditures, Humans, Insurance, Dental, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1552-7573}, doi = {10.1177/0164027514552681}, url = {http://roa.sagepub.com/content/early/2014/10/03/0164027514552681.abstract}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel Hyde and John V Pepper and Patricia A St Clair} } @article {8240, title = {Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {769-81}, publisher = {70}, abstract = {

OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data.

METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression.

RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one{\textquoteright}s neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group.

DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Family, Female, Humans, Interpersonal Relations, Male, Middle Aged, Mobility Limitation, Peer Group, Recovery of Function, Residence Characteristics, Sex Factors, Social Support, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu181}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/11/geronb.gbu181.abstract}, author = {Kenzie Latham and Philippa J Clarke and Gregory Pavela} } @article {8272, title = {Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {661-71}, publisher = {70}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition Disorders, Disabled Persons, Educational Status, Female, Health Status, Humans, Male, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu095}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract}, author = {Xiao Xu and Jersey Liang and Joan M. Bennett and Anda Botoseneanu and Heather G. Allore} } @article {8166, title = {Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {462-9}, publisher = {70}, abstract = {

OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.

METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.

RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.

DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

}, keywords = {Activities of Daily Living, Adult children, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Home Nursing, Humans, Male, Middle Aged, Nursing homes, Residence Characteristics, Social Class, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbu015}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @article {8302, title = {Spouses and depressive symptoms in older adulthood.}, journal = {Sci Rep}, volume = {5}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb 26}, pages = {8594}, publisher = {5}, abstract = {

Depressive symptoms may co-occur within couples and follow similar trajectories, but relatively little is known about this process in old age. This study thus examined the association between some spousal characteristics (spouse{\textquoteright}s depressive symptoms, age difference between spouses) and the trajectory of depressive symptoms in older adults. Participants >= 65 years old were drawn from the Health and Retirement Study (N = 12,010; Mean age = 70.60 and 69.16 for target husbands and wives, respectively). Depressive symptoms were measured with a short form of the Center for Epidemiological Studies Depression (CES-D) scale. Hierarchical Linear Modeling was used to model up to 9 assessments of depressive symptoms of target spouses (Mean number of CESD assessments per target spouse = 3, range 1-9). Depressive symptoms between spouses were correlated; convergence over time was modest. For both husbands and wives, having a younger spouse was associated with more depressive symptoms at age 65. These results suggest that there is concordance between spouses{\textquoteright} depressive symptoms and that the age difference between spouses contribute to depressive symptoms as couples enter old age. The association between spouses{\textquoteright} depressive symptoms is nearly as strong as the effect of each decade increase in age.

}, keywords = {Aged, depression, Female, Humans, Longitudinal Studies, Male, Sex Distribution, Spouses}, issn = {2045-2322}, doi = {10.1038/srep08594}, author = {Pradeep, Neeti and Angelina R Sutin} } @article {8239, title = {Substance-use coping and self-rated health among US middle-aged and older adults.}, journal = {Addict Behav}, volume = {42}, year = {2015}, note = {Export Date: 20 January 2015}, month = {2015 Mar}, pages = {96-100}, publisher = {42}, abstract = {

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

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Alcohol Drinking, depression, Female, Health Status, Humans, Male, Middle Aged, Smoking, Substance-Related Disorders, United States}, issn = {1873-6327}, doi = {10.1016/j.addbeh.2014.10.031}, author = {Pia M Mauro and Sarah L. Canham and Silvia S Martins and Adam P Spira} } @article {8201, title = {Trends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey.}, journal = {JAMA Oncol}, volume = {1}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Aug}, pages = {601-8}, publisher = {1}, abstract = {

IMPORTANCE: Advance care planning (ACP) may prevent end-of-life (EOL) care that is nonbeneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time.

OBJECTIVES: To characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences and to explore associations between ACP subtypes and EOL treatment intensity as reflected in EOL care decisions and terminal hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: We analyzed prospectively collected survey data from 1985 next-of-kin surrogates of Health and Retirement Study (HRS) participants with cancer who died between 2000 and 2012, including data from in-depth "exit" interviews conducted with the surrogates after the participant{\textquoteright}s death. The HRS is a nationally representative, biennial, longitudinal panel study of US residents older than 50 years. Trends in ACP subtypes were tested, and multivariable logistic regression models examined for associations between ACP subtypes and measures of treatment intensity.

MAIN OUTCOMES AND MEASURES: Trends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences; associations between ACP subtypes and both surrogate-reported EOL care decisions and terminal hospitalizations.

RESULTS: From 2000 to 2012, there was an increase in DPOA assignment (52\% to 74\%, P = .03), without significant change in use of living wills (49\% to 40\%, P = .63) or EOL discussions (68\% to 60\%, P = .62). Surrogate reports that patients received "all care possible" at EOL increased during the period (7\% to 58\%, P = .004), and rates of terminal hospitalizations were unchanged (29\% to 27\%, P = .70). Limiting or withholding treatment was associated with living wills (adjusted odds ratio [AOR], 2.51; 95\% CI, 1.53-4.11; P < .001) and EOL discussions (AOR, 1.93; 95\% CI, 1.53-3.14; P = .002) but not with DPOA assignment.

CONCLUSIONS AND RELEVANCE: Use of DPOA increased significantly between 2000 and 2012 but was not associated with EOL care decisions. Importantly, there was no growth in key ACP domains such as discussions of care preferences. Efforts that bolster communication of EOL care preferences and also incorporate surrogate decision makers are critically needed to ensure receipt of goal-concordant care.

}, keywords = {Female, Health Maintenance Organizations, Health Resources, Humans, Male, Neoplasms, Terminal Care}, issn = {2374-2445}, doi = {10.1001/jamaoncol.2015.1976}, author = {Amol K Narang and Alexi A Wright and Lauren Hersch Nicholas} } @article {8236, title = {Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort.}, journal = {BMC Public Health}, volume = {15}, year = {2015}, note = {Export Date: 9 September 2015}, month = {2015 Jun 05}, pages = {535}, publisher = {15}, abstract = {

BACKGROUND: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course.

METHODS: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect.

RESULTS: At ages 50-61, mother{\textquoteright}s education and birth region were associated with women{\textquoteright}s obesity risk, but not men{\textquoteright}s. Each year{\textquoteright}s increase in mother{\textquoteright}s education significantly reduces the odds of being obese by 6\% (OR = 0.94; 95\% CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women.

CONCLUSIONS: Women{\textquoteright}s obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men{\textquoteright}s obesity risk. Biological and social mechanisms may account for the gender difference.

}, keywords = {Aged, Aged, 80 and over, Body Weight, Cohort Studies, ethnicity, Family Characteristics, Female, Health Behavior, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Obesity, Prospective Studies, Qualitative Research, Retirement, Risk Factors, Socioeconomic factors, United States}, issn = {1471-2458}, doi = {10.1186/s12889-015-1870-7}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84934903370andpartnerID=40andmd5=b19c15d412d4437881f0111906f49570}, author = {Hui Zheng and Dmitry Tumin} } @article {8190, title = {Weight Discrimination and Risk of Mortality.}, journal = {Psychol Sci}, volume = {26}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Nov}, pages = {1803-11}, publisher = {26}, abstract = {

Discrimination based on weight is a stressful social experience linked to declines in physical and mental health. We examined whether this harmful association extends to risk of mortality. Participants in the Health and Retirement Study (HRS; N = 13,692) and the Midlife in the United States Study (MIDUS; N = 5,079) reported on perceived discriminatory experiences and attributed those experiences to a number of personal characteristics, including weight. Weight discrimination was associated with an increase in mortality risk of nearly 60\% in both HRS participants (hazard ratio = 1.57, 95\% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95\% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

}, keywords = {Adult, Aged, Female, Humans, Male, Mental Health, Middle Aged, Mortality, Overweight, Prejudice, Proportional Hazards Models, Social Discrimination, Stress, Psychological, Surveys and Questionnaires, United States}, issn = {1467-9280}, doi = {10.1177/0956797615601103}, author = {Angelina R Sutin and Yannick Stephan and Antonio Terracciano} } @article {8162, title = {What can genes tell us about the relationship between education and health?}, journal = {Soc Sci Med}, volume = {127}, year = {2015}, month = {2015 Feb}, pages = {171-80}, publisher = {127}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Computer Simulation, depression, Educational Status, Female, Gene-Environment Interaction, Genetic Predisposition to Disease, Genome-Wide Association Study, Health Status, Health Status Disparities, Humans, Male, Phenotype, Polymorphism, Single Nucleotide, Social determinants of health, Socioeconomic factors, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.08.001}, url = {http://www.sciencedirect.com/science/article/pii/S0277953614005188}, author = {Jason D Boardman and Benjamin W Domingue and Daw, Jonathan} } @article {8036, title = {Acute infection contributes to racial disparities in stroke mortality.}, journal = {Neurology}, volume = {82}, year = {2014}, note = {Times Cited: 0}, month = {2014 Mar 18}, pages = {914-21}, publisher = {82}, abstract = {

OBJECTIVE: It is unknown whether racial differences in exposure to acute precipitants of stroke, specifically infection, contribute to racial disparities in stroke mortality.

METHODS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1991-2007), we conducted a case-crossover study employing within-person comparisons to study racial/ethnic differences in the risks of death and hospitalization from ischemic stroke following acute infection.

RESULTS: There were 964 adults hospitalized for ischemic stroke. Acute infection increased the 30-day risks of ischemic stroke death (5.82-fold) and ischemic stroke hospitalization (1.87-fold). Acute infection was a more potent trigger of acute ischemic stroke death in non-Hispanic blacks (odds ratio [OR] 39.21; 95\% confidence interval [CI] 9.26-166.00) than in non-Hispanic whites (OR 4.50; 95\% CI 3.14-6.44) or Hispanics (OR 5.18; 95\% CI 1.34-19.95) (race-by-stroke interaction, p = 0.005). When adjusted for atrial fibrillation, infection remained more strongly associated with stroke mortality in blacks (OR 34.85) than in whites (OR 3.58) and Hispanics (OR 3.53). Acute infection increased the short-term risk of incident stroke similarly across racial/ethnic groups. Infection occurred often before stroke death in non-Hispanic blacks, with 70\% experiencing an infection in the 30 days before stroke death compared to a background frequency of 15\%.

CONCLUSIONS: Acute infection disproportionately increases the risk of stroke death for non-Hispanic blacks, independently of atrial fibrillation. Stroke incidence did not explain this finding. Acute infection appears to be one factor that contributes to the black-white disparity in stroke mortality.

}, keywords = {Black or African American, Case-Control Studies, Female, Health Status Disparities, Healthcare Disparities, Hispanic or Latino, Humans, Infections, Male, Odds Ratio, Retrospective Studies, Risk Factors, Stroke, White People}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000000214}, author = {Deborah A Levine and Kenneth M. Langa and Mary A M Rogers} } @article {8009, title = {Are people healthier if their partners are more optimistic? The dyadic effect of optimism on health among older adults.}, journal = {J Psychosom Res}, volume = {76}, year = {2014}, month = {2014 Jun}, pages = {447-53}, publisher = {76}, abstract = {

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

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

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

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

}, keywords = {Adult, Affect, Aged, Aged, 80 and over, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Personal Satisfaction, Self Report, Spouses}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2014.03.104}, url = {http://www.sciencedirect.com/science/article/pii/S0022399914001731}, author = {Eric S Kim and William J. Chopik and Jacqui Smith} } @article {10277, title = {Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care.}, journal = {J Manipulative Physiol Ther}, volume = {37}, year = {2014}, month = {2014 Oct}, pages = {542-51}, abstract = {

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

CONCLUSION: This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Manipulation, Chiropractic, Medicare, Patient Satisfaction, Time Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2014.08.003}, url = {https://www.ncbi.nlm.nih.gov/pubmed/25233887}, author = {Paula A Weigel and Jason Hockenberry and Frederic D Wolinsky} } @article {8095, title = {Cohort differences in the marriage-health relationship for midlife women.}, journal = {Soc Sci Med}, volume = {116}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Sep}, pages = {64-72}, publisher = {116}, abstract = {

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

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

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran{\textquoteright}s Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

}, keywords = {Aged, Female, Genetic Predisposition to Disease, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Physical Fitness, Retirement, United States}, issn = {1464-3685}, doi = {10.1093/ije/dyu067}, author = {Amanda Sonnega and Jessica Faul and Mary Beth Ofstedal and Kenneth M. Langa and John W R Phillips and David R Weir} } @article {10656, title = {Common genetic variants associated with cognitive performance identified using the proxy-phenotype method.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, month = {2014 Sep 23}, pages = {13790-4}, abstract = {

We identify common genetic variants associated with cognitive performance using a two-stage approach, which we call the proxy-phenotype method. First, we conduct a genome-wide association study of educational attainment in a large sample (n = 106,736), which produces a set of 69 education-associated SNPs. Second, using independent samples (n = 24,189), we measure the association of these education-associated SNPs with cognitive performance. Three SNPs (rs1487441, rs7923609, and rs2721173) are significantly associated with cognitive performance after correction for multiple hypothesis testing. In an independent sample of older Americans (n = 8,652), we also show that a polygenic score derived from the education-associated SNPs is associated with memory and absence of dementia. Convergent evidence from a set of bioinformatics analyses implicates four specific genes (KNCMA1, NRXN1, POU2F3, and SCRT). All of these genes are associated with a particular neurotransmitter pathway involved in synaptic plasticity, the main cellular mechanism for learning and memory.

}, keywords = {Cell Adhesion Molecules, Neuronal, Cognition, Female, Humans, Learning, Male, Memory, Multifactorial Inheritance, Nerve Tissue Proteins, Neuronal Plasticity, Octamer Transcription Factors, Polymorphism, Single Nucleotide, Synaptic Transmission}, issn = {1091-6490}, doi = {10.1073/pnas.1404623111}, author = {Cornelius A Rietveld and T{\~o}nu Esko and Gail Davies and Pers, Tune H and Turley, Patrick and Benyamin, Beben and Chabris, Christopher F and Emilsson, Valur and Andrew D Johnson and Lee, James J and Christiaan de Leeuw and Riccardo E Marioni and Sarah E Medland and Michael B Miller and Rostapshova, Olga and Sven J van der Lee and Anna A E Vinkhuyzen and Amin, Najaf and Dalton C Conley and Derringer, Jaime and Cornelia M van Duijn and Fehrmann, Rudolf and Lude L Franke and Edward L Glaeser and Narelle K Hansell and Caroline Hayward and Iacono, William G and Carla A Ibrahim-Verbaas and Vincent Jaddoe and Karjalainen, Juha and David I Laibson and Paul Lichtenstein and David C Liewald and Patrik K E Magnusson and Nicholas G Martin and McGue, Matt and McMahon, George and Nancy L Pedersen and Pinker, Steven and David J Porteous and Posthuma, Danielle and Fernando Rivadeneira and Smith, Blair H and John M Starr and Henning Tiemeier and Nicholas J Timpson and Trzaskowski, Maciej and Andr{\'e} G Uitterlinden and Verhulst, Frank C and Mary E Ward and Margaret J Wright and George Davey Smith and Ian J Deary and Johannesson, Magnus and Plomin, Robert and Peter M Visscher and Daniel J. Benjamin and Cesarini, David and Philipp D Koellinger} } @article {10278, title = {The comparative effect of episodes of chiropractic and medical treatment on the health of older adults.}, journal = {J Manipulative Physiol Ther}, volume = {37}, year = {2014}, month = {2014 Mar-Apr}, pages = {143-54}, abstract = {

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants{\textquoteright} Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

CONCLUSION: The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.

}, keywords = {Activities of Daily Living, Aged, 80 and over, Back Pain, Episode of Care, Female, Humans, Male, Manipulation, Chiropractic, Treatment Outcome}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2013.12.009}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24636108}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Frederic D Wolinsky} } @article {8006, title = {Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Sep}, pages = {798-808}, publisher = {69}, abstract = {

OBJECTIVES: To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans.

METHOD: Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations.

RESULTS: In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations.

DISCUSSION: Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Cross-Sectional Studies, Female, Health Status Disparities, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medicare, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu005}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/24/geronb.gbu005.abstract}, author = {Ben Lennox Kail and Miles G Taylor} } @article {8104, title = {Death certificates underestimate infections as proximal causes of death in the U.S.}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0}, month = {2014}, pages = {e97714}, publisher = {9}, abstract = {

BACKGROUND: Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG) coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization.

METHODS: We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993-2007). Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS)-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2{\texttimes}2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen{\textquoteright}s kappa statistic.

RESULTS: 2074 inpatient deaths were included in our analysis. 36.6\% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61\%. Overall Kappa was 0.21, or "fair." Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations.

CONCLUSION: There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate-based strategies.

}, keywords = {Cause of Death, Death Certificates, Hospitalization, Humans, Infections, Medicare, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0097714}, author = {Govindan, Sushant and Shapiro, Letitia and Kenneth M. Langa and Theodore J Iwashyna} } @article {7992, title = {Dental usage under changing economic conditions.}, journal = {J Public Health Dent}, volume = {74}, year = {2014}, note = {Times Cited: 1}, month = {2014 Winter}, pages = {1-12}, publisher = {74}, abstract = {

OBJECTIVE: The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans.

METHODS: Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates.

RESULTS: We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population.

CONCLUSIONS: Older Americans{\textquoteright} dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive.

}, keywords = {Dental Health Services, Financing, Personal, Humans, Middle Aged, United States}, issn = {1752-7325}, doi = {10.1111/j.1752-7325.2012.00370.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {8142, title = {Depression and risk of hospitalization for pneumonia in a cohort study of older Americans.}, journal = {J Psychosom Res}, volume = {77}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {528-34}, publisher = {77}, abstract = {

OBJECTIVE: The aim of this study is to determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments.

METHODS: This secondary analysis of prospectively collected data examined a population-based sample of 6704 Health and Retirement Study (HRS) (1998-2008) participants>50years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression.

RESULTS: After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (odds ratio [OR]: 1.28, 95\% confidence interval [95\%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95\%CI: 1.03, 1.50). In this cohort, 6\% (95\%CI: 2\%, 10\%) of hospitalizations for pneumonia were potentially attributable to depression.

CONCLUSION: Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Comorbidity, depression, Depressive Disorder, Female, Hospitalization, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Pneumonia, Risk Assessment, Risk Factors, United States}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2014.08.002}, author = {Dimitry S Davydow and Catherine L Hough and Zivin, Kara and Kenneth M. Langa and Wayne J Katon} } @article {7996, title = {Development and validation of a brief dementia screening indicator for primary care.}, journal = {Alzheimers Dement}, volume = {10}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Nov}, pages = {656-665.e1}, publisher = {10}, abstract = {

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12~years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5~kg/m(2) (8 points), requiring assistance with money or medications (10 points), and~depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell{\textquoteright}s C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

}, keywords = {Aged, Cohort Studies, Dementia, Female, Humans, Male, Mass Screening, Predictive Value of Tests, Primary Health Care, Proportional Hazards Models, Risk Assessment}, issn = {1552-5279}, doi = {10.1016/j.jalz.2013.11.006}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1}, author = {Deborah E Barnes and Alexa S. Beiser and Anne Lee and Kenneth M. Langa and Alain Koyama and Sarah R Preis and John Neuhaus and Ryan J McCammon and Kristine Yaffe and Seshadri, Sudha and Mary Haan and David R Weir} } @article {7995, title = {The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {860-70}, publisher = {69}, abstract = {

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Disabled Persons, Female, Humans, Male, Prospective Studies, Stroke, United States, White People}, issn = {1758-535X}, doi = {10.1093/gerona/glt191}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract}, author = {Benjamin D Capistrant and Nicte I Mejia and Sze Y Liu and Qianyi Wang and M. Maria Glymour} } @article {7982, title = {Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {766-70}, publisher = {22}, abstract = {

OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.

METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n~= 9,420) at baseline from 2000 to 2010. Current (>=14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (>=3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.

RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p~<0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p~= 0.06).

CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving.

}, keywords = {Aged, Caregivers, depression, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Spouses, Time Factors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2013.01.073}, author = {Benjamin D Capistrant and Lisa F Berkman and M. Maria Glymour} } @article {8105, title = {Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun}, pages = {606-13}, publisher = {22}, abstract = {

OBJECTIVES: Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death.

METHODS: In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders.

RESULTS: Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95\% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95\% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95\% CI: 1.13-1.46).

CONCLUSION: Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Anhedonia, depression, Disabled Persons, Female, Humans, Interview, Psychological, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors}, issn = {1545-7214}, doi = {10.1016/j.jagp.2012.12.001}, author = {Kenneth E Covinsky and Irena Cenzer and Kristine Yaffe and Sarah O{\textquoteright}Brien and Dan G. Blazer} } @article {8125, title = {Factors influencing the use of intensive procedures at the end of life.}, journal = {J Am Geriatr Soc}, volume = {62}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov}, pages = {2088-94}, publisher = {62}, abstract = {

OBJECTIVES: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.

DESIGN: Retrospective cohort study.

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

PARTICIPANTS: HRS decedents aged 66 and older (N = 3,069).

MEASUREMENTS: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.

RESULTS: Approximately 18\% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95\% confidence interval (CI) = 0.51-0.90), Alzheimer{\textquoteright}s disease (AOR = 0.71, 95\% CI = 0.54-0.94), cancer (AOR = 0.60, 95\% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95\% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95\% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95\% CI = 1.48-3.13) and black race (AOR = 2.02, 95\% CI = 1.52-2.69) each doubled one{\textquoteright}s odds of undergoing an intensive procedure.

CONCLUSION: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Alzheimer disease, Cause of Death, Chronic disease, Critical Care, Female, Homes for the Aged, Humans, Life Support Care, Logistic Models, Male, Multivariate Analysis, Neoplasms, Nursing homes, Odds Ratio, Terminal Care, United States, Utilization Review}, issn = {1532-5415}, doi = {10.1111/jgs.13104}, author = {Evan C Tschirhart and Qingling Du and Amy Kelley} } @article {8086, title = {Fine particulate matter air pollution and cognitive function among older US adults.}, journal = {Am J Epidemiol}, volume = {180}, year = {2014}, note = {Ailshire, Jennifer A Crimmins, Eileen M eng K99 AG039528/AG/NIA NIH HHS/ K99AG039528/AG/NIA NIH HHS/ P30 AG017265/AG/NIA NIH HHS/ P30AG17265/AG/NIA NIH HHS/ R00 AG039528/AG/NIA NIH HHS/ R21 AG045625/AG/NIA NIH HHS/ T32 AG000037/AG/NIA NIH HHS/ T32AG0037/AG/NIA NIH HHS/ U01 AG009740/AG/NIA NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Research Support, N.I.H., Extramural 2014/06/27 06:00 Am J Epidemiol. 2014 Aug 15;180(4):359-66. doi: 10.1093/aje/kwu155. Epub 2014 Jun 24.}, month = {2014 Aug 15}, pages = {359-66}, publisher = {180}, abstract = {

Existing research on the adverse health effects of exposure to pollution has devoted relatively little attention to the potential impact of ambient air pollution on cognitive function in older adults. We examined the cross-sectional association between residential concentrations of particulate matter with aerodynamic diameter of 2.5 μm or less (PM2.5) and cognitive function in older adults. Using hierarchical linear modeling, we analyzed data from the 2004 Health and Retirement Study, a large, nationally representative sample of US adults aged 50 years or older. We linked participant data with 2000 US Census tract data and 2004 census tract-level annual average PM2.5 concentrations. Older adults living in areas with higher PM2.5 concentrations had worse cognitive function (β = -0.26, 95\% confidence interval: -0.47, -0.05) even after adjustment for community- and individual-level social and economic characteristics. Results suggest that the association is strongest for the episodic memory component of cognitive function. This study adds to a growing body of research highlighting the importance of air pollution to cognitive function in older adults. Improving air quality in large metropolitan areas, where much of the aging US population resides, may be an important mechanism for reducing age-related cognitive decline.

}, keywords = {Aged, Aged, 80 and over, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Humans, Inhalation Exposure, Male, Memory, Episodic, Middle Aged, Neuropsychological tests, Particulate Matter, Socioeconomic factors, United States, Urban Population}, issn = {1476-6256}, doi = {10.1093/aje/kwu155}, url = {http://aje.oxfordjournals.org/content/early/2014/06/24/aje.kwu155.abstract}, author = {Jennifer A Ailshire and Eileen M. Crimmins} } @article {7971, title = {Five-factor model personality traits and inflammatory markers: new data and a meta-analysis.}, journal = {Psychoneuroendocrinology}, volume = {50}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {181-93}, publisher = {50}, abstract = {

The purpose of this research is to examine the association between five major dimensions of personality and systemic inflammation through (a) new data on C-reactive protein (CRP) from three large national samples of adults that together cover most of the adult lifespan and (b) a meta-analysis of published studies on CRP and interleukin-6 (IL-6). New data (total N=26,305) were drawn from the National Longitudinal Study of Adolescent Health, the Midlife in the United States study, and the Health and Retirement Study. PRISMA guidelines were used for the meta-analysis to combine results of up to seven studies on CRP (N=34,067) and six on IL-6 (N=7538). Across the three new samples, higher conscientiousness was associated with lower CRP. The conscientiousness-CRP relation was virtually identical controlling for smoking; controlling for body mass index attenuated this association but did not eliminate it. Compared to participants in the highest quartile of conscientiousness, participants in the lowest quartile had an up to 50\% increased risk of CRP levels that exceeded the clinical threshold (>=3 mg/l). The meta-analysis supported the association between conscientiousness and both CRP and IL-6 and also suggested a negative association between openness and CRP; no associations were found for neuroticism, extraversion and agreeableness. The present work indicates a modest, but consistent, association between conscientiousness and a more favorable inflammatory profile, which may contribute to the role of conscientiousness in better health across the lifespan.

}, keywords = {Adult, Aged, Aged, 80 and over, Biomarkers, C-reactive protein, Female, Humans, Inflammation, Male, Middle Aged, Personality}, issn = {1873-3360}, doi = {10.1016/j.psyneuen.2014.08.014}, author = {Martina Luchetti and James M Barkley and Yannick Stephan and Antonio Terracciano and Angelina R Sutin} } @article {8126, title = {Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {7}, year = {2014}, note = {Times Cited: 1 0 1}, month = {2014 Nov}, pages = {863-71}, publisher = {7}, abstract = {

BACKGROUND: We assessed the acute and long-term effect of myocardial infarction (MI) and stroke on postevent functional disability and cognition while controlling for survivors{\textquoteright} changes in functioning over the years before the event.

METHODS AND RESULTS: Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we determined within-person changes in functional limitations (basic and instrumental activities of daily living) and cognitive impairment after hospitalization for stroke (n=432) and MI (n=450), controlling for premorbid functioning using fixed-effects regression. In persons without baseline impairments, an acute MI yielded a mean acute increase of 0.41 functional limitations (95\% confidence interval [CI], 0.18-0.63) with a linear increase of 0.14 limitations/year in the following decade. These increases were 0.65 limitations (95\% CI, 0.07-1.23) and 0.27 limitations/year afterward for those with mild-to-moderate impairment at baseline. Stroke resulted in an acute increase of 2.07 (95\% CI, 1.51-2.63) limitations because of the acute event and an increase of 0.15 limitations/year afterward for those unimpaired at baseline. There were 2.65 new limitations (95\% CI, 1.86-3.44) and 0.19/year afterward for those with baseline mild-to-moderate impairment. Stroke hospitalization was associated with greater odds of moderate-to-severe cognitive impairment (odds ratio, 3.86; 95\% CI, 2.10-7.11) at the time of the event, after adjustment for premorbid cognition but MI hospitalization was not.

CONCLUSIONS: In this population-based cohort, most MI and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of MI and stroke warrant screening for functional disability over the long-term.

}, keywords = {Activities of Daily Living, Cognition, Cognition Disorders, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Odds Ratio, Retrospective Studies, Stroke, Time Factors, United States}, issn = {1941-7705}, doi = {10.1161/HCQ.0000000000000008}, author = {Deborah A Levine and Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Mary A M Rogers and Theodore J Iwashyna} } @article {8110, title = {Genetic and educational assortative mating among US adults.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun 03}, pages = {7996-8000}, publisher = {111}, abstract = {

Understanding the social and biological mechanisms that lead to homogamy (similar individuals marrying one another) has been a long-standing issue across many fields of scientific inquiry. Using a nationally representative sample of non-Hispanic white US adults from the Health and Retirement Study and information from 1.7 million single-nucleotide polymorphisms, we compare genetic similarity among married couples to noncoupled pairs in the population. We provide evidence for genetic assortative mating in this population but the strength of this association is substantially smaller than the strength of educational assortative mating in the same sample. Furthermore, genetic similarity explains at most 10\% of the assortative mating by education levels. Results are replicated using comparable data from the Framingham Heart Study.

}, keywords = {Databases, Genetic, Educational Status, ethnicity, Female, Genome-Wide Association Study, Genotype, Humans, Male, Marriage, Metagenomics, Phenotype, Racial Groups, Sexual Behavior, Spouses, United States}, issn = {1091-6490}, doi = {10.1073/pnas.1321426111}, author = {Benjamin W Domingue and Jason M. Fletcher and Dalton C Conley and Jason D Boardman} } @article {8604, title = {Genetic diversity is a predictor of mortality in humans.}, journal = {BMC Genet}, volume = {15}, year = {2014}, month = {2014 Dec 29}, pages = {159}, abstract = {

BACKGROUND: It has been well-established, both by population genetics theory and direct observation in many organisms, that increased genetic diversity provides a survival advantage. However, given the limitations of both sample size and genome-wide metrics, this hypothesis has not been comprehensively tested in human populations. Moreover, the presence of numerous segregating small effect alleles that influence traits that directly impact health directly raises the question as to whether global measures of genomic variation are themselves associated with human health and disease.

RESULTS: We performed a meta-analysis of 17 cohorts followed prospectively, with a combined sample size of 46,716 individuals, including a total of 15,234 deaths. We find a significant association between increased heterozygosity and survival (P = 0.03). We estimate that within a single population, every standard deviation of heterozygosity an individual has over the mean decreases that person{\textquoteright}s risk of death by 1.57\%.

CONCLUSIONS: This effect was consistent between European and African ancestry cohorts, men and women, and major causes of death (cancer and cardiovascular disease), demonstrating the broad positive impact of genomic diversity on human survival.

}, keywords = {Genome-Wide Association Study, Heterozygote, Humans, Mortality, Polymorphism, Single Nucleotide, Proportional Hazards Models}, issn = {1471-2156}, doi = {10.1186/s12863-014-0159-7}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301661/}, author = {Bihlmeyer, Nathan A and Brody, Jennifer A and Albert Vernon Smith and Kathryn L Lunetta and Michael A Nalls and Jennifer A Smith and Toshiko Tanaka and Gail Davies and Lei Yu and Saira S Mirza and Teumer, Alexander and Coresh, Josef and Pankow, James S and Franceschini, Nora and Scaria, Anish and Oshima, Junko and Psaty, Bruce M and Gudnason, Vilmundur and Gu{\dh}ny Eir{\'\i}ksd{\'o}ttir and Tamara B Harris and Li, Hanyue and Karasik, David and Douglas P Kiel and Melissa E Garcia and Yongmei Liu and Jessica Faul and Sharon L R Kardia and Wei Zhao and Luigi Ferrucci and Allerhand, Michael and David C Liewald and Redmond, Paul and John M Starr and Philip L de Jager and Nese Direk and Mohammed Arfan Ikram and Andr{\'e} G Uitterlinden and Homuth, Georg and Lorbeer, Roberto and Hans-J{\"o}rgen Grabe and Lenore J Launer and Joanne M Murabito and Andrew B Singleton and David R Weir and Bandinelli, Stefania and Ian J Deary and David A Bennett and Henning Tiemeier and Kocher, Thomas and Lumley, Thomas and Dan E Arking} } @article {8622, title = {Genetic susceptibility to accelerated cognitive decline in the US Health and Retirement Study.}, journal = {Neurobiol Aging}, volume = {35}, year = {2014}, month = {2014 Jun}, pages = {1512.e11-8}, abstract = {

Age-related cognitive decline is a major public health concern facing a large segment of the US population. To identify genetic risk factors related to cognitive decline, we used nationally representative longitudinal data from the US Health and Retirement Study to conduct genome-wide association studies with 5765 participants of European ancestry, and 890 participants of African ancestry. Mixed effects models were used to derive cognitive decline phenotypes from data on repeated cognitive assessments and to perform single nucleotide polymorphism-based heritability estimation. We found 2 independent associations among European-Americans in the 19q13.32 region: rs769449 (APOE intron; p = 3.1 {\texttimes} 10(-20)) and rs115881343 (TOMM40 intron; p = 6.6 {\texttimes} 10(-11)). rs769449 was also associated with cognitive decline among African-Americans (p = 0.005), but rs115881343 was not. Cross-sectional cognitive function showed moderate heritability (15\%-32\%) across several age strata (50-59, 60-69, 70-79 years), but the cognitive decline heritability estimate was low (\~{}5\%). These results indicate that despite multiple association signals for cognitive decline in the 19q13.32 region, inter-individual variation is likely influenced substantially by environmental factors.

}, keywords = {African Americans, Aged, Aged, 80 and over, Chromosomes, Human, Pair 9, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Gene-Environment Interaction, Genetic Predisposition to Disease, Genetic Variation, Genome-Wide Association Study, Humans, Male, Membrane Transport Proteins, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Risk Factors, United States}, issn = {1558-1497}, doi = {10.1016/j.neurobiolaging.2013.12.021}, author = {Zhang, Chenan and Brandon L Pierce} } @article {8580, title = {Genetic variation associated with differential educational attainment in adults has anticipated associations with school performance in children.}, journal = {PLoS One}, volume = {9}, year = {2014}, month = {2014}, pages = {e100248}, abstract = {

Genome-wide association study results have yielded evidence for the association of common genetic variants with crude measures of completed educational attainment in adults. Whilst informative, these results do not inform as to the mechanism of these effects or their presence at earlier ages and where educational performance is more routinely and more precisely assessed. Single nucleotide polymorphisms exhibiting genome-wide significant associations with adult educational attainment were combined to derive an unweighted allele score in 5,979 and 6,145 young participants from the Avon Longitudinal Study of Parents and Children with key stage 3 national curriculum test results (SATS results) available at age 13 to 14 years in English and mathematics respectively. Standardised (z-scored) results for English and mathematics showed an expected relationship with sex, with girls exhibiting an advantage over boys in English (0.433 SD (95\%CI 0.395, 0.470), p<10(-10)) with more similar results (though in the opposite direction) in mathematics (0.042 SD (95\%CI 0.004, 0.080), p = 0.030). Each additional adult educational attainment increasing allele was associated with 0.041 SD (95\%CI 0.020, 0.063), p = 1.79{\texttimes}10(-04) and 0.028 SD (95\%CI 0.007, 0.050), p = 0.01 increases in standardised SATS score for English and mathematics respectively. Educational attainment is a complex multifactorial behavioural trait which has not had heritable contributions to it fully characterised. We were able to apply the results from a large study of adult educational attainment to a study of child exam performance marking events in the process of learning rather than realised adult end product. Our results support evidence for common, small genetic contributions to educational attainment, but also emphasise the likely lifecourse nature of this genetic effect. Results here also, by an alternative route, suggest that existing methods for child examination are able to recognise early life variation likely to be related to ultimate educational attainment.

}, keywords = {Adolescent, Adult, Child, Child, Preschool, Educational Status, Female, Genetic Association Studies, Genome-Wide Association Study, Humans, Intelligence, Intelligence Tests, Learning, Longitudinal Studies, Male, Mathematics, Polymorphism, Single Nucleotide}, issn = {1932-6203}, doi = {10.1371/journal.pone.0100248}, url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100248}, author = {Mary E Ward and McMahon, George and St Pourcain, Beate and Cornelius A Rietveld and Daniel J. Benjamin and Philipp D Koellinger and Cesarini, David and Nicholas J Timpson}, editor = {Yun Li} } @article {8609, title = {Genomic assortative mating in marriages in the United States.}, journal = {PLoS One}, volume = {9}, year = {2014}, month = {2014}, pages = {e112322}, abstract = {

Assortative mating in phenotype in human marriages has been widely observed. Using genome-wide genotype data from the Framingham Heart study (FHS; number of married couples = 989) and Health Retirement Survey (HRS; number of married couples = 3,474), this study investigates genomic assortative mating in human marriages. Two types of genomic marital correlations are calculated. The first is a correlation specific to a single married couple "averaged" over all available autosomal single-nucleotide polymorphism (SNPs). In FHS, the average married-couple correlation is 0.0018 with p = 3 {\texttimes} 10(-5); in HRS, it is 0.0017 with p = 7.13 {\texttimes} 10(-13). The marital correlation among the positively assorting SNPs is 0.001 (p = .0043) in FHS and 0.015 (p = 1.66 {\texttimes} 10(-24)) in HRS. The sizes of these estimates in FHS and HRS are consistent with what are suggested by the distribution of the allelic combination. The study also estimated SNP-specific correlation "averaged" over all married couples. Suggestive evidence is reported. Future studies need to consider a more general form of genomic assortment, in which different allelic forms in homologous genes and non-homologous genes result in the same phenotype.

}, keywords = {Data collection, Female, Genome, Human, Genomics, Genotype, Humans, Male, Marriage, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Reproduction, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0112322}, author = {Guo, Guang and Wang, Lin and Hexuan Liu and Randall, Thomas} } @article {8107, title = {Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries.}, journal = {J Am Geriatr Soc}, volume = {62}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun}, pages = {1097-104}, publisher = {62}, abstract = {

OBJECTIVES: To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans.

DESIGN: Retrospective cohort study.

SETTING: Data from the Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008.

MEASUREMENTS: The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums.

RESULTS: Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001).

CONCLUSION: Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Geography, Health Care Costs, Health Expenditures, Humans, Male, Medicare, Retrospective Studies, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12834}, author = {Lena M. Chen and Edward C Norton and Kenneth M. Langa and Le, Sidney and Arnold M. Epstein} } @article {8101, title = {The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease?}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0}, month = {2014}, pages = {e101193}, publisher = {9}, abstract = {

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

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

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

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

}, keywords = {Aged, Cardiovascular Diseases, Female, Geography, Humans, Incidence, Insurance Benefits, Insurance, Health, Longitudinal Studies, Male, Middle Aged, Risk Factors, Unemployment, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0101193}, author = {Stefan Walter and M. Maria Glymour and Mauricio Avendano} } @article {8065, title = {Health numeracy: the importance of domain in assessing numeracy.}, journal = {Med Decis Making}, volume = {34}, year = {2014}, month = {2014 Jan}, pages = {107-15}, publisher = {34}, abstract = {

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

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

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

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

}, keywords = {Aged, Humans, Mathematics, Middle Aged, Self Efficacy, Surveys and Questionnaires, Task Performance and Analysis}, issn = {1552-681X}, doi = {10.1177/0272989X13493144}, url = {http://mdm.sagepub.com/content/34/1/107.abstract}, author = {Helen G Levy and Peter A. Ubel and Amanda J. Dillard and David R Weir and Angela Fagerlin} } @article {8033, title = {Heterogeneity in healthy aging.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jun}, pages = {640-9}, publisher = {69}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Middle Aged, Population Surveillance, Quality of Life, Retrospective Studies, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glt162}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2013/11/13/gerona.glt162.abstract}, author = {David J Lowsky and S Jay Olshansky and Bhattacharya, Jay and Dana P Goldman} } @article {8088, title = {History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, month = {2014 Oct}, pages = {1047-54}, publisher = {22}, abstract = {

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

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

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

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

}, keywords = {Alcohol-Related Disorders, Cognition Disorders, Diagnosis, Dual (Psychiatry), Female, Humans, Incidence, Male, Memory Disorders, Middle Aged, Prospective Studies, Risk Factors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2014.06.001}, url = {http://www.sciencedirect.com/science/article/pii/S1064748114001675}, author = {Ku{\'z}ma, El{\.z}bieta and David J Llewellyn and Kenneth M. Langa and Robert B Wallace and Iain A Lang} } @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 {8115, title = {Increased 1-year healthcare use in survivors of severe sepsis.}, journal = {Am J Respir Crit Care Med}, volume = {190}, year = {2014}, note = {Times Cited: 1}, month = {2014 Jul 01}, pages = {62-9}, publisher = {190}, abstract = {

RATIONALE: Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors{\textquoteright} post-discharge healthcare use.

OBJECTIVES: To measure inpatient healthcare use of severe sepsis survivors compared with patients{\textquoteright} own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.

METHODS: This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998-2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we measured patients{\textquoteright} use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3-45] vs. 7 [0-29]; P < 0.001) and a higher proportion of days alive (median, 9.6\% [interquartile range, 1.4-33.8\%] vs. 1.9\% [0.0-7.9\%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2\% [95\% confidence interval, 41.3-47.2\%] vs. 31.4\% [95\% confidence interval, 28.6-34.2\%] at 1 year), a steeper decline in days spent at home (difference-in-differences, -38.6 d [95\% confidence interval, -50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4\% [95\% confidence interval, 2.8-8.1\%]; P < 0.001).

CONCLUSIONS: Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.

}, keywords = {Aged, Female, Health Facilities, Humans, Insurance Claim Review, Long-term Care, Male, Medical Record Linkage, Medicare, Mortality, Outcome Assessment, Health Care, Patient Readmission, Prospective Studies, Sepsis, Skilled Nursing Facilities, Survivors, United States}, issn = {1535-4970}, doi = {10.1164/rccm.201403-0471OC}, author = {Hallie C Prescott and Kenneth M. Langa and Liu, Vincent and Gabriel J. Escobar and Theodore J Iwashyna} } @article {8119, title = {Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality.}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0 0}, month = {2014}, pages = {e108540}, publisher = {9}, abstract = {

BACKGROUND: Guidelines recommend incorporating life expectancy (LE) into clinical decision-making for preventive interventions such as cancer screening. Previous research focused on mortality risk (e.g. 28\% at 4 years) which is more difficult to interpret than LE (e.g. 7.3 years) for both patients and clinicians. Our objective was to utilize the Gompertz Law of Human Mortality which states that mortality risk doubles in a fixed time interval to transform the Lee mortality index into a LE calculator.

METHODS: We examined community-dwelling older adults age 50 and over enrolled in the nationally representative 1998 wave of the Health and Retirement Study or HRS (response rate 81\%), dividing study respondents into development (n = 11701) and validation (n = 8009) cohorts. In the development cohort, we fit proportional hazards Gompertz survival functions for each of the risk groups defined by the Lee mortality index. We validated our LE estimates by comparing our predicted LE with observed survival in the HRS validation cohort and an external validation cohort from the 2004 wave of the English Longitudinal Study on Ageing or ELSA (n = 7042).

RESULTS: The ELSA cohort had a lower 8-year mortality risk (14\%) compared to our HRS development (23\%) and validation cohorts (25\%). Our model had good discrimination in the validation cohorts (Harrell{\textquoteright}s c 0.78 in HRS and 0.80 in the ELSA). Our predicted LE{\textquoteright}s were similar to observed survival in the HRS validation cohort without evidence of miscalibration (Hosmer-Lemeshow, p = 0.2 at 8 years). However, our predicted LE{\textquoteright}s were longer than observed survival in the ELSA cohort with evidence of miscalibration (Hosmer-Lemeshow, p<0.001 at 8 years) reflecting the lower mortality rate in ELSA.

CONCLUSION: We transformed a previously validated mortality index into a LE calculator that incorporated patient-level risk factors. Our LE calculator may help clinicians determine which preventive interventions are most appropriate for older US adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Female, Humans, Life Expectancy, Longevity, Longitudinal Studies, Male, Middle Aged, Mortality, Proportional Hazards Models, Risk Factors}, issn = {1932-6203}, doi = {10.1371/journal.pone.0108540}, author = {Sei J. Lee and W John Boscardin and Katharine A Kirby and Kenneth E Covinsky} } @article {8028, title = {An investigation of activity profiles of older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Sep}, pages = {809-21}, publisher = {69}, abstract = {

OBJECTIVES: In this study, we advance knowledge about activity engagement by considering many activities simultaneously to identify profiles of activity among older adults. Further, we use cross-sectional data to explore factors associated with activity profiles and prospective data to explore activity profiles and well-being outcomes.

METHOD: We used the core survey data from the years 2008 and 2010, as well as the 2009 Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS). The HRS CAMS includes information on types and amounts of activities. We used factor analysis and latent class analysis to identify activity profiles and regression analyses to assess antecedents and outcomes associated with activity profiles.

RESULTS: We identified 5 activity profiles: Low Activity, Moderate Activity, High Activity, Working, and Physically Active. These profiles varied in amount and type of activities. Demographic and health factors were related to profiles. Activity profiles were subsequently associated with self-rated health and depression symptoms.

DISCUSSION: The use of a 5-level categorical activity profile variable may allow more complex analyses of activity that capture the "whole person." There is clearly a vulnerable group of low-activity individuals as well as a High Activity group that may represent the "active ageing" vision.

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Cross-Sectional Studies, Employment, Female, Florida, Health Surveys, Hispanic or Latino, Human Activities, Humans, Male, Middle Aged, Models, Psychological, Motor Activity, Prospective Studies, Regression Analysis, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu002}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract}, author = {Morrow-Howell, Nancy and Putnam, Michelle and Lee, Yung Soo and Jennifer C. Greenfield and Inoue, Megumi and Chen, Huajuan} } @article {8008, title = {Leveraging the health and retirement study to advance palliative care research.}, journal = {J Palliat Med}, volume = {17}, year = {2014}, month = {2014 May}, pages = {506-11}, publisher = {17}, abstract = {

BACKGROUND: The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine{\textquoteright}s series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject{\textquoteright}s death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care.

SETTING: While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas.

CONCLUSION: In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research.

}, keywords = {Aged, Caregivers, Evidence-Based Practice, Health Services Research, Health Surveys, Humans, Longitudinal Studies, Needs Assessment, Pain Management, Palliative care, Quality of Life, Retirement, Sociological Factors, United States}, issn = {1557-7740}, doi = {10.1089/jpm.2013.0648}, author = {Amy Kelley and Kenneth M. Langa and John G. Cagle and Katherine A Ornstein and Maria J Silveira and Lauren Hersch Nicholas and Kenneth E Covinsky and Christine S Ritchie} } @article {8070, title = {Life satisfaction and frequency of doctor visits.}, journal = {Psychosom Med}, volume = {76}, year = {2014}, month = {2014 Jan}, pages = {86-93}, publisher = {76}, abstract = {

OBJECTIVE: Identifying positive psychological factors that reduce health care use may lead to innovative efforts that help build a more sustainable and high-quality health care system. Prospective studies indicate that life satisfaction is associated with good health behaviors, enhanced health, and longer life, but little information about the association between life satisfaction and health care use is available. We tested whether higher life satisfaction was prospectively associated with fewer doctor visits. We also examined potential interactions between life satisfaction and health behaviors.

METHODS: Participants were 6379 adults from the Health and Retirement Study, a prospective and nationally representative panel study of American adults older than 50 years. Participants were tracked for 4 years. We analyzed the data using a generalized linear model with a gamma distribution and log link.

RESULTS: Higher life satisfaction was associated with fewer doctor visits. On a 6-point life satisfaction scale, each unit increase in life satisfaction was associated with an 11\% decrease in doctor visits--after adjusting for sociodemographic factors (relative risk = 0.89, 95\% confidence interval = 0.86-0.93). The most satisfied respondents (n = 1121; 17.58\%) made 44\% fewer doctor visits than did the least satisfied (n = 182; 2.85\%). The association between higher life satisfaction and reduced doctor visits remained even after adjusting for baseline health and a wide range of sociodemographic, psychosocial, and health-related covariates (relative risk = 0.96, 95\% confidence interval = 0.93-0.99).

CONCLUSIONS: Higher life satisfaction is associated with fewer doctor visits, which may have important implications for reducing health care costs.

}, keywords = {Aged, Female, Health Behavior, Humans, Male, Middle Aged, Office Visits, Personal Satisfaction, Prospective Studies, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000024}, url = {http://www.psychosomaticmedicine.org/content/76/1/86.abstract}, author = {Eric S Kim and Nansook Park and Jennifer K Sun and Jacqui Smith and Christopher Peterson} } @article {8098, title = {Longitudinal predictors of self-rated health and mortality in older adults.}, journal = {Prev Chronic Dis}, volume = {11}, year = {2014}, note = {Times Cited: 0}, month = {2014 Jun 05}, pages = {E93}, publisher = {11}, abstract = {

INTRODUCTION: Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years.

METHODS: We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50-104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality.

RESULTS: Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health.

CONCLUSION: Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Body Mass Index, Chronic disease, depression, Educational Status, Female, Health Behavior, Health Status Indicators, Humans, Longitudinal Studies, Male, Mental Recall, Middle Aged, Proportional Hazards Models, Psychometrics, Retirement, Self Report, Survival Analysis, United States}, issn = {1545-1151}, doi = {10.5888/pcd11.130241}, author = {Diane C Wagner and Jerome L Short} } @article {8022, title = {Mental work demands, retirement, and longitudinal trajectories of cognitive functioning.}, journal = {J Occup Health Psychol}, volume = {19}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Apr}, pages = {231-42}, publisher = {19}, abstract = {

Age-related changes in cognitive abilities are well-documented, and a very important indicator of health, functioning, and decline in later life. However, less is known about the course of cognitive functioning before and after retirement and specifically whether job characteristics during one{\textquoteright}s time of employment (i.e., higher vs. lower levels of mental work demands) moderate how cognition changes both before and after the transition to retirement. We used data from n = 4,182 (50\% women) individuals in the Health and Retirement Study, a nationally representative panel study in the United States, across an 18 year time span (1992-2010). Data were linked to the O*NET occupation codes to gather information about mental job demands to examine whether job characteristics during one{\textquoteright}s time of employment moderates level and rate of change in cognitive functioning (episodic memory and mental status) both before and after retirement. Results indicated that working in an occupation characterized by higher levels of mental demands was associated with higher levels of cognitive functioning before retirement, and a slower rate of cognitive decline after retirement. We controlled for a number of important covariates, including socioeconomic (education and income), demographic, and health variables. Our discussion focuses on pathways through which job characteristics may be associated with the course of cognitive functioning in relation to the important transition of retirement. Implications for job design as well as retirement are offered.

}, keywords = {Cognition, Employment, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Stress, Psychological}, issn = {1939-1307}, doi = {10.1037/a0035724}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84896104239andpartnerID=40andmd5=8a0c0422ba5b68927fdc926a3e8a25b4}, author = {Gwenith G Fisher and Stachowski, Alicia and Frank J Infurna and Jessica Faul and James Grosch and Lois E Tetrick} } @article {7983, title = {Mortality and cardiovascular disease among older live kidney donors.}, journal = {Am J Transplant}, volume = {14}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {1853-61}, publisher = {14}, abstract = {

Over the past two decades, live kidney donation by older individuals (>=55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41\% were male and 7\% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.

}, keywords = {Age Factors, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Kidney Transplantation, Living Donors, Longitudinal Studies, Male, Medicare, Middle Aged, Nephrectomy, Quality of Life, Renal Insufficiency, Time Factors, Treatment Outcome, United States}, issn = {1600-6143}, doi = {10.1111/ajt.12822}, author = {P. P. Reese and R. D. Bloom and H. I. Feldman and Rosenbaum, P and Wang, W and P. Saynisch and Tarsi, N M and Mukherjee, N and Garg, A X and A. Mussell and J. Shults and Even-Shoshan, O and R. R. Townsend and J. H. Silber} } @article {7967, title = {Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans.}, journal = {J Gen Intern Med}, volume = {29}, year = {2014}, note = {Export Date: 6 August 2014 Article in Press}, month = {2014 Oct}, pages = {1362-71}, publisher = {29}, abstract = {

BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN: Prospective cohort study.

PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).

MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95\% Confidence Interval [95\%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95\%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95\%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95\%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95\%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95\%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95\%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95\%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, depression, Female, Hospitalization, Humans, Male, Mental Disorders, Prospective Studies, Risk Factors, United States}, issn = {1525-1497}, doi = {10.1007/s11606-014-2916-8}, author = {Dimitry S Davydow and Zivin, Kara and Wayne J Katon and Gregory M Pontone and Lydia Chwastiak and Kenneth M. Langa and Theodore J Iwashyna} } @article {8053, title = {Obesity and 1-year outcomes in older Americans with severe sepsis.}, journal = {Crit Care Med}, volume = {42}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Aug}, pages = {1766-74}, publisher = {42}, abstract = {

OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN: Observational cohort study.

SETTING: U.S. hospitals.

PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5\%) were normal weight, 473 (33.7\%) were overweight, and 334 (23.8\%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95\% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95\% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Critical Illness, Delivery of Health Care, Female, Health Expenditures, Hospitalization, Humans, Male, Medicare, Middle Aged, Obesity, Sepsis, Survival Rate, Survivors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0000000000000336}, author = {Hallie C Prescott and Virginia W Chang and James M. O{\textquoteright}Brien Jr and Kenneth M. Langa and Theodore J Iwashyna} } @article {8123, title = {Perceived neighbourhood social cohesion and myocardial infarction.}, journal = {J Epidemiol Community Health}, volume = {68}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov}, pages = {1020-6}, publisher = {68}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Confounding Factors, Epidemiologic, Female, Health Behavior, Health Status, Health Surveys, Humans, Incidence, Interviews as Topic, Male, Mental Health, Middle Aged, Multilevel Analysis, Myocardial Infarction, Perception, Prospective Studies, Protective factors, Residence Characteristics, Self Report, Social Environment, Socioeconomic factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2014-204009}, author = {Eric S Kim and Armani M. Hawes and Jacqui Smith} } @article {8057, title = {A polygenic risk score associated with measures of depressive symptoms among older adults.}, journal = {Biodemography Soc Biol}, volume = {60}, year = {2014}, note = {Times Cited: 0 SI 0}, month = {2014}, pages = {199-211}, publisher = {60}, abstract = {

It has been suggested that depression is a polygenic trait, arising from the influences of multiple loci with small individual effects. The aim of this study is to generate a polygenic risk score (PRS) to examine the association between genetic variation and depressive symptoms. Our analytic sample included N = 10,091 participants aged 50 and older from the Health and Retirement Study (HRS). Depressive symptoms were measured by Center for Epidemiological Studies-Depression scale (CESD) scores assessed on up to nine occasions across 18 years. We conducted a genome-wide association analysis for a discovery set (n = 7,000) and used the top 11 single-nucleotide polymorphisms, all with p < 10(-5) to generate a weighted PRS for our replication sample (n = 3,091). Results showed that the PRS was significantly associated with mean CESD score in the replication sample (β = .08, p = .002). The R(2) change for the inclusion of the PRS was .003. Using a multinomial logistic regression model, we also examined the association between genetic risk and chronicity of high (4+) CESD scores. We found that a one-standard-deviation increase in PRS was associated with a 36 percent increase in the odds of having chronically high CESD scores relative to never having had high CESD scores. Our findings are consistent with depression being a polygenic trait and suggest that the cumulative influence of multiple variants increases an individual{\textquoteright}s susceptibility for chronically experiencing high levels of depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Depressive Disorder, Major, Female, Genetic Predisposition to Disease, Genetic Variation, Genome-Wide Association Study, Humans, Male, Middle Aged, Multifactorial Inheritance, Odds Ratio, Risk Factors}, issn = {1948-5573}, doi = {10.1080/19485565.2014.952705}, author = {Morgan E. Levine and Eileen M. Crimmins and Carol A Prescott and Drystan F. Phillips and Thalida E. Arpawong and Jinkook Lee} } @article {7968, title = {Predictors of older adults{\textquoteright} personal and community mobility: using a comprehensive theoretical mobility framework.}, journal = {Gerontologist}, volume = {54}, year = {2014}, month = {2014 Jun}, pages = {398-408}, publisher = {54}, abstract = {

PURPOSE OF THE STUDY: Forty-six percent of older adults report limitations in their mobility, and maintaining mobility is considered an important factor in keeping adults independent and active in later life. This study tests a comprehensive theoretical framework of mobility (Webber, S. C., Porter, M. M., \& Menec, V. H. [2010]. Mobility in older adults: A comprehensive framework. The Gerontologist, 50[4], 443-450. doi:10.1093/geront/gnq013) identifying multiple determinants that additively influence mobility (financial, psychosocial, environmental, physical, and cognitive), as well as cross-cutting influences of gender, culture, and biography.

DESIGN AND METHODS: Structural equation modeling was used to examine several models of mobility using data from 6,112 respondents in the Health and Retirement Study (mean age: 74.74, 85\% white, 41\% male, 57\% married).

RESULTS: The original measurement model fit the data well. When both personal and community mobility were simultaneously predicted, only the physical, cognitive, psychosocial, and environmental determinants were retained in the independent models. Age and marital status also predicted personal and community mobility. Although most of these relationships were in the expected direction, interestingly when both forms of mobility were included in the model, poorer cognitive ability was associated with greater personal mobility in the final model.

IMPLICATIONS: Results indicate the importance of accounting for and examining comprehensive models of mobility. The factors affecting older adults{\textquoteright} mobility are complex, and these relationships need to be explored in more depth to ensure the maintenance of individuals{\textquoteright} independence and quality of life.

}, keywords = {Aged, Female, Humans, Male, Mobility Limitation, Models, Theoretical}, issn = {1758-5341}, doi = {10.1093/geront/gnt054}, author = {M. Ren{\'e}e Umstattd Meyer and Megan C Janke and Beaujean, A. Alexander} } @article {6464, title = {Preparedness for natural disasters among older US adults: a nationwide survey.}, journal = {Am J Public Health}, volume = {104}, year = {2014}, month = {2014 Mar}, pages = {506-11}, chapter = {506}, abstract = {

OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents.

METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness.

RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3\% reported participating in an educational program or reading materials about disaster preparation. Nearly 15\% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness.

CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

}, keywords = {Aged, Aged, 80 and over, Disaster Planning, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2013.301559}, url = {http://dx.doi.org/10.2105/AJPH.2013.301559}, author = {Tala M. Al-rousan and Linda M. Rubenstein and Robert B Wallace} } @article {8103, title = {Prospective study of the association between dispositional optimism and incident heart failure.}, journal = {Circ Heart Fail}, volume = {7}, year = {2014}, note = {Times Cited: 1}, month = {2014 May}, pages = {394-400}, publisher = {7}, abstract = {

BACKGROUND: Although higher optimism has been linked with an array of positive health behaviors, biological processes, and cardiovascular outcomes, the relationship between optimism and heart failure has not been examined. In the United States, 80\% of heart failures occur in adults aged 65+ years. Therefore, we examined whether higher optimism was linked with a reduced incidence of heart failure among older adults.

METHODS AND RESULTS: Prospective data were from the Health and Retirement Study, a nationally representative study of older US adults. Our sample included 6808 participants who were followed for 4 years. Multiple logistic regression models were used to assess whether optimism was independently associated with incident heart failure. We adjusted for sociodemographic, behavioral, biological, and psychological covariates. Higher optimism was associated with a lower risk of incident heart failure during the follow-up period. In a model that adjusted for sociodemographic factors, each SD increase in optimism had an odds ratio of 0.74 (95\% confidence interval, 0.63-0.85) for heart failure. Effects of optimism persisted even after adjusting for a wide range of covariates. There was also evidence of a dose-response relationship. As optimism increased, risk of developing heart failure decreased monotonically, with a 48\% reduced odds among people with the highest versus lowest optimism.

CONCLUSIONS: This is the first study to suggest that optimism is associated with a lower risk of heart failure. If future studies confirm these findings, they may be used to inform new strategies for preventing or delaying the onset of heart failure.

}, keywords = {Affect, Aged, Aged, 80 and over, Emotions, Female, Heart Failure, Humans, Incidence, Logistic Models, Male, Middle Aged, Outcome Assessment, Health Care, Prospective Studies, Retrospective Studies, Risk Factors, Socioeconomic factors, United States}, issn = {1941-3297}, doi = {10.1161/CIRCHEARTFAILURE.113.000644}, author = {Eric S Kim and Jacqui Smith and Laura D Kubzansky} } @article {8062, title = {Public beliefs and knowledge about risk and protective factors for Alzheimer{\textquoteright}s disease.}, journal = {Alzheimers Dement}, volume = {10}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Oct}, pages = {S381-9}, publisher = {10}, abstract = {

BACKGROUND: The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer{\textquoteright}s disease (AD).

METHODS: A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50.

RESULTS: Respondents were 1641 adults (mean age=64.4 years, 53.6\% female, 81.7\% White). Most (60.1\%) indicated interest in learning their AD risk, with 29.4\% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1\%) or that having an affected first-degree relative is associated with increased disease risk (32\%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk.

CONCLUSION: Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors.

}, keywords = {Aged, Alzheimer disease, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Protective factors, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2013.07.001}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84895853906andpartnerID=40andmd5=336a2df47951d1d5c021f44b8055d10e}, author = {J Scott Roberts and Sara J McLaughlin and Cathleen M. Connell} } @article {8128, title = {Purpose in life and use of preventive health care services.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov 18}, pages = {16331-6}, publisher = {111}, abstract = {

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95\% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95\% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95\% CI = 1.16-1.39) or pap smear (OR = 1.16, 95\% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95\% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17\% fewer nights spent in the hospital (rate ratio = 0.83, 95\% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

}, keywords = {Aged, Aged, 80 and over, Early Detection of Cancer, Educational Status, ethnicity, Female, Habits, Hematologic Tests, Hospitalization, Humans, Influenza Vaccines, Insurance Coverage, Male, Marital Status, Middle Aged, Models, Psychological, Motivation, Patient Acceptance of Health Care, Preventive Health Services, Surveys and Questionnaires, Vaccination}, issn = {1091-6490}, doi = {10.1073/pnas.1414826111}, author = {Eric S Kim and Victor J Strecher and Carol D Ryff} } @article {8079, title = {Question context and priming meaning of health: effect on differences in self-rated health between Hispanics and non-Hispanic Whites.}, journal = {Am J Public Health}, volume = {104}, year = {2014}, month = {2014 Jan}, pages = {179-85}, publisher = {104}, abstract = {

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

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

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

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

}, keywords = {Aged, Female, Health Status, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Mortality, Self Report, United States, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301055}, author = {Lee, Sunghee and Schwarz, Norbert} } @article {8094, title = {Racial/Ethnic predictors of falls among older adults: the health and retirement study.}, journal = {J Aging Health}, volume = {26}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Sep}, pages = {1060-75}, publisher = {26}, abstract = {

OBJECTIVE: The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older.

METHOD: Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls.

RESULTS: The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24\%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls.

DISCUSSION: African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

}, keywords = {Accidental Falls, Aged, Black or African American, Female, Health Surveys, Hispanic or Latino, Humans, Logistic Models, Male, Poisson Distribution, Risk Factors, White People}, issn = {1552-6887}, doi = {10.1177/0898264314541698}, author = {Emily J Nicklett and Taylor, Robert Joseph} } @article {8016, title = {Satisfaction with aging and use of preventive health services.}, journal = {Prev Med}, volume = {69}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {176-80}, publisher = {69}, abstract = {

OBJECTIVE: Preventive health service use is relatively low among older age groups. We hypothesized that aging satisfaction would be associated with increased use of preventive health services four years later.

METHOD: We conducted multiple logistic regression analyses on a sample of 6177 people from the Health and Retirement Study, a nationally representative study of U.S. adults over the age of 50 (M age=70.6; women n=3648; men n=2529).

RESULTS: Aging satisfaction was not associated with obtaining flu shots. However, in fully-adjusted models, each standard deviation increase in aging satisfaction was associated with higher odds of reporting service use for cholesterol tests (OR=1.10, 95\% CI=1.00-1.20). Further, women with higher aging satisfaction were more likely to obtain a mammogram/x-ray (OR=1.17, 95\% CI=1.06-1.29) or Pap smear (OR=1.10, 95\% CI=1.00-1.21). Among men, the odds of obtaining a prostate exam increased with higher aging satisfaction (OR=1.20 95\% CI=1.09-1.34).

CONCLUSION: These results suggest that aging satisfaction potentially influences preventive health service use after age 50.

}, keywords = {Aged, Aged, 80 and over, Aging, Chronic disease, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Influenza Vaccines, Logistic Models, Male, Mammography, Middle Aged, Patient Acceptance of Health Care, Patient Satisfaction, Personal Satisfaction, Preventive Health Services, Prostatic Neoplasms, Surveys and Questionnaires, United States, Vaginal Smears}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2014.09.008}, author = {Eric S Kim and Kyle D Moored and Hannah L. Giasson and Jacqui Smith} } @article {8026, title = {Self-rated health changes and oldest-old mortality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {612-21}, publisher = {69}, abstract = {

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

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

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

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

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

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

}, keywords = {Adult, Aged, Aged, 80 and over, Diagnostic Self Evaluation, Female, health, Health Status, Humans, Life Style, Male, Middle Aged, Mortality, Retirement, Retrospective Studies}, issn = {1932-6203}, doi = {10.1371/journal.pone.0107879}, author = {Stenholm, Sari and Pentti, Jaana and Ichiro Kawachi and Westerlund, Hugo and Mika Kivim{\"a}ki and Vahtera, Jussi} } @article {8029, title = {Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses.}, journal = {J Public Health (Oxf)}, volume = {36}, year = {2014}, month = {2014 Sep}, pages = {382-9}, publisher = {36}, abstract = {

BACKGROUND: Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this {\textquoteright}widowhood effect{\textquoteright} persists over time.

METHODS: Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

RESULTS: Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95\% CI: 1.27, 2.75; OR for women = 1.47, 95\% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95\% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95\% CI: 0.90, 1.28), though the gender difference was non-significant.

CONCLUSION: The {\textquoteright}widowhood effect{\textquoteright} was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.

}, keywords = {Bereavement, Female, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors, Sex Factors, Socioeconomic factors, Time Factors, United States, Widowhood}, issn = {1741-3850}, doi = {10.1093/pubmed/fdt101}, url = {http://jpubhealth.oxfordjournals.org/content/early/2013/10/27/pubmed.fdt101.abstract}, author = {J Robin Moon and M. Maria Glymour and Anusha M Vable and Sze Y Liu and S. V. Subramanian} } @article {8096, title = {Social relationships, leisure activity, and health in older adults.}, journal = {Health Psychol}, volume = {33}, year = {2014}, note = {Times Cited: 1 Si}, month = {2014 Jun}, pages = {516-23}, publisher = {33}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, Humans, Interpersonal Relations, Leisure activities, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1930-7810}, doi = {10.1037/hea0000051}, author = {Chang, Po-Ju and Linda A. Wray and Lin, Yeqiang} } @article {7993, title = {Testing the key assumption of heritability estimates based on genome-wide genetic relatedness.}, journal = {J Hum Genet}, volume = {59}, year = {2014}, month = {2014 Jun}, pages = {342-5}, publisher = {59}, abstract = {

Comparing genetic and phenotypic similarity among unrelated individuals seems a promising way to quantify the genetic component of traits while avoiding the problematic assumptions plaguing twin- and other kin-based estimates of heritability. One approach uses a Genetic Relatedness Estimation through Maximum Likelihood (GREML) model for individuals who are related at less than 0.025 to predict their phenotypic similarity by their genetic similarity. Here we test the key underlying assumption of this approach: that genetic relatedness is orthogonal to environmental similarity. Using data from the Health and Retirement Study (and two other surveys), we show two unrelated individuals may be more likely to have been reared in a similar environment (urban versus nonurban setting) if they are genetically similar. This effect is not eliminated by controls for population structure. However, when we include this environmental confound in GREML models, heritabilities do not change substantially and thus potential bias in estimates of most biological phenotypes is probably minimal.

}, keywords = {Body Height, Body Weight, Educational Status, Gene-Environment Interaction, Genome, Human, Humans, Likelihood Functions, Models, Genetic, Phenotype, Quantitative Trait, Heritable, Urban Population}, issn = {1435-232X}, doi = {10.1038/jhg.2014.14}, author = {Dalton C Conley and Mark L Siegal and Benjamin W Domingue and Kathleen Mullan Harris and Matthew B McQueen and Jason D Boardman} } @article {8613, title = {Validation of a polygenic risk score for dementia in black and white individuals.}, journal = {Brain Behav}, volume = {4}, year = {2014}, month = {2014 Sep}, pages = {687-97}, abstract = {

OBJECTIVE: To determine whether a polygenic risk score for Alzheimer{\textquoteright}s disease (AD) predicts dementia probability and memory functioning in non-Hispanic black (NHB) and non-Hispanic white (NHW) participants from a sample not used in previous genome-wide association studies.

METHODS: Non-Hispanic white and NHB Health and Retirement Study (HRS) participants provided genetic information and either a composite memory score (n = 10,401) or a dementia probability score (n = 7690). Dementia probability score was estimated for participants{\textquoteright} age 65+ from 2006 to 2010, while memory score was available for participants age 50+. We calculated AD genetic risk scores (AD-GRS) based on 10 polymorphisms confirmed to predict AD, weighting alleles by beta coefficients reported in AlzGene meta-analyses. We used pooled logistic regression to estimate the association of the AD-GRS with dementia probability and generalized linear models to estimate its effect on memory score.

RESULTS: Each 0.10 unit change in the AD-GRS was associated with larger relative effects on dementia among NHW aged 65+ (OR = 2.22; 95\% CI: 1.79, 2.74; P < 0.001) than NHB (OR=1.33; 95\% CI: 1.00, 1.77; P = 0.047), although additive effect estimates were similar. Each 0.10 unit change in the AD-GRS was associated with a -0.07 (95\% CI: -0.09, -0.05; P < 0.001) SD difference in memory score among NHW aged 50+, but no significant differences among NHB (β = -0.01; 95\% CI: -0.04, 0.01; P = 0.546). [Correction added on 29 July 2014, after first online publication: confidence intervalshave been amended.] The estimated effect of the GRS was significantly smaller among NHB than NHW (P < 0.05) for both outcomes.

CONCLUSION: This analysis provides evidence for differential relative effects of the GRS on dementia probability and memory score among NHW and NHB in a new, national data set.

}, keywords = {African Americans, Aged, Aged, 80 and over, Dementia, European Continental Ancestry Group, Female, Humans, Male, Middle Aged, Multifactorial Inheritance, Polymorphism, Genetic, Reproducibility of Results, Risk Assessment, Risk Factors, Surveys and Questionnaires, United States}, issn = {2162-3279}, doi = {10.1002/brb3.248}, author = {Jessica R Marden and Stefan Walter and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and M. Maria Glymour} } @article {8602, title = {Validation of blood-based assays using dried blood spots for use in large population studies.}, journal = {Biodemography Soc Biol}, volume = {60}, year = {2014}, month = {2014}, pages = {38-48}, abstract = {

Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading.

}, keywords = {Biomarkers, C-reactive protein, Cholesterol, Cholesterol, HDL, Cystatin C, Dried Blood Spot Testing, Glycated Hemoglobin A, Humans, Middle Aged, Reference Values, Reproducibility of Results}, issn = {1948-5573}, doi = {10.1080/19485565.2014.901885}, url = {http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885}, author = {Eileen M. Crimmins and Jung K Kim and Heather McCreath and Jessica Faul and David R Weir and Teresa Seeman} } @article {8034, title = {Why do older people change their ratings of childhood health?}, journal = {Demography}, volume = {51}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {1999-2023}, publisher = {51}, abstract = {

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

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

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

}, keywords = {Activities of Daily Living, Aged, Cardiovascular Diseases, depression, Female, Health Status, Helping Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Time Factors}, issn = {1573-3521}, doi = {10.1007/s10865-012-9414-4}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1318045378?accountid=14667}, author = {Michele M Heisler and Choi, Hwajung and John D Piette and Ann Marie Rosland and Kenneth M. Langa and Stephanie Brown} } @article {7821, title = {Advance care planning and the quality of end-of-life care in older adults.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, note = {Times Cited: 0}, month = {2013 Feb}, pages = {209-14}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether advance care planning influences quality of end-of-life care.

DESIGN: In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics.

SETTING: The nationally representative HRS.

PARTICIPANTS: Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55\% women).

MEASUREMENTS: Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice <= 3 days).

RESULTS: Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95\% confidence interval (CI) = 0.80-0.94), more likely to be enrolled in hospice (aRR = 1.68, 95\% CI = 1.43-1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95\% CI = 0.85-0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all).

CONCLUSION: ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.

}, keywords = {Adaptation, Psychological, Advance care planning, Aged, 80 and over, Female, Humans, Male, Quality of Life, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12105}, author = {Bischoff, Kara E and Rebecca L. Sudore and Yinghui Miao and W John Boscardin and Alexander K Smith} } @article {8605, title = {The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer{\textquoteright}s dementia: findings from a nationally representative study.}, journal = {Neuropsychology}, volume = {27}, year = {2013}, month = {2013 Jan}, pages = {86-94}, abstract = {

OBJECTIVE: The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer{\textquoteright}s dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers.

METHOD: The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging{\textquoteright}s Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set.

RESULTS: Epsilon 4 increased the rate of progression from normal functioning to MCI (58\% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4.

CONCLUSIONS: The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Apolipoproteins E, Cognitive Dysfunction, disease progression, Female, Genetic Predisposition to Disease, Genetic Testing, Genotype, Humans, Logistic Models, Longitudinal Studies, Male, National Institutes of Health (U.S.), Neuropsychological tests, Risk Factors, United States}, issn = {1931-1559}, doi = {10.1037/a0030855}, url = {http://psycnet.apa.org/journals/neu/27/1/86/}, author = {Brainerd, C. J. and V. F. Reyna and Ronald C Petersen and Glenn E Smith and Kenney, A. E. and C. J. Gross and Taub, E. S. and Brenda L Plassman and Gwenith G Fisher} } @article {7844, title = {BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach.}, journal = {J Gen Intern Med}, volume = {28}, year = {2013}, note = {Copyright - Society of General Internal Medicine 2013 Last updated - 2013-09-09 Bowman, Robert L.; DeLucia, Janice L. Accuracy of self-reported weight: A meta-analysis. Behavior Therapy, 23. 4 (1992): 637-655. Association for Advancement of Behavior Therapy; Elsevier Science Carnethon, Mercedes R, and De Chavez, Peter John D, and Biggs, Mary L, and Lewis, Cora E, and Pankow, James S, and Bertoni, Alain G, and Golden, Sherita H, and Liu, Kiang , and Mukamal, Kenneth J, and Campbell-Jenkins, Brenda , and Dyer, Alan R. Association of Weight Status With Mortality in Adults With Incident Diabetes. JAMA 308:6 Aug 8, 2012 Chaudhry, Z W; Gannon, M C; Nuttall, F Q. Stability of body weight in type 2 diabetes. DIABETES CARE, 29. 3 (2006): 493-497. AMER DIABETES ASSOC COLDITZ, G. A.; MARTIN, P.; STAMPFER, M. J.; WILLETT, W. C.; et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. American journal of epidemiology, 123. 5 (1986): 894-900. Oxford University Press D{\textquoteright}Unger, Amy V; D{\textquoteright}Unger, Amy V; Land, Kenneth C; McCall, Patricia L. How many latent classes of delinquent/criminal careers? Results from mixed Poisson regression analyses. American Journal of Sociology, 103. 6 (1998): 1593-1630 de Fine Olivarius, N.; Andreasen, A. H.; Siersma, V.; Richelsen, B.; et al. Changes in patient weight and the impact of antidiabetic therapy during the first 5 years after diagnosis of diabetes mellitus. DIABETOLOGIA, 49. 9 (2006): 2058-2067. SPRINGER FELDSTEIN, Adrianne C.; NICHOLS, Gregory A.; SMITH, David H.; STEVENS, Victorj.; et al. Weight Change in Diabetes and Glycemic and Blood Pressure Control. Diabetes care, 31. 10 (2008): 1960-1965. American Diabetes Association Feldstein, Adrianne C.; Nichols, Gregory A.; Smith, David H.; Rosales, A. Gabriela; et al. Weight change and glycemic control after diagnosis of type 2 diabetes. JOURNAL OF GENERAL INTERNAL MEDICINE, 23. 9 (2008): 1339-1345. SPRINGER Ferraro, Kenneth F.; Su, Ya-Ping; Gretebeck, Randall J.; Black, David R.; et al. Body mass index and disability in adulthood: A 20-year panel study. American Journal of Public Health, 92. 5 (2002): 834-840. American Public Health Association Inc Goldman, N; Lin, I F; Weinstein, M; Lin, Y H. Evaluating the quality of self-reports of hypertension and diabetes. JOURNAL OF CLINICAL EPIDEMIOLOGY, 56. 2 (2003): 148-154. PERGAMON-ELSEVIER SCIENCE LTD Gorber, S C; Tremblay, M; Moher, D; Gorber, B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obesity Reviews, 8. 4 (2007): 307-326. Blackwell Publishing Guare, J.C.; Wing, R.R.; Grant, A. Comparison of obese NIDDM and nondiabetic women: short- and long-term weight loss. Obesity research, 3. 4 (1995): 329-335 Hensrud, D D; Hensrud, D D. Dietary treatment and long-term weight loss and maintenance in type 2 diabetes. Obesity Research, 9. Suppl. 4 (2001): 348S-353S Wray LA, Blaum C, Ofstedal MB, Herzog R. Diabetes dianosis and weight loss in middle-aged adults. Res Aging. 2004;26(1):62 81. Hoeymans, N; Feskens, EJM; vandenBos, GAM; Kromhout, D. Measuring functional status: Cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993) JOURNAL OF CLINICAL EPIDEMIOLOGY, 49. 10 (1996): 1103-1110. PERGAMON-ELSEVIER SCIENCE LTD Bobby L Jones, and Daniel S Nagin. Advances in Group-Based Trajectory Modeling and an SAS Procedure for Estimating Them. Sociological Methods and Research 35:4 May 2007: 542-571 Juster, F Thomas; Suzman, Richard. An overview of the Health and Retirement Study. Journal of Human Resources, v30. n1 (1995): pS7(50). University of Wisconsin Press Kahng, Sang Kyoung; Dunkle, Ruth E.; Jackson, James S. The Relationship between the Trajectory of Body Mass Index and Health Trajectory among Older Adults: Multilevel Modeling Analyses. Research on Aging, 26. 1 (2004): 31-61. SAGE Publications Inc LANGLOIS, J. A.; MAGGI, S.; HARRIS, T.; SIMONSICK, E. M.; et al. Self-report of difficulty in performing functional activities identifies a broad range of disability in old age. Journal of the American Geriatrics Society, 44. 12 (1996): 1421-1428. Blackwell LOOKER, Helen C.; KNOWLER, William C.; HANSON, Robert L. Changes in BMI and weight before and after the development of type 2 diabetes. Diabetes care, 24. 11 (2001): 1917-1922. American Diabetes Association McAdams, Mara A.; Hu, Frank B.; Van Dam, Rob M. Comparison of self-reported and measured BMI as correlates of disease markers in U.S. adults. Obesity, 15. 1 (2007): 188-196. Nature Publishing Group NAGIN, Daniel S.; TREMBLAY, Richard E. Analyzing developmental trajectories of distinct but related behaviors : A group-based method. Psychological methods, 6. 1 (2001): 18-34. American Psychological Association NIH-NHLBI. Clinical guidelines on the identification. Evaluation, and treatment of overweight and obesity in adults. Clinical guidelines on the identification. Evaluation, and treatment of overweight and obesity in adults (1998) Jacob AN, Salinas K, Adams-Huet B, Raskin P. Weight gain in type 2 diabetes mellitus. Diabetes Obes Metabol. 2007;9(3):386 93. Jones BL, Nagin DS, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Socio Meth Res. 2001;29(3):374 93. Russell-Jones, David; Russell-Jones, David; Khan, Rehman. Insulin-associated weight gain in diabetes - causes, effects and coping strategies. Diabetes, obesity and metabolism., 9. 6 (2007): 799-812 Sairenchi, Toshimi , and Iso, Hiroyasu , and Irie, Fujiko , and Fukasawa, Nobuko , and Ota, Hitoshi , and Muto, Takashi . Underweight as a Predictor of Diabetes in Older Adults: A large cohort study. Diabetes Care 31:3 Mar 2008: 583-4 Suzanne M Shoff, Ronald Klein, Scot E Moss, Barbara E K Klein, and Karen J Cruickshanks. Weight change and glycemic control in a population-based sample of adults with older-onset diabetes. The Journals of Gerontology 53A:1 Jan 1998: M27-32 Turner, R C; Holman, R R; Cull, CA; Stratton, I M; et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) LANCET, 352. 9131 (1998): 837-853. ELSEVIER SCIENCE INC Tuthill, A.; McKenna, M. J.; O{\textquoteright}Shea, D.; McKenna, T. J. Weight changes in type 2 diabetes and the impact of gender. DIABETES OBESITY and METABOLISM, 10. 9 (2008): 726-732. BLACKWELL PUBLISHING Wang, Ching-Yi; Sheu, Ching-Fan; Protas, Elizabeth. Construct validity and physical performance of older adults in different hierarchical physical-disability levels. JOURNAL OF AGING AND PHYSICAL ACTIVITY, 15. 1 (2007): 75-89. HUMAN KINETICS PUBL INC WRAY, L. A.; HERZOG, A. R.; WILLIS, R. J.; WALLACE, R. B. The impact of education and heart attack on smoking cessation among middle-aged adults. Journal of health and social behavior, 39. 4 (1998): 271-294. American Sociological Association Zamboni, M.; Mazzali, G.; Zoico, E.; Di Francesco, V.; et al. Health consequences of obesity in the elderly: A review of four unresolved questions. International Journal of Obesity, 29. 9 (2005): 1011-1029. Nature Publishing Group}, month = {2013 Sep}, pages = {1150-6}, publisher = {28}, abstract = {

BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability.

OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes.

DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories.

PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064).

MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined.

RESULTS: Four distinct weight trajectories (stable normal weight, 28.7~\%; stable overweight, 46.2~\%; loss and regain obese, 18.0~\%; weight cumulating morbidly obese, 7.1~\%) and three disability trajectories (little or low increase, 34.4~\%; moderate increase, 45.4~\%; chronic high increase, 20.2~\%) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group.

CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.

}, keywords = {Activities of Daily Living, Body Mass Index, Diabetes Mellitus, Type 2, Disability Evaluation, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Obesity, Obesity, Morbid, Overweight, Retrospective Studies, United States, Weight Gain, Weight Loss}, issn = {1525-1497}, doi = {10.1007/s11606-013-2399-z}, author = {Chiu, Ching-Ju and Linda A. Wray and Lu, Feng-hwa and Elizabeth A Beverly} } @article {10279, title = {Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study.}, journal = {J Manipulative Physiol Ther}, volume = {36}, year = {2013}, month = {2013 Nov-Dec}, pages = {572-84}, abstract = {

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Disability Evaluation, Female, Geriatric Assessment, Humans, Low Back Pain, Male, Manipulation, Chiropractic, Medicare, Mobility Limitation, Musculoskeletal Diseases, Patient Satisfaction, Quality of Life, Risk Assessment, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2013.08.008}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24636108}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Frederic D Wolinsky} } @article {7830, title = {Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Jun 24, 2013 Last updated - 2013-07-12 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Jun 24}, pages = {1100-7}, publisher = {173}, abstract = {

IMPORTANCE: Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration.

OBJECTIVE: To examine the role of beneficiaries{\textquoteright} cognitive abilities in explaining this puzzle.

DESIGN AND SETTING: Analysis of survey data from the nationally representative Health and Retirement Study.

PARTICIPANTS: Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying.

MAIN OUTCOMES AND MEASURES: Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions.

RESULTS: Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5\% vs 52.0\%; P = .002), LIS awareness (58.3\% vs 33.3\%; P = .001), and LIS application (25.5\% vs 12.7\%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02).

CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.

}, keywords = {Cognition, Comprehension, Cost Sharing, Eligibility Determination, Health Care Surveys, Humans, Medicare, Medicare Part D, Poverty, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.845}, author = {Ifedayo Kuye and Richard G Frank and J. Michael McWilliams} } @article {7896, title = {Cohorts based on decade of death: no evidence for secular trends favoring later cohorts in cognitive aging and terminal decline in the AHEAD study.}, journal = {Psychol Aging}, volume = {28}, year = {2013}, month = {2013 Mar}, pages = {115-27}, publisher = {28}, abstract = {

Studies of birth-year cohorts examined over the same age range often report secular trends favoring later-born cohorts, who are cognitively fitter and show less steep cognitive declines than earlier-born cohorts. However, there is initial evidence that those advantages of later-born cohorts do not carry into the last years of life, suggesting that pervasive mortality-related processes minimize differences that were apparent earlier in life. Elaborating this work from an alternative perspective on cohort differences, we compared rates of cognitive aging and terminal decline in episodic memory between cohorts based on the year participants had died, earlier (between 1993 and 1999) or later in historical time (between 2000 and 2010). Specifically, we compared trajectories of cognitive decline in 2 death-year cohorts of participants in the Asset and Health Dynamics Among the Oldest Old study that were matched on age at death and education and controlled for a variety of additional covariates. Results revealed little evidence of secular trends favoring later cohorts. To the contrary, the cohort that died in the 2000s showed a less favorable trajectory of age-related memory decline than the cohort that died in the 1990s. In examinations of change in relation to time to death, the cohort dying in the 2000s experienced even steeper terminal declines than the cohort dying in the 1990s. We suggest that secular increases in "manufacturing" survival may exacerbate age- and mortality-related cognitive declines among the oldest old.

}, keywords = {Aged, Aged, 80 and over, Aging, Death, Epidemiologic Research Design, Female, Health Surveys, Humans, Longitudinal Studies, Male, Memory Disorders, Memory, Episodic, Time Factors, United States}, issn = {1939-1498}, doi = {10.1037/a0029965}, author = {H{\"u}l{\"u}r, Gizem and Frank J Infurna and Ram, Nilam and Denis Gerstorf} } @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 {7914, title = {Dementia and out-of-pocket spending on health care services.}, journal = {Alzheimers Dement}, volume = {9}, year = {2013}, note = {Times Cited: 0}, month = {2013 Jan}, pages = {19-29}, publisher = {9}, abstract = {

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.

}, keywords = {Aged, Dementia, Female, Financing, Personal, Health Expenditures, Humans, Male}, issn = {1552-5279}, doi = {10.1016/j.jalz.2011.11.003}, author = {Delavande, Adeline and Michael D Hurd and Martorell, Paco and Kenneth M. Langa} } @article {7789, title = {Disability during the last two years of life.}, journal = {JAMA Intern Med}, volume = {173}, year = {2013}, note = {Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US}, month = {2013 Sep 09}, pages = {1506-13}, publisher = {173}, abstract = {

IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life.

OBJECTIVE: To determine national estimates of disability during the last 2 years of life.

DESIGN: Prospective cohort study.

SETTING: A nationally representative study of older adults in the United States.

PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex.

MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet.

RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52\% women). The prevalence of disability increased from 28\% (95\% CI, 24\%-31\%) 2 years before death to 56\% (95\% CI, 52\%-60\%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14\%; 70-79 years, 21\%; 80-89 years, 32\%; 90 years or more, 50\%; P for trend, <.001). Disability was more common in women 2 years before death (32\% [95\% CI, 28\%-36\%]) than men (21\% [95\% CI, 18\%-25\%]; P < .001), even after adjustment for older age at death.

CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Educational Status, Female, Frail Elderly, Humans, Income, Longitudinal Studies, Male, Marital Status, Middle Aged, Prospective Studies, Sex Distribution, Socioeconomic factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2013.8738}, author = {Alexander K Smith and Louise C Walter and Yinghui Miao and W John Boscardin and Kenneth E Covinsky} } @article {7796, title = {Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study.}, journal = {Ethn Dis}, volume = {23}, year = {2013}, month = {2013 Spring}, pages = {155-60}, publisher = {23}, abstract = {

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95\% CI: 1.33, 1.61; Blacks: HR=1.42, 95\% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13\% excess hazard of CVD mortality (HR=1.13, 95\% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95\% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

}, keywords = {Aged, Black or African American, Cardiovascular Diseases, depression, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Risk Assessment, Risk Factors, White People}, issn = {1049-510X}, author = {Benjamin D Capistrant and Paola Gilsanz and J Robin Moon and Anna Kosheleva and Kristen K Patton and M. Maria Glymour} } @article {7834, title = {Early life predictors of atrial fibrillation-related mortality: evidence from the health and retirement study.}, journal = {Health Place}, volume = {21}, year = {2013}, month = {2013 May}, pages = {133-9}, publisher = {21}, abstract = {

Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality.

}, keywords = {Aged, Atrial Fibrillation, Child, Geography, Medical, Humans, Middle Aged, Risk Factors, Social determinants of health, Socioeconomic factors, Southeastern United States}, issn = {1873-2054}, doi = {10.1016/j.healthplace.2012.12.008}, author = {M. Maria Glymour and Emelia J Benjamin and Anna Kosheleva and Paola Gilsanz and Lesley H Curtis and Kristen K Patton} } @article {7929, title = {Fall-associated difficulty with activities of daily living in functionally independent individuals aged 65 to 69 in the United States: a cohort study.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jan}, pages = {96-100}, publisher = {61}, abstract = {

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

DESIGN: Longitudinal analysis.

SETTING: Community.

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

MEASUREMENTS: ADL difficulty.

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

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

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aging, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Status, Humans, Male, Odds Ratio, Retrospective Studies, Risk Factors, United States, Wounds and Injuries}, issn = {1532-5415}, doi = {10.1111/jgs.12071}, author = {Nishant K. Sekaran and Choi, Hwajung and Rodney A. Hayward and Kenneth M. Langa} } @article {7816, title = {Former stepparents{\textquoteright} contact with their stepchildren after midlife.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, note = {Copyright - Copyright Oxford University Press, UK May 2013 Last updated - 2013-04-19 DOI - 2948942401; 77441762; 9698; PGN2; INODPGN20000698908}, month = {2013 May}, pages = {409-19}, publisher = {68}, abstract = {

OBJECTIVES: Based on the life course perspective and gender differences in stepparental roles, this study examines frequency of social contact between mid- to late-life stepparents and their stepchildren after stepparents{\textquoteright} marriage to their stepchildren{\textquoteright}s biological parent has been dissolved through widowhood or divorce.

METHOD: Using 5 waves of panel data on stepparent-stepchild pairs from the Health and Retirement Study (N = 12,947 stepchild observations on 4,063 stepchildren belonging to 1,663 stepparents) spanning 10 years (1998-2008), I estimate ordered logit multilevel models predicting former stepparent-stepchild contact frequency.

RESULTS: Results indicate that former stepparents have notably less frequent contact with their stepchildren than current stepparents, particularly following divorce. Widowed stepparents{\textquoteright} contact with their stepchildren diminishes gradually following union disruption, whereas divorced stepparents{\textquoteright} contact frequency drops abruptly. Former stepfathers have less contact with their stepchildren than former stepmothers. Finally, I uncover evidence of the moderating role of (step)parents{\textquoteright} marriage length and stepparents{\textquoteright} number of biological children on widowed stepparent-stepchild contact frequency.

DISCUSSION: Older stepparents{\textquoteright} social contact with their stepchildren is largely conditional on stepparents{\textquoteright} enduring marital bond to their stepchildren{\textquoteright}s biological parent. This study contributes to a growing literature portraying relatively weak ties between older adults and their stepchildren.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Child, Family Characteristics, Female, Health Surveys, Humans, Male, Marital Status, Middle Aged, Parent-Child Relations, Parents, Social Support, Young Adult}, issn = {1758-5368}, doi = {10.1093/geronb/gbt021}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1329184768?accountid=14667}, author = {Claire No{\"e}l-Miller} } @article {7801, title = {Functional disability, cognitive impairment, and depression after hospitalization for pneumonia.}, journal = {Am J Med}, volume = {126}, year = {2013}, month = {2013 Jul}, pages = {615-24.e5}, abstract = {

OBJECTIVE: The study objective was to examine whether hospitalization for pneumonia is associated with functional decline, cognitive impairment, and depression, and to compare this impairment with that seen after known disabling conditions, such as myocardial infarction or stroke.

METHODS: We used data from a prospective cohort of 1434 adults aged more than 50 years who survived 1711 hospitalizations for pneumonia, myocardial infarction, or stroke drawn from the Health and Retirement Study (1998-2010). Main outcome measures included the number of Activities and Instrumental Activities of Daily Living requiring assistance and the presence of cognitive impairment and substantial depressive symptoms.

RESULTS: Hospitalization for pneumonia was associated with 1.01 new impairments in Activities and Instrumental Activities of Daily Living (95\% confidence interval [CI], 0.71-1.32) among patients without baseline functional impairment and 0.99 new impairments in Activities and Instrumental Activities of Daily Living (95\% CI, 0.57-1.41) among those with mild-to-moderate baseline limitations, as well as moderate-to-severe cognitive impairment (odds ratio, 2.46; 95\% CI, 1.60-3.79) and substantial depressive symptoms (odds ratio, 1.63; 95\% CI, 1.06-2.51). Patients without baseline functional impairment who survived pneumonia hospitalization had more subsequent impairments in Activities and Instrumental Activities of Daily Living than those who survived myocardial infarction hospitalization. There were no significant differences in subsequent moderate-to-severe cognitive impairment or substantial depressive symptoms between patients who survived myocardial infarction or stroke and those who survived pneumonia.

CONCLUSIONS: Hospitalization for pneumonia in older adults is associated with subsequent functional and cognitive impairment. Improved pneumonia prevention and interventions to ameliorate adverse sequelae during and after hospitalization may improve outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognitive Dysfunction, depression, Hospitalization, Humans, Logistic Models, Longitudinal Studies, Middle Aged, Myocardial Infarction, Pneumonia, Stroke}, issn = {1555-7162}, doi = {10.1016/j.amjmed.2012.12.006}, author = {Dimitry S Davydow and Catherine L Hough and Deborah A Levine and Kenneth M. Langa and Theodore J Iwashyna} } @article {7799, title = {Functional limitations in older adults who have cognitive impairment without dementia.}, journal = {J Geriatr Psychiatry Neurol}, volume = {26}, year = {2013}, note = {NLM Title Abbreviation: J Geriatr Psychiatry Neurol}, month = {2013 Jun}, pages = {78-85}, abstract = {

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged >= 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9\%) had dementia, 201 (21.3\%) had CIND, and 280 (64.8\%) had normal cognition. Informants reported >=1 instrumental activities of daily living (ADLs) limitation in 45\% of the patients with CIND compared to 13\% of the patients with normal cognition and 85\% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40\%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cognitive Dysfunction, Dementia, Female, Humans, Male, Neuropsychological tests, Severity of Illness Index, Surveys and Questionnaires}, issn = {0891-9887}, doi = {10.1177/0891988713481264}, author = {Tanya R Gure and Kenneth M. Langa and Gwenith G Fisher and John D Piette and Brenda L Plassman} } @article {8603, title = {Genetics in population health science: strategies and opportunities.}, journal = {Am J Public Health}, volume = {103 Suppl 1}, year = {2013}, month = {2013 Oct}, pages = {S73-83}, abstract = {

Translational research is needed to leverage discoveries from the frontiers of genome science to improve public health. So far, public health researchers have largely ignored genetic discoveries, and geneticists have ignored important aspects of population health science. This mutual neglect should end. In this article, we discuss 3 areas where public health researchers can help to advance translation: (1) risk assessment: investigate genetic profiles as components in composite risk assessments; (2) targeted intervention: conduct life-course longitudinal studies to understand when genetic risks manifest in development and whether intervention during sensitive periods can have lasting effects; and (3) improved understanding of environmental causation: collaborate with geneticists on gene-environment interaction research. We illustrate with examples from our own research on obesity and smoking.

}, keywords = {Gene-Environment Interaction, Genetic Engineering, Genetic Research, Humans, Obesity, Public Health, Risk Assessment, Smoking, Translational Medical Research}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301139}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786748/}, author = {Daniel W. Belsky and Terrie E Moffitt and Caspi, Avshalom} } @article {8608, title = {Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations.}, journal = {Am J Hum Genet}, volume = {93}, year = {2013}, month = {2013 Sep 05}, pages = {545-54}, abstract = {

High blood pressure (BP) is more prevalent and contributes to more severe manifestations of cardiovascular disease (CVD) in African Americans than in any other United States ethnic group. Several small African-ancestry (AA) BP genome-wide association studies (GWASs) have been published, but their findings have failed to replicate to date. We report on a large AA BP GWAS meta-analysis that includes 29,378 individuals from 19 discovery cohorts and subsequent replication in additional samples of AA (n = 10,386), European ancestry (EA) (n = 69,395), and East Asian ancestry (n = 19,601). Five loci (EVX1-HOXA, ULK4, RSPO3, PLEKHG1, and SOX6) reached genome-wide significance (p < 1.0~{\texttimes} 10(-8)) for either systolic or diastolic BP in a transethnic meta-analysis after correction for multiple testing. Three of these BP loci (EVX1-HOXA, RSPO3, and PLEKHG1) lack previous associations with BP. We also identified one independent signal in a known BP locus (SOX6) and provide evidence for fine mapping in four additional validated BP loci. We also demonstrate that validated EA BP GWAS loci, considered jointly, show significant effects in AA samples. Consequently, these findings suggest that BP loci might have universal effects across studied populations, demonstrating that multiethnic samples are an essential component in identifying, fine mapping, and understanding their trait variability.

}, keywords = {Africa, African Continental Ancestry Group, Blood pressure, Cohort Studies, Databases, Genetic, Genetic Loci, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Polymorphism, Single Nucleotide, Quantitative Trait, Heritable, Reproducibility of Results}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2013.07.010}, author = {Franceschini, Nora and Fox, Ervin and Zhang, Zhaogong and Edwards, Todd L and Michael A Nalls and Yun Ju Sung and Bamidele O Tayo and Yan V Sun and Gottesman, Omri and Adebawole Adeyemo and Andrew D Johnson and Young, J Hunter and Kenneth Rice and Duan, Qing and Chen, Fang and Yun Li and Tang, Hua and Myriam Fornage and Keene, Keith L and Andrews, Jeanette S and Jennifer A Smith and Jessica Faul and Guangfa, Zhang and Guo, Wei and Liu, Yu and Murray, Sarah S and Musani, Solomon K and Srinivasan, Sathanur and Digna R Velez Edwards and Wang, Heming and Becker, Lewis C and Bovet, Pascal and Bochud, Murielle and Broeckel, Ulrich and Burnier, Michel and Carty, Cara and Daniel I Chasman and Georg B Ehret and Chen, Wei-Min and Chen, Guanjie and Wei Chen and Ding, Jingzhong and Dreisbach, Albert W and Michele K Evans and Guo, Xiuqing and Melissa E Garcia and Jensen, Rich and Keller, Margaux F and Lettre, Guillaume and Lotay, Vaneet and Martin, Lisa W and Moore, Jason H and Alanna C Morrison and Thomas H Mosley and Ogunniyi, Adesola and Walter R Palmas and George J Papanicolaou and Alan Penman and Polak, Joseph F and Ridker, Paul M and Babatunde Salako and Andrew B Singleton and Daniel Shriner and Kent D Taylor and Ramachandran S Vasan and Kerri Wiggins and Williams, Scott M and Yanek, Lisa R and Wei Zhao and Alan B Zonderman and Becker, Diane M and Berenson, Gerald and Boerwinkle, Eric and Erwin P Bottinger and Cushman, Mary and Charles B Eaton and Nyberg, Fredrik and Gerardo Heiss and Joel N Hirschhron and Howard, Virginia J and Karczewsk, Konrad J and Lanktree, Matthew B and Liu, Kiang and Yongmei Liu and Ruth J F Loos and Margolis, Karen and Snyder, Michael and Psaty, Bruce M and Schork, Nicholas J and David R Weir and Charles N Rotimi and Sale, Michele M and Tamara B Harris and Sharon L R Kardia and Hunt, Steven C and Donna K Arnett and Redline, Susan and Cooper, Richard S and Neil Risch and Rao, D C and Rotter, Jerome I and Chakravarti, Aravinda and Reiner, Alex P and Levy, Daniel and Keating, Brendan J and Zhu, Xiaofeng} } @article {8620, title = {GWAS of 126,559 individuals identifies genetic variants associated with educational attainment.}, journal = {Science}, volume = {340}, year = {2013}, month = {2013 Jun 21}, pages = {1467-71}, abstract = {

A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02\%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2\% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.

}, keywords = {Cognition, Educational Status, Endophenotypes, Female, Genetic Loci, Genome-Wide Association Study, Humans, Male, Multifactorial Inheritance, Polymorphism, Single Nucleotide}, issn = {1095-9203}, doi = {10.1126/science.1235488}, author = {Cornelius A Rietveld and Sarah E Medland and Derringer, Jaime and Yang, Jian and T{\~o}nu Esko and Martin, Nicolas W and Westra, Harm-Jan and Shakhbazov, Konstantin and Abdel Abdellaoui and Agrawal, Arpana and Albrecht, Eva and Alizadeh, Behrooz Z and Amin, Najaf and Barnard, John and Baumeister, Sebastian E and Benke, Kelly S and Bielak, Lawrence F and Boatman, Jeffrey A and Patricia A. Boyle and Gail Davies and Christiaan de Leeuw and Eklund, Niina and Daniel S Evans and Rudolf Ferhmann and Fischer, Krista and Gieger, Christian and Gjessing, H{\r a}kon K and H{\"a}gg, Sara and Harris, Jennifer R and Caroline Hayward and Holzapfel, Christina and Carla A Ibrahim-Verbaas and Ingelsson, Erik and Jacobsson, Bo and Joshi, Peter K and Jugessur, Astanand and Marika A Kaakinen and Kanoni, Stavroula and Karjalainen, Juha and Kolcic, Ivana and Kristiansson, Kati and Kutalik, Zolt{\'a}n and J. Lahti and Lee, Sang H and Lin, Peng and Penelope A Lind and Yongmei Liu and Kurt Lohman and Loitfelder, Marisa and McMahon, George and Vidal, Pedro Marques and Osorio Meirelles and Lili Milani and Myhre, Ronny and Nuotio, Marja-Liisa and Christopher J Oldmeadow and Katja E Petrovic and Wouter J Peyrot and Polasek, Ozren and Quaye, Lydia and Reinmaa, Eva and Rice, John P and Rizzi, Thais S and Schmidt, Helena and Schmidt, Reinhold and Albert Vernon Smith and Jennifer A Smith and Toshiko Tanaka and Antonio Terracciano and van der Loos, Matthijs J H M and Vitart, Veronique and V{\"o}lzke, Henry and J{\"u}rgen Wellmann and Lei Yu and Wei Zhao and Allik, J{\"u}ri and John R. Attia and Bandinelli, Stefania and Bastardot, Fran{\c c}ois and Jonathan P. Beauchamp and David A Bennett and Klaus Berger and Laura Bierut and Dorret I Boomsma and B{\"u}ltmann, Ute and Campbell, Harry and Chabris, Christopher F and Cherkas, Lynn and Chung, Mina K and Francesco Cucca and de Andrade, Mariza and Philip L de Jager and De Neve, Jan-Emmanuel and Ian J Deary and George Dedoussis and Deloukas, Panos and Dimitriou, Maria and Gu{\dh}ny Eir{\'\i}ksd{\'o}ttir and Elderson, Martin F and Johan G Eriksson and Jessica Faul and Luigi Ferrucci and Melissa E Garcia and Gr{\"o}nberg, Henrik and Gu{\dh}nason, Vilmundur and Hall, Per and Harris, Juliette M and Tamara B Harris and Nicholas D Hastie and Andrew C Heath and Dena G Hernandez and Hoffmann, Wolfgang and Hofman, Adriaan and Holle, Rolf and Holliday, Elizabeth G and Jouke-Jan Hottenga and Iacono, William G and Illig, Thomas and J{\"a}rvelin, Marjo-Riitta and K{\"a}h{\"o}nen, Mika and Kaprio, Jaakko and Kirkpatrick, Robert M and Kowgier, Matthew and Latvala, Antti and Lenore J Launer and Lawlor, Debbie A and Lehtim{\"a}ki, Terho and Li, Jingmei and Paul Lichtenstein and Lichtner, Peter and David C Liewald and Pamela A F Madden and Patrik K E Magnusson and M{\"a}kinen, Tomi E and Masala, Marco and McGue, Matt and Andres Metspalu and Mielck, Andreas and Michael B Miller and Grant W Montgomery and Mukherjee, Sutapa and Nyholt, Dale R and Ben A Oostra and Palmer, Lyle J and Aarno Palotie and Brenda W J H Penninx and Markus Perola and Peyser, Patricia A and Preisig, Martin and Katri R{\"a}ikk{\"o}nen and Olli T Raitakari and Realo, Anu and Ring, Susan M and Ripatti, Samuli and Fernando Rivadeneira and Rudan, Igor and Rustichini, Aldo and Veikko Salomaa and Sarin, Antti-Pekka and Schlessinger, David and Rodney J Scott and Snieder, Harold and St Pourcain, Beate and John M Starr and Sul, Jae Hoon and Surakka, Ida and Svento, Rauli and Teumer, Alexander and Henning Tiemeier and van Rooij, Frank J A and Van Wagoner, David R and Vartiainen, Erkki and Viikari, Jorma and Vollenweider, Peter and Vonk, Judith M and Waeber, G{\'e}rard and David R Weir and Wichmann, H-Erich and Elisabeth Widen and Gonneke Willemsen and James F Wilson and Alan F Wright and Dalton C Conley and Davey-Smith, George and Lude L Franke and Groenen, Patrick J F and Hofman, Albert and Johannesson, Magnus and Sharon L R Kardia and Krueger, Robert F and David I Laibson and Nicholas G Martin and Meyer, Michelle N and Posthuma, Danielle and A. Roy Thurik and Nicholas J Timpson and Andr{\'e} G Uitterlinden and Cornelia M van Duijn and Peter M Visscher and Daniel J. Benjamin and Cesarini, David and Philipp D Koellinger} } @article {7916, title = {Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Feb}, pages = {136-58}, publisher = {25}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, depression, Female, Health Status, Health Transition, Humans, Longitudinal Studies, Male, Marriage, Memory Disorders, Middle Aged, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbs111}, url = {http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html}, author = {Kandauda Wickrama and Jay A. Mancini and Kwag, Kyunghwa and Kwon, Josephine} } @article {8745, title = {Hospital and nursing home use from 2002 to 2008 among U.S. older adults with cognitive impairment, not dementia in 2002.}, journal = {Alzheimer Dis Assoc Disord}, volume = {27}, year = {2013}, month = {2013 Oct-Dec}, pages = {372-8}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition Disorders, Dementia, Female, Homes for the Aged, Hospitalization, Humans, Male, Nursing homes, United States}, issn = {1546-4156}, doi = {10.1097/WAD.0b013e318276994e}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00002093-201310000-00012}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller and Kenneth M. Langa and Frederick W Unverzagt and Christopher M. Callahan} } @article {7892, title = {Impact of cigarette smoking on utilization of nursing home services.}, journal = {Nicotine Tob Res}, volume = {15}, year = {2013}, month = {2013 Nov}, pages = {1902-9}, abstract = {

INTRODUCTION: Few studies have examined the effects of smoking on nursing home utilization, generally using poor data on smoking status. No previous study has distinguished utilization for recent from long-term quitters.

METHODS: Using the Health and Retirement Study, we assessed nursing home utilization by never-smokers, long-term quitters (quit >3 years), recent quitters (quit <=3 years), and current smokers. We used logistic regression to evaluate the likelihood of a nursing home admission. For those with an admission, we used negative binomial regression on the number of nursing home nights. Finally, we employed zero-inflated negative binomial regression to estimate nights for the full sample.

RESULTS: Controlling for other variables, compared with never-smokers, long-term quitters have an odds ratio (OR) for nursing home admission of 1.18 (95\% CI: 1.07-1.2), current smokers 1.39 (1.23-1.57), and recent quitters 1.55 (1.29-1.87). The probability of admission rises rapidly with age and is lower for African Americans and Hispanics, more affluent respondents, respondents with a spouse present in the home, and respondents with a living child. Given admission, smoking status is not associated with length of stay (LOS). LOS is longer for older respondents and women and shorter for more affluent respondents and those with spouses present.

CONCLUSIONS: Compared with otherwise identical never-smokers, former and current smokers have a significantly increased risk of nursing home admission. That recent quitters are at greatest risk of admission is consistent with evidence that many stop smoking because they are sick, often due to smoking.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Black or African American, Cross-Sectional Studies, Female, Hispanic or Latino, Humans, Length of Stay, Logistic Models, Longitudinal Studies, Male, Middle Aged, Nursing homes, Risk, Self Report, Smoking, Socioeconomic factors, United States, White People}, issn = {1469-994X}, doi = {10.1093/ntr/ntt079}, url = {http://ntr.oxfordjournals.org/content/early/2013/06/18/ntr.ntt079.abstract}, author = {Kenneth E. Warner and Ryan J McCammon and Brant E Fries and Kenneth M. Langa} } @article {7762, title = {The influence of unpaid work on the transition out of full-time paid work.}, journal = {Gerontologist}, volume = {53}, year = {2013}, month = {2013 Feb}, pages = {92-101}, abstract = {

PURPOSE: Continued employment after retirement and engagement in unpaid work are both important ways of diminishing the negative economic effects of the retirement of baby boomer cohorts on society. Little research, however, examines the relationship between paid and unpaid work at the transition from full-time work. Using a resource perspective framework this study examines how engagement in unpaid work prior to and at the transition from full-time work influences whether individuals partially or fully retire.

DESIGN AND METHODS: This study used a sample of 2,236 Americans between the ages 50 and 68, who were interviewed between 1998 and 2008. Logistic regression was used to estimate transitioning into partial retirement (relative to full retirement) after leaving full-time work.

RESULTS: We found that the odds of transitioning into part-time work were increased by continuous volunteering (78\%) and reduced by starting parental (84\%), grandchild (41\%), and spousal (90\%) caregiving and unaffected by all other patterns of engagement in unpaid work.

IMPLICATIONS: Our findings suggest that volunteering is complementary with a transition to part-time work, and starting a new caregiving role at this transitioncreates a barrier to continued employment. In order to provide workers the opportunity to engage in the work force longer at the brink of retirement, it may be necessary to increase the support mechanisms for those who experience new caregiving responsibilities.

}, keywords = {Age Factors, Aged, Employment, Female, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Retirement, Salaries and Fringe Benefits, Volunteers, Work}, issn = {1758-5341}, doi = {10.1093/geront/gns080}, author = {Dawn C Carr and Ben Lennox Kail} } @article {7913, title = {Latent heterogeneity in long-term trajectories of body mass index in older adults.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Mar}, pages = {342-63}, publisher = {25}, abstract = {

OBJECTIVE: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults.

METHODS: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI).

RESULTS: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory $\#$1), overweight and increasing (trajectory $\#$2), borderline-obese and increasing (trajectory $\#$3), obese and increasing (trajectory $\#$4), and morbidly obese with decelerating gain (trajectory $\#$5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males.

DISCUSSION: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.

}, keywords = {Aging, Black or African American, Body Mass Index, Female, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Obesity, Morbid, Overweight, Risk Factors, Sex Distribution, United States}, issn = {1552-6887}, doi = {10.1177/0898264312468593}, author = {Anda Botoseneanu and Jersey Liang} } @article {7955, title = {Longer lived parents: protective associations with cancer incidence and overall mortality.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {68}, year = {2013}, note = {Times Cited: 0}, month = {2013 Nov}, pages = {1409-18}, publisher = {68}, abstract = {

BACKGROUND: Children of centenarians have lower cardiovascular disease prevalence and live longer. We aimed to estimate associations between the full range of parental attained ages and health status in a middle-aged U.S. representative sample.

METHODS: Using Health and Retirement Study data, models estimated disease incidence and mortality hazards for respondents aged 51-61 years at baseline, followed up for 18 years. Full adjustment included sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. Mother{\textquoteright}s and father{\textquoteright}s attained age distributions were used to define short-, intermediate-, and long-lived groups, yielding a ranked parental longevity score (n = 6,055, excluding short-long discordance). Linear models (n = 8,340) tested mother{\textquoteright}s or father{\textquoteright}s attained ages, adjusted for each other.

RESULTS: With increasing mother{\textquoteright}s or father{\textquoteright}s survival (>65 years), all-cause mortality declined 19\% (hazard ratio [HR] = 0.81, 95\% CI: 0.76-0.86, p < .001) and 14\% per decade (HR = 0.87, 95\% CI: 0.81-0.92, p < .001). Estimates changed only modestly when fully adjusted. Parent-in-law survival was not associated with mortality (n = 1,809, HR = 1.00, 95\% CI: 0.90-1.12, p = .98). Offspring with one or two long-lived parents had lower cancer incidence (938 cases, HR per parental longevity score = 0.76, 95\% CI: 0.61-0.94, p = .01) versus two intermediate parents. Similar HRs for diabetes (HR = 0.89, 95\% CI: 0.84-0.96, p = .001), heart disease (HR = 0.88, 95\% CI: 0.82-0.93, p < .001), and stroke (HR = 0.86, 95\% CI: 0.78-0.95, p = .002) were significant, but there was no trend for arthritis.

CONCLUSIONS: The results provide the first robust evidence that increasing parental attained age is associated with lower cancer incidence in offspring. Health advantages of having centenarian parents extend to a wider range of parental longevity and may provide a quantitative trait of slower aging.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Incidence, Longevity, Male, Middle Aged, Mortality, Neoplasms, Parents}, issn = {1758-535X}, doi = {10.1093/gerona/glt061}, author = {Ambarish Dutta and Henley, William and Robine, Jean-Marie and Kenneth M. Langa and Robert B Wallace and David Melzer} } @article {7798, title = {Monetary costs of dementia in the United States.}, journal = {N Engl J Med}, volume = {368}, year = {2013}, month = {2013 Apr 04}, pages = {1326-34}, publisher = {386}, abstract = {

BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.

METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers.

RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7\%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95\% confidence interval [CI], $42,746 to $69,834) or $41,689 (95\% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.

CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

}, keywords = {Aged, Aged, 80 and over, Cost of Illness, Dementia, Female, Health Care Costs, Home Care Services, Home Nursing, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Nursing homes, United States}, issn = {1533-4406}, doi = {10.1056/NEJMsa1204629}, url = {http://www.nejm.org/doi/full/10.1056/NEJMsa1204629}, author = {Michael D Hurd and Martorell, Paco and Delavande, Adeline and Kathleen J Mullen and Kenneth M. Langa} } @article {7752, title = {Out-of-pocket spending in the last five years of life.}, journal = {J Gen Intern Med}, volume = {28}, year = {2013}, month = {2013 Feb}, pages = {304-9}, publisher = {28}, abstract = {

BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.

DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries{\textquoteright} total out-of-pocket healthcare expenditures over the last 5 years of life.

PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject{\textquoteright}s date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209).

MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars.

RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 \% Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 \% CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 \% of subjects{\textquoteright} expenditures exceeded baseline total household assets, and 43 \% of subjects{\textquoteright} spending surpassed their non-housing assets. Among those survived by a spouse, 10 \% exceeded total baseline assets and 24 \% exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer{\textquoteright}s disease.

CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.

}, keywords = {Aged, Cause of Death, Female, Health Expenditures, Health Services for the Aged, Humans, Male, Marital Status, Medicare, Retrospective Studies, Socioeconomic factors, Terminal Care, United States}, issn = {1525-1497}, doi = {10.1007/s11606-012-2199-x}, author = {Amy Kelley and Kathleen McGarry and Sean Fahle and Samuel M Marshall and Qingling Du and Jonathan S Skinner} } @article {7859, title = {Pain among older Hispanics in the United States: is acculturation associated with pain?}, journal = {Pain Med}, volume = {14}, year = {2013}, note = {Times Cited: 0}, month = {2013 Aug}, pages = {1134-9}, publisher = {14}, abstract = {

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

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

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

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

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

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

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

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

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

DESIGN: Prospective cohort study.

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7860, title = {Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults.}, journal = {Am J Epidemiol}, volume = {178}, year = {2013}, note = {Times Cited: 0}, month = {2013 Sep 01}, pages = {667-75}, publisher = {178}, abstract = {

Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study{\textquoteright}s graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4\% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95\% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.

}, keywords = {Age Factors, Anxiety Disorders, Cohort Studies, Extraversion, Psychological, Female, Humans, Male, Middle Aged, Mortality, Neuroticism, Personality, Prospective Studies, Risk Factors, Sex Factors, Socioeconomic factors}, issn = {1476-6256}, doi = {10.1093/aje/kwt170}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23911610}, author = {Markus Jokela and G David Batty and Solja T. Nyberg and Virtanen, Marianna and Nabi, Hermann and Archana Singh-Manoux and Mika Kivim{\"a}ki} } @article {7800, title = {Personality profile of the children of long-lived parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {730-8}, abstract = {

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

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

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

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

}, keywords = {Aged, Extraversion, Psychological, Fathers, Female, Health Status, Humans, Interviews as Topic, Longevity, Longitudinal Studies, Male, Mothers, Parents, Personality, Personality Inventory, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt003}, author = {Evangelia E Antoniou and Ambarish Dutta and Kenneth M. Langa and David Melzer and David J Llewellyn} } @article {7894, title = {Predicting 10-year mortality for older adults.}, journal = {JAMA}, volume = {309}, year = {2013}, month = {2013 Mar 06}, pages = {874-6}, publisher = {309}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Forecasting, Humans, Kaplan-Meier Estimate, Life Expectancy, Male, Middle Aged, Mortality, Risk Assessment, United States}, issn = {1538-3598}, doi = {10.1001/jama.2013.1184}, author = {Cruz, Marisa and Kenneth E Covinsky and Eric W Widera and Stijacic-Cenzer, Irena and Sei J. Lee} } @article {7833, title = {A prospective study of volunteerism and hypertension risk in older adults.}, journal = {Psychol Aging}, volume = {28}, year = {2013}, note = {Copyright - Copyright American Psychological Association Jun 2013 Last updated - 2013-06-30}, month = {2013 Jun}, pages = {578-86}, publisher = {28}, abstract = {

The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95\% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk.

}, keywords = {Aged, Aged, 80 and over, Female, Health Surveys, Humans, Hypertension, Male, Middle Aged, Prospective Studies, Risk Assessment, Time Factors, Volunteers}, issn = {1939-1498}, doi = {10.1037/a0032718}, author = {Rodlescia S. Sneed and Cohen, Sheldon} } @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 {7795, title = {The role of pain in understanding racial/ethnic differences in the frequency of physical activity among older adults.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Apr}, pages = {405-21}, publisher = {25}, abstract = {

OBJECTIVE: To evaluate racial/ethnic differences in physical activity among white, black, and Hispanic adults aged 65 years and older, and to assess the potential role of pain as a mediator.

METHODS: Analyses were based on data from the 2008 Health and Retirement Study. Logistic regression was used to evaluate associations between race/ethnicity and pain and the odds of regular physical activity.

RESULTS: Compared to Whites, the odds of both light physical activity and moderate/vigorous physical activity were lower among Blacks, but not Hispanics. A graded inverse association between levels of pain severity and the odds of physical activity was found, but pain did not mediate racial/ethnic differences in physical activity.

DISCUSSION: When compared to Whites, older Blacks appear to have relatively low rates of physical activity even without comparatively high levels of pain, while older Hispanics experience relatively high rates of pain, but are perhaps more resilient to the effects of pain on physical activity.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Female, Health Surveys, Hispanic or Latino, Humans, Male, Motor Activity, pain, Severity of Illness Index, United States, White People}, issn = {1552-6887}, doi = {10.1177/0898264312469404}, author = {Grubert, Elizabeth and Tamara A. Baker and McGeever, Kelly and Benjamin A Shaw} } @article {7921, title = {Self-rated health and morbidity onset among late midlife U.S. adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Jan}, pages = {107-16}, publisher = {68}, abstract = {

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Educational Status, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Sex Factors, Socioeconomic factors, United States}, issn = {1879-6974}, doi = {10.1016/j.alcr.2013.08.001}, author = {Jennifer Karas Montez} } @article {7852, title = {Spouses of stroke survivors may be at risk for poor cognitive functioning: a cross-sectional population-based study.}, journal = {Top Stroke Rehabil}, volume = {20}, year = {2013}, month = {2013 Jul-Aug}, pages = {369-78}, publisher = {20}, abstract = {

BACKGROUND: Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning.

OBJECTIVE: To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers.

METHODS: Existing data from the United States{\textquoteright} Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory.

RESULTS: Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors.

CONCLUSIONS: Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Community Health Planning, Cross-Sectional Studies, Female, Humans, Male, Neuropsychological tests, Retrospective Studies, Spouses, Stroke, Survivors, United States}, issn = {1074-9357}, doi = {10.1310/tsr2004-369}, author = {Peii Chen and Amanda L. Botticello} } @article {7814, title = {Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jun}, pages = {931-938}, publisher = {61}, abstract = {

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor{\textquoteright}s diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

}, keywords = {Activities of Daily Living, Age of Onset, Aged, Aged, 80 and over, Bayes Theorem, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Humans, Male, Middle Aged, Morbidity, Prospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Stroke, Stroke Rehabilitation, Survival Rate, Survivors, Time Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12270}, author = {Benjamin D Capistrant and Qianyi Wang and Sze Y Liu and M. Maria Glymour} } @article {7839, title = {Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans.}, journal = {Am J Geriatr Psychiatry}, volume = {21}, year = {2013}, month = {2013 Sep}, pages = {887-97}, publisher = {21}, abstract = {

OBJECTIVES: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims.

RESULTS: The point prevalence of substantial depressive symptoms was 28\% at a median of 1.2~years before sepsis, and remained 28\% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95\% confidence interval [CI]:~0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95\% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95\% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis.

CONCLUSIONS: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, depression, Female, Hospitalization, Humans, Longitudinal Studies, Male, Poisson Distribution, Prospective Studies, Regression Analysis, Risk Factors, Sepsis, Severity of Illness Index, Survivors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2013.01.017}, author = {Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Theodore J Iwashyna} } @article {7911, title = {Trends in depressive symptom burden among older adults in the United States from 1998 to 2008.}, journal = {J Gen Intern Med}, volume = {28}, year = {2013}, month = {2013 Dec}, pages = {1611-9}, publisher = {28}, abstract = {

CONTEXT: Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.

OBJECTIVE: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN: Serial cross-sectional analysis of six biennial assessments.

SETTING: Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998).

MAIN OUTCOME MEASURE: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.

RESULTS: Having no depressive symptoms increased over the 10-year period from 40.9~\% to 47.4~\% (prevalence ratio [PR]: 1.16, 95 \% CI: 1.13-1.19), with significant increases in those aged >= 60 relative to those aged 55-59. There was a 7~\% prevalence reduction of elevated symptoms from 15.5~\% to 14.2~\% (PR: 0.93, 95 \% CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3~\% to 9.6~\%. Prevalence of having severe depressive symptoms increased from 5.8~\% to 6.8~\% (PR: 1.17, 95 \% CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7~\% to 11.8~\%. No significant changes in severe symptoms were observed for those aged >= 60.

CONCLUSIONS: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cohort Studies, Cost of Illness, Cross-Sectional Studies, depression, Female, Humans, Male, Middle Aged, United States}, issn = {1525-1497}, doi = {10.1007/s11606-013-2533-y}, author = {Zivin, Kara and Paul A Pirraglia and Ryan J McCammon and Kenneth M. Langa and Sandeep Vijan} } @article {7819, title = {Trends in late-life activity limitations in the United States: an update from five national surveys.}, journal = {Demography}, volume = {50}, year = {2013}, month = {2013 Apr}, pages = {661-71}, publisher = {50}, abstract = {

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disabled Persons, Female, Health Surveys, Humans, Male, Mobility Limitation, Models, Statistical, United States}, issn = {0070-3370}, doi = {10.1007/s13524-012-0167-z}, author = {Vicki A Freedman and Brenda C Spillman and Patricia Andreski and Jennifer C. Cornman and Eileen M. Crimmins and Kramarow, Ellen and Lubitz, James and Linda G Martin and Sharon S. Merkin and Robert F. Schoeni and Teresa Seeman and Timothy A Waidmann} } @article {7865, title = {Type of high-school credentials and older age ADL and IADL limitations: is the GED credential equivalent to a diploma?}, journal = {Gerontologist}, volume = {53}, year = {2013}, month = {2013 Apr}, pages = {326-33}, publisher = {53}, abstract = {

PURPOSE: Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20\% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders.

METHODS: We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008.

RESULTS: HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95\% CI = 0.58, 0.90 and OR = 0.69, 95\% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95\% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95\% CI = 0.70, 1.12 for IADLs).

IMPLICATIONS: Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, Disabled Persons, Educational Status, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gns077}, author = {Sze Y Liu and Chavan, Niraj R. and M. Maria Glymour} } @article {7917, title = {Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals.}, journal = {Health Econ}, volume = {22}, year = {2013}, month = {2013 Jan}, pages = {89-105}, publisher = {22}, abstract = {

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

}, keywords = {Adult, Aged, Aged, 80 and over, Alcohol Drinking, Alcoholic Beverages, Behavior, Body Height, Costs and Cost Analysis, Female, Health Status, Humans, Male, Middle Aged, Models, Econometric, Socioeconomic factors, Taxes, United States}, issn = {1099-1050}, doi = {10.1002/hec.1817}, author = {Padmaja Ayyagari and Deb, Partha and Jason M. Fletcher and William T Gallo and Jody L Sindelar} } @article {7880, title = {Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults.}, journal = {J Epidemiol Community Health}, volume = {67}, year = {2013}, month = {2013 Feb}, pages = {153-8}, publisher = {67}, abstract = {

BACKGROUND: Little is known about how a neighbourhood{\textquoteright}s unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed.

METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood{\textquoteright}s unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models.

RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood{\textquoteright}s unemployment history.

CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

}, keywords = {Age Factors, depression, Female, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multilevel Analysis, Residence Characteristics, Retirement, Risk Factors, Socioeconomic factors, Stress, Psychological, Surveys and Questionnaires, Time Factors, Unemployment, United States, Urban Population}, issn = {1470-2738}, doi = {10.1136/jech-2012-201537}, author = {Richard G Wight and Carol S Aneshensel and Barrett, Christopher and Michelle J Ko and Joshua Chodosh and Arun S Karlamangla} } @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 {7840, title = {What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline.}, journal = {Neuroepidemiology}, volume = {41}, year = {2013}, month = {2013}, pages = {101-9}, publisher = {41}, abstract = {

BACKGROUND/AIMS: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans.

METHODS: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health.

RESULTS: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time.

CONCLUSIONS: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cognitive Reserve, Cohort Studies, Female, Humans, Longevity, Longitudinal Studies, Male, Parents, Prospective Studies, Socioeconomic factors, United States}, issn = {1423-0208}, doi = {10.1159/000350723}, author = {Hector M Gonz{\'a}lez and Wassim Tarraf and Mary E Bowen and Michelle D Johnson-Jennings and Gwenith G Fisher} } @article {7901, title = {Women{\textquoteright}s receipt of Social Security retirement benefits: expectations compared to elections.}, journal = {J Women Aging}, volume = {25}, year = {2013}, month = {2013}, pages = {321-36}, publisher = {25}, abstract = {

This research contributes knowledge regarding the options of early, normal, or delayed receipt of Social Security retirement benefits and research-based findings regarding women{\textquoteright}s expected and actual timing of election of Social Security retirement benefits. First, descriptive analyses of alternative retirement options, based on Social Security retirement benefit rules, are provided. Second, the 2000, 2002, 2004, and 2006 waves of Health and Retirement Study (HRS) data are used to analyze women{\textquoteright}s anticipated and actual election of Social Security retirement benefits. Third, based on these considerations, recommendations are made regarding Social Security retirement benefit receipt alternatives.

}, keywords = {Age Factors, Aged, Decision making, Female, Humans, Longitudinal Studies, Middle Aged, Pensions, Retirement, Social Security, Socioeconomic factors, Time Factors, United States}, issn = {1540-7322}, doi = {10.1080/08952841.2013.816219}, author = {Gillen, Martie and Claudia J Heath} } @article {7944, title = {Work stress and depressive symptoms in older employees: impact of national labour and social policies.}, journal = {BMC Public Health}, volume = {13}, year = {2013}, month = {2013 Nov 21}, pages = {1086}, publisher = {13}, abstract = {

BACKGROUND: Maintaining health and work ability among older employees is a primary target of national labour and social policies (NLSP) in Europe. Depression makes a significant contribution to early retirement, and chronic work-related stress is associated with elevated risks of depression. We test this latter association among older employees and explore to what extent indicators of distinct NLSP modify the association between work stress and depressive symptoms. We choose six indicators, classified in three categories: (1) investment in active labour market policies, (2) employment protection, (3) level of distributive justice.

METHODS: We use data from three longitudinal ageing studies (SHARE, HRS, ELSA) including 5650 men and women in 13 countries. Information on work stress (effort-reward imbalance, low work control) and depressive symptoms (CES-D, EURO-D) was obtained. Six NLSP indicators were selected from OECD databases. Associations of work stress (2004) with depressive symptoms (2006) and their modification by policy indicators were analysed using logistic multilevel models.

RESULTS: Risk of depressive symptoms at follow-up is higher among those experiencing effort-reward imbalance (OR: 1.55 95\% CI 1.27-1.89) and low control (OR: 1.46 95\% CI 1.19-1.79) at work. Interaction terms indicate a modifying effect of a majority of protective NLSP indicators on the strength of associations of effort - reward imbalance with depressive symptoms.

CONCLUSIONS: Work stress is associated with elevated risk of prospective depressive symptoms among older employees from 13 European countries. Protective labour and social policies modify the strength of these associations. If further supported findings may have important policy implications.

}, keywords = {depression, Employment, Europe, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Public Policy, Risk Factors, Stress, Psychological, Surveys and Questionnaires}, issn = {1471-2458}, doi = {10.1186/1471-2458-13-1086}, author = {Lunau, T. and Morten Wahrendorf and Dragano, N. and Johannes Siegrist} } @article {7838, title = {Is working later in life good or bad for health? An investigation of multiple health outcomes.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {807-15}, publisher = {68}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, depression, Educational Status, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Memory, Short-Term, Middle Aged, Neuropsychological tests, Psychiatric Status Rating Scales, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt069}, author = {Kandauda Wickrama and Catherine W. O{\textquoteright}Neal and Kyung H. Kwag and Lee, Tae K.} } @article {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 {7714, title = {Association of chronic diseases and impairments with disability in older adults: a decade of change?}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {501-7}, publisher = {50}, abstract = {

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99\% confidence interval (CI), 1.06-1.46; OR = 1.07; 99\% CI, 0.90-1.27; OR = 1.00; 99\% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99\% CI, 1.13-1.54; OR=0.97; 99\% CI, 0.82-1.14; OR = 0.99; 99\% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99\% CI, 1.01-1.46; OR = 1.37; 99\% CI, 1.15-1.64; OR = 1.52; 99\% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99\% CI, 1.33-2.03; OR = 1.63; 99\% CI, 1.32-2.01; OR = 2.11; 99\% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

}, keywords = {Activities of Daily Living, Aged, Aging, Cardiovascular Diseases, Chronic disease, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Hearing loss, Humans, Hypertension, Male, Mobility Limitation, Residence Characteristics, Respiratory Tract Diseases, Self Care, Socioeconomic factors, United States, Vision Disorders}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a0e0}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7737, title = {Beware of being unaware: racial/ethnic disparities in chronic illness in the USA.}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Sep}, pages = {1040-60}, abstract = {

We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.

}, keywords = {Aged, Biomarkers, Black People, Chronic disease, Data collection, Diabetes Mellitus, ethnicity, Female, Health Knowledge, Attitudes, Practice, Health Status Disparities, Hispanic or Latino, Humans, Hypertension, Male, Racial Groups, Self Report, United States, White People}, issn = {1099-1050}, doi = {10.1002/hec.2856}, author = {Chatterji, Pinka and Heesoo Joo and Kajal Chatterji Lahiri} } @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 {7708, title = {Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study.}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Oct}, pages = {849-55}, abstract = {

OBJECTIVES: This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy.

SUBJECTS: Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims.

MEASURES: The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year.

RESULTS: We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95\% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95\% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model).

CONCLUSIONS: There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Antineoplastic Agents, Antineoplastic Protocols, Bayes Theorem, Breast Neoplasms, Cognition Disorders, Colorectal Neoplasms, Female, Health Behavior, Humans, Interviews as Topic, Male, Memory, Prospective Studies}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31825a8bb0}, author = {Victoria A. Shaffer and Edgar C. Merkle and Angela Fagerlin and Jennifer J Griggs and Kenneth M. Langa and Theodore J Iwashyna} } @article {10280, title = {Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries.}, journal = {Journal of Manipulative \& Physiological Therapeutics}, volume = {35}, year = {2012}, pages = {168-175}, abstract = {

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9\% to 10.9\% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Chiropractic, Combined Modality Therapy, Episode of Care, Female, Geriatric Assessment, Health Care Surveys, Health Services, Humans, Incidence, Insurance Claim Reporting, Low Back Pain, Medicare Part B, Musculoskeletal Diseases, Primary Health Care, Retrospective Studies, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2012.01.011}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Kaskie, Brian and Frederic D Wolinsky} } @article {7738, title = {Chronic back pain among older construction workers in the United States: a longitudinal study.}, journal = {Int J Occup Environ Health}, volume = {18}, year = {2012}, month = {2012 Apr-Jun}, pages = {99-109}, publisher = {18}, abstract = {

This study assessed chronic back pain among older construction workers in the United States by analyzing data from the 1992-2008 Health and Retirement Study (HRS), a large-scale longitudinal survey. Fixed-effects methods were applied in the multiple logistic regression model to explore the association between back pain and time-varying factors (e.g., employment, job characteristics, general health status) while controlling for stable variables (e.g., gender, race, ethnicity). Results showed that about 40\% of older construction workers over the age of 50 suffered from persistent back pain or problems. Jobs involving a great deal of stress or physical effort significantly increased the risk of back disorders and longest-held jobs in construction increased the odds of back disorders by 32\% (95\% CI: 1{\textperiodcentered}04-1{\textperiodcentered}67). Furthermore, poor physical and mental health were strongly correlated with back problems. Enhanced interventions for construction workers are urgently needed given the aging workforce and high prevalence of back disorders in this industry.

}, keywords = {Back Pain, Employment, Humans, Longitudinal Studies, Occupational Diseases, Occupations, United States}, issn = {2049-3967}, doi = {10.1179/1077352512Z.0000000004}, author = {Xiuwen S Dong and Wang, Xuanwen and Fujimoto, Alissa and Dobbin, Ronald} } @article {7775, title = {Clinical complexity and mortality in middle-aged and older adults with diabetes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Dec}, pages = {1313-20}, publisher = {67}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Caregivers, Censuses, Family Characteristics, Female, Health Status, Humans, Likelihood Functions, Longitudinal Studies, Male, Middle Aged, Nuclear Family, Population Growth, Residence Characteristics, Retirement, Risk, Socioeconomic factors}, issn = {1758-5341}, doi = {10.1093/geront/gnr142}, author = {Lindsay H Ryan and Jacqui Smith and Toni C Antonucci and James S Jackson} } @article {10933, title = {A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults.}, journal = {Medical Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {534-9}, abstract = {

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0\% and 7.3\% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Chronic disease, Female, Humans, Male, Mobility Limitation, Models, Statistical, Risk Assessment, Sex Factors}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a50c}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {7689, title = {Coverage or costs: the role of health insurance in labor market reentry among early retirees.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Jan}, pages = {113-20}, publisher = {67B}, abstract = {

OBJECTIVES: This study evaluated the impact of insurance coverage on the odds of returning to work after early retirement and the change in insurance coverage after returning to work.

METHOD: The Health and Retirement Study was used to estimate hierarchical linear models of transitions to full-time work and part-time work relative to remaining retired. A chi-square test was also used to assess change in insurance coverage after returning to work.

RESULTS: Insurance coverage was unrelated to the odds of transitioning to full-time work. However, relative to employer-provided insurance, private nongroup insurance increased the odds of transitioning to part-time work, whereas public insurance reduced the odds of making this transition. Additionally, after returning to work, insurance coverage increased among those who were without employer-provided insurance in retirement.

DISCUSSION: Results indicated that source of coverage may be more useful in explaining returns to part-time work than simply whether people have coverage at all. In other words, the mechanism underlying the positive relationship between insurance and returning to work appeared to be limited to those who return to work because of the cost of private nongroup insurance. Among these people, however, there was some evidence that they are able to secure new coverage once they return to work.

}, keywords = {Employment, Female, Health Benefit Plans, Employee, Health Surveys, Humans, Insurance Coverage, Insurance, Health, Male, Middle Aged, Retirement, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr130}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2579962341andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ben Lennox Kail} } @article {7779, title = {The cumulative effect of unemployment on risks for acute myocardial infarction.}, journal = {Arch Intern Med}, volume = {172}, year = {2012}, month = {2012 Dec 10}, pages = {1731-7}, publisher = {172}, abstract = {

BACKGROUND: Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI).

METHODS: We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13,451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors.

RESULTS: The median age of the study cohort was 62 years, and 1061 AMI events (7.9\%) occurred during the 165,169 person-years of observation. Among the sample, 14.0\% of subjects were unemployed at baseline, 69.7\% had 1 or more cumulative job losses, and 35.1\% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95\% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95\% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.

CONCLUSIONS: Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.

}, keywords = {Female, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Stress, Psychological, Survival Rate, Unemployment, United States}, issn = {1538-3679}, doi = {10.1001/2013.jamainternmed.447}, author = {Matthew E Dupre and Linda K George and Liu, Guangya and Eric D Peterson} } @article {7625, title = {Current and long-term spousal caregiving and onset of cardiovascular disease.}, journal = {J Epidemiol Community Health}, volume = {66}, year = {2012}, month = {2012 Oct}, pages = {951-6}, abstract = {

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.

METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living >=14 h/week according to the care recipients{\textquoteright} report in the most recent prior biennial survey; we define providing >=14 h/week of care at two consecutive biennial surveys as {\textquoteright}long-term caregiving{\textquoteright}. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.

RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95\% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95\% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95\% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95\% CI 0.06 to 1.28).

CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Caregivers, Female, Follow-Up Studies, Humans, Incidence, Interviews as Topic, Long-term Care, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Self Report, Socioeconomic factors, Spouses, Stress, Psychological, United States}, issn = {1470-2738}, doi = {10.1136/jech-2011-200040}, author = {Benjamin D Capistrant and J Robin Moon and Lisa F Berkman and M. Maria Glymour} } @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 {7709, title = {Depressive symptoms in spouses of older patients with severe sepsis.}, journal = {Crit Care Med}, volume = {40}, year = {2012}, month = {2012 Aug}, pages = {2335-41}, abstract = {

OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse{\textquoteright}s presepsis history, whether this risk differs by sex, and is associated with a sepsis patient{\textquoteright}s disability after hospitalization.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).

PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.

MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20\% at a median of 1.1 yrs presepsis to 34\% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95\% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95\% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95\% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95\% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives{\textquoteright} depression (odds ratio 2.61, 95\% confidence interval 0.93, 7.38).

CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

}, keywords = {Age Factors, Aged, depression, Female, Hospitalization, Humans, Male, Multivariate Analysis, Prospective Studies, Psychiatric Status Rating Scales, Sepsis, Sex Factors, Spouses, Time Factors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0b013e3182536a81}, author = {Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Theodore J Iwashyna} } @article {7727, title = {Despite {\textquoteright}welcome to Medicare{\textquoteright} benefit, one in eight enrollees delay first use of part B services for at least two years.}, journal = {Health Aff (Millwood)}, volume = {31}, year = {2012}, month = {2012 Jun}, pages = {1260-8}, publisher = {31}, abstract = {

Much research has focused on the possible overuse of health care services within Medicare, but there is also substantial evidence of underuse. In recent years, Congress has added a "welcome to Medicare" physician visit and a number of preventive services with no cost sharing to the Medicare benefit package to encourage early and appropriate use of services. We examined national longitudinal data on first claims for Part B services-the portion of Medicare that covers physician visits-to learn how people used these benefits. We found that 12 percent of people, or about one in eight, who enrolled in Medicare at age sixty-five waited more than two years before making their first use of care covered by Part B. In part, this delay reflected patterns of use before enrollment, in that people who sought preventive care before turning sixty-five continued to do so after enrolling in Medicare. Enrollees with Medigap coverage, higher household wealth, and a higher level of education typically received care under Part B sooner than others, whereas having greater tolerance for risk was more likely to lead enrollees to delay use of Part B services. Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites. Although the "welcome to Medicare" checkup does not appear to have had a positive effect on use of services soon after enrollment, the percentage of beneficiaries receiving Part B services in the first two years after enrollment has steadily increased over time. Whether or not delays in receipt of care should be a considerable public policy concern may depend on what factors are leading specific categories of enrollees to delay care and how such delays affect health.

}, keywords = {Aged, Female, Humans, Insurance Claim Review, Male, Medicare Part B, Time Factors, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2011.0479}, author = {Frank A Sloan and Kofi F Acquah and Paul P Lee and Devdutta G. Sangvai} } @article {7743, title = {Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions.}, journal = {J Aging Soc Policy}, volume = {24}, year = {2012}, month = {2012}, pages = {291-308}, publisher = {24}, abstract = {

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

}, keywords = {Activities of Daily Living, Age Factors, Australia, Cross-Cultural Comparison, Florida, Health Benefit Plans, Employee, Health Status, Humans, Job Satisfaction, Middle Aged, Pensions, Public Policy, Retirement, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420.2012.676324}, author = {K. A. Sargent-Cox and Kaarin J. Anstey and Kendig, H. and Skladzien, E.} } @article {7703, title = {Disability and decline in physical function associated with hospital use at end of life.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 Jul}, pages = {794-800}, publisher = {27}, abstract = {

BACKGROUND: Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.

OBJECTIVE: To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.

DESIGN/PARTICIPANTS: We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).

KEY RESULTS: Median hospital days was 7 (range = 0-183). 53\% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).

CONCLUSIONS: Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Dementia, Disability Evaluation, Disabled Persons, Female, Frail Elderly, Geriatric Assessment, Hospitalization, Humans, Length of Stay, Longitudinal Studies, Male, Medicare, Socioeconomic factors, Terminal Care, United States}, issn = {1525-1497}, doi = {10.1007/s11606-012-2013-9}, author = {Amy Kelley and Susan L Ettner and R Sean Morrison and Qingling Du and Catherine A Sarkisian} } @article {7742, title = {The Disability burden of COPD.}, journal = {COPD}, volume = {9}, year = {2012}, month = {2012 Aug}, pages = {513-21}, abstract = {

Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95\% CI 0.50-0.67), from 44\% to 35\%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95\% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2\% to 7.1\%, as well as a 1.7 percentage point (OR 2.87, 95\% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0\% to 2.7\%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.

}, keywords = {Aged, Cost of Illness, Disabled Persons, Employment, Female, Humans, Income, Insurance, Disability, Likelihood Functions, Logistic Models, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Social Security, United States}, issn = {1541-2563}, doi = {10.3109/15412555.2012.696159}, author = {Thornton Snider, Julia and J. A. Romley and Ken S Wong and Zhang, Jie and Eber, Michael and Dana P Goldman} } @article {7755, title = {Does retirement trigger ill health?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Mar}, pages = {282-300}, publisher = {21}, abstract = {

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

}, keywords = {Activities of Daily Living, Cardiovascular Diseases, Chronic disease, England, Health Status, Humans, Longitudinal Studies, Models, Econometric, Neoplasms, Quality of Life, Retirement, Risk Factors}, issn = {1099-1050}, doi = {10.1002/hec.1712}, author = {Stefanie Behncke} } @article {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 {7684, title = {The effect of retirement on cognitive functioning.}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Aug}, pages = {913-27}, publisher = {21}, abstract = {

Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers.

}, keywords = {Age Factors, Aged, Aging, Cognition, Decision making, Humans, Longitudinal Studies, Male, Mental Recall, Middle Aged, Occupations, Retirement, Socioeconomic factors, Time Factors}, issn = {1099-1050}, doi = {10.1002/hec.1771}, author = {Norma B Coe and von Gaudecker, Hans-Martin and Maarten Lindeboom and J{\"u}rgen Maurer} } @article {7746, title = {The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Oct}, pages = {1075-84}, abstract = {

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

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

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

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

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

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

}, keywords = {Adult, Aged, Employment, Health Benefit Plans, Employee, Health Status, Hospitalization, Humans, Longitudinal Studies, Lung Diseases, Male, Neoplasms, Occupations, Retirement, Socioeconomic factors, Spouses}, issn = {1573-6962}, doi = {10.1007/s10754-012-9113-2}, author = {Cathy J. Bradley and David Neumark and Meryl Motika} } @article {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 {7682, title = {Ethnic/race differences in the attrition of older American survey respondents: implications for health-related research.}, journal = {Health Serv Res}, volume = {47}, year = {2012}, month = {2012 Feb}, pages = {241-54}, publisher = {47}, abstract = {

OBJECTIVE: To compare models of attrition across race/ethnic groups of aging populations and discuss implications for health-related research.

DATA SOURCES: The Health and Retirement Study (1992-2008).

STUDY DESIGN: A competing risks model was estimated using a multinomial logit model when respondents faced competing types of risks, such as dying, being lost from the study, and nonresponse in some years for different groups of elderly. Key explanatory variables were foreign birth, health insurance, and health status.

PRINCIPAL FINDINGS: Variables describing foreign birth, health insurance, and health status differed in their prediction of attrition across ethnic groups of aging populations.

CONCLUSIONS: Differences in the predictors of attrition across ethnic groups of elderly could potentially lead to biased estimates in health-related research using longitudinal data sources.

}, keywords = {Bias, ethnicity, Female, Health Care Surveys, Health Services Research, Health Surveys, Hispanic or Latino, Humans, Male, Mexican Americans, Middle Aged, Racial Groups, Risk, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2011.01322.x}, author = {Natalia A. Zhivan and Alfonso Ang and Hortensia Amaro and William A. Vega and Kyriakos S Markides} } @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 {7778, title = {Gardening as a potential activity to reduce falls in older adults.}, journal = {J Aging Phys Act}, volume = {20}, year = {2012}, month = {2012 Jan}, pages = {15-31}, publisher = {20}, abstract = {

This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.

}, keywords = {Accidental Falls, Age Factors, Aged, Aged, 80 and over, Aging, Chi-Square Distribution, Confidence Intervals, Exercise Test, Female, Gait, Gardening, Humans, Leisure activities, Male, Motor Activity, Odds Ratio, Postural Balance, Risk Assessment, Self Report, Task Performance and Analysis}, issn = {1543-267X}, doi = {10.1123/japa.20.1.15}, author = {Tuo-Yu Chen and Megan C Janke} } @article {7699, title = {Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, note = {.}, month = {2012 Dec}, pages = {1380-98}, abstract = {

OBJECTIVE: This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD: Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS: Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION: Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

}, keywords = {Aged, Alcohol Drinking, Alcohol-Related Disorders, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Humans, Intelligence, Male, Multivariate Analysis, Regression Analysis, Sex Factors}, issn = {1552-6887}, doi = {10.1177/0898264312459346}, author = {Jiyoung Lyu and SeungAh H. Lee} } @article {7736, title = {The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings.}, journal = {Soc Secur Bull}, volume = {72}, year = {2012}, month = {2012}, pages = {49-61}, publisher = {72}, abstract = {

Analysts have proposed raising the maximum level of earnings subject to the Social Security payroll tax (the "tax max") to improve long-term Social Security Trust Fund solvency. This article investigates how raising the tax max leads to the "leakage" of portions of the additional revenue into higher benefit payments. Using Health and Retirement Study data matched to Social Security earnings records, we compare historical payroll tax payments and benefit amounts for Early Boomers (born 1948-1953) with tax and benefit simulations had they been subject to the tax max (adjusted for wage growth) faced by cohorts 12 and 24 years older. We find that 43.2 percent of the additional payroll tax revenue attributable to tax max increases affecting Early Boomers relative to taxes paid by the cohort 12 years older leaked into higher benefits. For Early Boomers relative to those 24 years older, we find 53.5 percent leakage.

}, keywords = {Aged, Cohort Studies, Female, Humans, Insurance Benefits, Male, Middle Aged, Models, Econometric, Public Policy, Salaries and Fringe Benefits, Social Security, Taxes, United States}, issn = {0037-7910}, url = {https://www.ssa.gov/policy/docs/ssb/v72n2/v72n2p49.html}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {7722, title = {Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there.}, journal = {Health Aff (Millwood)}, volume = {31}, year = {2012}, month = {2012 Jun}, pages = {1277-85}, publisher = {31}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospital Mortality, Hospitalization, Humans, Insurance Claim Review, Male, Terminal Care, Terminally Ill, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2011.0922}, author = {Alexander K Smith and Ellen P McCarthy and Ellen Weber and Irena Cenzer and W John Boscardin and Jonathan Fisher and Kenneth E Covinsky} } @article {7695, title = {Health behavior change following chronic illness in middle and later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 May}, pages = {279-88}, publisher = {67B}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alcohol Drinking, Chi-Square Distribution, Chronic disease, Diabetes Mellitus, Exercise, Female, Health Behavior, Heart Diseases, Humans, Longitudinal Studies, Lung Diseases, Male, Middle Aged, Neoplasms, Smoking, Stroke, Time Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbr103}, author = {Jason T Newsom and Nathalie Huguet and Michael J. McCarthy and Pamela Ramage-Morin and Mark S Kaplan and Julie Bernier and Bentson McFarland and Jillian Oderkirk} } @article {7717, title = {Health investment decisions in response to diabetes information in older Americans.}, journal = {J Health Econ}, volume = {31}, year = {2012}, month = {2012 May}, pages = {502-20}, publisher = {31}, abstract = {

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

}, keywords = {Adult, Age Factors, Aged, Aged, 80 and over, Alcohol Drinking, Body Weight, Decision making, Diabetes Mellitus, Empirical Research, Exercise, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Models, Psychological, Smoking, United States}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2012.04.001}, author = {Alexander N Slade} } @article {7758, title = {Health service use among the previously uninsured: is subsidized health insurance enough?}, journal = {Health Econ}, volume = {21}, year = {2012}, month = {2012 Oct}, pages = {1155-68}, publisher = {21}, abstract = {

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

}, keywords = {Aged, Female, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Medicare, Middle Aged, Socioeconomic factors, United States}, issn = {1099-1050}, doi = {10.1002/hec.1780}, author = {Decker, Sandra L and Jalpa A Doshi and Amy E. Knaup and Daniel Polsky} } @article {7763, title = {Higher rates of Clostridium difficile infection among smokers.}, journal = {PLoS One}, volume = {7}, year = {2012}, month = {2012}, pages = {e42091}, publisher = {7}, abstract = {

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

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

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

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

}, keywords = {Clostridioides difficile, Enterocolitis, Pseudomembranous, Female, Humans, Male, Middle Aged, Smoking, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0042091}, author = {Mary A M Rogers and M. Todd Greene and Sanjay Saint and Carol E Chenoweth and Preeti N Malani and Itishree Trivedi and David M. Aronoff} } @article {7622, title = {How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 May}, pages = {541-7}, abstract = {

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

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

DESIGN/SETTING: Longitudinal, community-based.

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Residence Characteristics, Safety, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-011-1943-y}, author = {Vivien K Sun and Irena Cenzer and Helen Kao and Cyrus Ahalt and Brie A Williams} } @article {7685, title = {The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States.}, journal = {Health Soc Care Community}, volume = {20}, year = {2012}, note = {Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6.}, month = {2012 Jan}, pages = {42-51}, publisher = {20}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, depression, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.11.028}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ye Luo and Louise C Hawkley and Linda J. Waite and John T. Cacioppo} } @article {7764, title = {Loneliness in older persons: a predictor of functional decline and death.}, journal = {Arch Intern Med}, volume = {172}, year = {2012}, month = {2012 Jul 23}, pages = {1078-83}, publisher = {172}, abstract = {

BACKGROUND: Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States.

METHODS: This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study, a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up assessments occurred every 2 years until 2008. Subjects were asked if they (1) feel left out, (2) feel isolated, or (3) lack companionship. Subjects were categorized as not lonely if they responded hardly ever to all 3 questions and lonely if they responded some of the time or often to any of the 3 questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following 4 measures: difficulty on an increased number of activities of daily living (ADL), difficulty in an increased number of upper extremity tasks, decline in mobility, or increased difficulty in stair climbing. Multivariate analyses adjusted for demographic variables, socioeconomic status, living situation, depression, and various medical conditions.

RESULTS: The mean age of subjects was 71 years. Fifty-nine percent were women; 81\% were white, 11\%, black, and 6\%, Hispanic; and 18\% lived alone. Among the elderly participants, 43\% reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADL (24.8\% vs 12.5\%; adjusted risk ratio [RR], 1.59; 95\% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5\% vs 28.3\%; adjusted RR, 1.28; 95\% CI, 1.08-1.52); experience decline in mobility (38.1\% vs 29.4\%; adjusted RR, 1.18; 95\% CI, 0.99-1.41); or experience difficulty in climbing (40.8\% vs 27.9\%; adjusted RR, 1.31; 95\% CI, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8\% vs 14.2\%; adjusted HR, 1.45; 95\% CI, 1.11-1.88).

CONCLUSION: Among participants who were older than 60 years, loneliness was a predictor of functional decline and death.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Female, Humans, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, United States, Upper Extremity, Walking}, issn = {1538-3679}, doi = {10.1001/archinternmed.2012.1993}, author = {Perissinotto, Carla M and Irena Cenzer and Kenneth E Covinsky} } @article {7759, title = {Long-term rate of change in memory functioning before and after stroke onset.}, journal = {Stroke}, volume = {43}, year = {2012}, month = {2012 Oct}, pages = {2561-6}, abstract = {

BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals.

METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free.

RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50\% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory.

CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, disease progression, Female, Follow-Up Studies, Humans, Linear Models, Longitudinal Studies, Male, Memory, Memory Disorders, Middle Aged, Stroke, Survivors, Time Factors}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.112.661587}, author = {Qianyi Wang and Benjamin D Capistrant and Amy Ehntholt and M. Maria Glymour} } @article {7735, title = {Marriage, gender and obesity in later life.}, journal = {Econ Hum Biol}, volume = {10}, year = {2012}, month = {2012 Dec}, pages = {431-53}, abstract = {

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

}, keywords = {Age Factors, Aged, Body Mass Index, Female, Humans, Male, Marital Status, Middle Aged, Models, Statistical, Obesity, Sex Factors, United States, Weight Gain, Weight Loss}, issn = {1873-6130}, doi = {10.1016/j.ehb.2012.04.012}, author = {Sven E. Wilson} } @article {7760, title = {Maternal age and offspring adult health: evidence from the health and retirement study.}, journal = {Demography}, volume = {49}, year = {2012}, month = {2012 Nov}, pages = {1231-57}, abstract = {

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

}, keywords = {Adolescent, Adult, Adult children, Aging, Body Weights and Measures, Educational Status, Female, Health Status, Humans, Maternal Age, Middle Aged, Mortality, Prospective Studies, Socioeconomic factors, Young Adult}, issn = {0070-3370}, doi = {10.1007/s13524-012-0132-x}, author = {Mikko Myrskyl{\"a} and Andrew Fenelon} } @article {7623, title = {Measurement equivalence in ADL and IADL difficulty across international surveys of aging: findings from the HRS, SHARE, and ELSA.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Jan}, pages = {121-32}, abstract = {

OBJECTIVE: To examine the measurement equivalence of items on disability across three international surveys of aging.

METHOD: Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items.

RESULTS: HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA.

DISCUSSION: Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Bias, Europe, Female, Health Surveys, Humans, Internationality, Longitudinal Studies, Male, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr133}, author = {Kitty S. Chan and Judith D Kasper and Jason Brandt and Liliana E Pezzin} } @article {7620, title = {Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes.}, journal = {Med Care}, volume = {50}, year = {2012}, note = {Medical care Med Care. 2011 Dec 20.}, month = {2012 May}, pages = {441-5}, abstract = {

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

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

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

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

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

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

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

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Awareness, Chi-Square Distribution, Comorbidity, Female, Health Knowledge, Attitudes, Practice, Health Status, Health Surveys, Heart Failure, Humans, Insurance Claim Review, Logistic Models, Male, Medicare, Odds Ratio, Patients, Predictive Value of Tests, Self Report, Socioeconomic factors, United States}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.111.963116}, author = {Tanya R Gure and Ryan J McCammon and Christine T Cigolle and Todd M Koelling and Caroline S Blaum and Kenneth M. Langa} } @article {7767, title = {Presepsis depressive symptoms are associated with incident cognitive impairment in survivors of severe sepsis: a prospective cohort study of older Americans.}, journal = {J Am Geriatr Soc}, volume = {60}, year = {2012}, month = {2012 Dec}, pages = {2290-6}, publisher = {60}, abstract = {

OBJECTIVES: To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis.

RESULTS: The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38\% (95\% confidence interval (CI) = 34-42\%). After severe sepsis, 18\% (95\% CI = 15-20\%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95\% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95\% CI = 1.45-4.59).

CONCLUSION: Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, depression, Female, Humans, Longitudinal Studies, Male, Sepsis, Survivors}, issn = {1532-5415}, doi = {10.1111/jgs.12001}, author = {Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Theodore J Iwashyna} } @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 {7757, title = {Progressive and accelerated disability onset by race/ethnicity and education among late midlife and older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, month = {2012 Dec}, pages = {1320-45}, abstract = {

OBJECTIVE: This study explores the pace of severe disability onset with an emphasis on the role of race/ethnicity and education. More specifically, this research examines whether race/ethnicity and educational attainment are independent predictors of progressive and accelerated disability onset.

METHOD: Using the Health and Retirement Study (HRS) Waves 2 to 10 (1994-2010), a series of discrete-time Cox proportional hazards models with multiple competing events were created to ascertain whether respondents developed progressive or accelerated disability in subsequent waves.

RESULTS: Black and Hispanic respondents were at an increased risk of developing progressive disability. Respondents without a high school degree were more likely to experience progressive or accelerated disability.

DISCUSSION: Low educational attainment was a particularly strong predictor of accelerated disability onset and may represent an acute lack of resources over the life course. Race and ethnicity were important predictors of progressive disability onset, which may reflect racial/ethnic variations in the disabling process.

}, keywords = {Black or African American, Disabled Persons, disease progression, Educational Status, Female, Follow-Up Studies, Health Status Disparities, Hispanic or Latino, Humans, Male, Middle Aged, Qualitative Research, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, United States, White People}, issn = {1552-6887}, doi = {10.1177/0898264312459345}, author = {Kenzie Latham} } @article {7786, title = {A prospective cohort study of health behavior profiles after age 50 and mortality risk.}, journal = {BMC Public Health}, volume = {12}, year = {2012}, month = {2012 Sep 18}, pages = {803}, publisher = {12}, abstract = {

BACKGROUND: This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors.

METHODS: Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent{\textquoteright}s smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression.

RESULTS: Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51-65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers.

CONCLUSIONS: In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

}, keywords = {Aged, Alcohol-Related Disorders, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Regression Analysis, Risk Assessment, Risk-Taking, Sedentary Behavior, Smoking, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-12-803}, author = {Benjamin A Shaw and Agahi, Neda} } @article {7740, title = {A prospective examination of the relationship between physical activity and dementia risk in later life.}, journal = {Am J Health Promot}, volume = {26}, year = {2012}, month = {2012 Jul-Aug}, pages = {333-40}, publisher = {26}, abstract = {

PURPOSE: To examine the relationship between vigorous physical activity and dementia risk.

DESIGN: Prospective study design utilizing physical activity data from the Health and Retirement Study and cognitive outcome data from the Aging, Demographics, and Memory Study.

SETTING: Community-based.

SUBJECTS: Adults age 71 and over (N  =  808) with 3 to 7 years of physical activity information prior to dementia/no dementia diagnosis.

MEASURES: Physical activity was measured by participation in vigorous activities such as aerobics, sports, running, bicycling, and heavy housework three or more times per week (yes/no). Dementia diagnosis was based on an expert panel (e.g., neuropsychologists, neurologists, geropsychiatrists) who performed and reviewed a battery of neuropsychological tests.

ANALYSIS: Binary logistic regression models were used to account for demographic characteristics, genetic risk factors (one or two apolipoprotein E ε4 alleles), health behaviors (e.g., smoking, drinking alcohol), health indicators (body mass index), and health conditions (e.g., diabetes, heart disease) in a sequential model-building process.

RESULTS: The relationship between vigorous physical activity and dementia risk remained robust across models. In the final model, older adults who were physically active were 21\% (p <= .05) less likely than their counterparts to be diagnosed with dementia.

CONCLUSION: Vigorous physical activity may reduce the risk for dementia independently of the factors examined here. This study{\textquoteright}s findings are important given that few preventative strategies for dementia have been explored beyond hormonal therapy and anti-inflammatory drugs.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Confidence Intervals, Dementia, disease progression, Exercise, Female, Health Promotion, Health Status Indicators, Health Surveys, Humans, Logistic Models, Male, Motor Activity, Multivariate Analysis, Odds Ratio, Prospective Studies, Psychometrics, Risk Factors, United States}, issn = {2168-6602}, doi = {10.4278/ajhp.110311-QUAN-115}, author = {Mary E Bowen} } @article {7693, title = {Race/ethnic and nativity disparities in later life physical performance: the role of health and socioeconomic status over the life course.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Mar}, pages = {238-48}, publisher = {67B}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, ethnicity, Female, Gait, Hand Strength, Health Status, Health Status Disparities, Health Surveys, Humans, Male, Middle Aged, Racial Groups, Respiratory Function Tests, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr155}, author = {Steven A Haas and Patrick M. Krueger and Leah Rohlfsen} } @article {7750, title = {Race-ethnicity and health trajectories: tests of three hypotheses across multiple groups and health outcomes.}, journal = {J Health Soc Behav}, volume = {53}, year = {2012}, month = {2012 Sep}, pages = {359-77}, publisher = {53}, abstract = {

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.

}, keywords = {Age Factors, Aging, Black or African American, ethnicity, Female, Health Behavior, Health Status Disparities, Health Surveys, Humans, Male, Mexican Americans, Middle Aged, Racial Groups, Risk Factors, Socioeconomic factors, Sociology, Medical, White People}, issn = {2150-6000}, doi = {10.1177/0022146512455333}, author = {Tyson H Brown and Angela M O{\textquoteright}Rand and Daniel E Adkins} } @article {7698, title = {Racial and ethnic differences in hypertension risk: new diagnoses after age 50.}, journal = {Ethn Dis}, volume = {22}, year = {2012}, month = {2012 Spring}, pages = {175-80}, publisher = {22}, abstract = {

OBJECTIVES: Our study examines the differences in estimated risk of developing hypertension in Whites, Blacks, and Mexican-Americans aged > or = 50 for a period of 11 years.

DESIGN, SETTING, AND PARTICIPANTS: Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study (HRS) with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension.

MAIN OUTCOME MEASURE: Estimated odds of developing hypertension.

RESULTS: The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants aged > or = 50. After adjusting for demographic and health status, the probability of incident hypertension among Black Americans was .10 during the period of 1995/96-1998, which increased steadily to .17 in 2004-2006, with cumulative incidence over the 11-year period at 51\%. In contrast, among White Americans the risk was .07 during 1995/96-1998 and .13 in 2004-2006, with cumulative incidence at 43\%. For Mexican-Americans, the probability also increased from .08 during 1995/ 96-1998 to .14 during 2004-2006, with cumulative incidence at 42\%.

CONCLUSIONS: Relative to White and Mexican-Americans, Black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were accounted for.

}, keywords = {Age Factors, Aged, Black or African American, Cohort Studies, Female, Health Status Disparities, Humans, Hypertension, Incidence, Male, Mexican Americans, Middle Aged, Risk Factors, Socioeconomic factors, White People}, issn = {1049-510X}, author = {A. R. Quinones and Jersey Liang and Wen Ye} } @article {7751, title = {The relationship between body weight, frailty, and the disablement process.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Sep}, pages = {618-26}, publisher = {67}, abstract = {

OBJECTIVES: To prospectively examine the relationship between body weight, frailty, and the disablement process.

METHOD: Longitudinal data from the Health and Retirement Study (1998-2006) were used to examine the relationship between being underweight, overweight, or obese (compared with normal weight) and the onset and progression of functional limitations and disabilities in instrumental activities of daily living (IADL) and activities of daily living (ADL) among a nationally representative sample of community-dwelling older adults (aged 50 and older) with characteristics of frailty (n= 11,491). Nonlinear multilevel models additionally adjusted for demographic characteristics and intra-individual changes in body weight, socioeconomic status, health behaviors, and health conditions over the course of 8 years.

RESULTS: Compared with their nonfrail normal weight counterparts, prefrail obese respondents have a 16\% (p <= 0.001) reduction in the expected functional limitations rate and frail overweight and obese respondents have a 10\% (p <= 0.01) and 36\% (p <= 0.001) reduction in the expected functional limitations rate, respectively. In addition, frail obese respondents have a 27\% (p <= 0.05) reduction in the expected ADL disability rate.

DISCUSSION: This study{\textquoteright}s findings suggest that underweight, overweight, and obese status differentially affect the risk for functional limitations and disabilities in IADL and ADL. Among prefrail and frail adults, some excess body weight in later life may be beneficial, reducing the rate of functional limitations and disability.

}, keywords = {Activities of Daily Living, Aged, Body Weight, Cross-Sectional Studies, Disability Evaluation, Disabled Persons, Female, Frail Elderly, Geriatric Assessment, Health Behavior, Health Surveys, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Overweight, Physical Fitness, Prospective Studies, sarcopenia, Socioeconomic factors, Thinness, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbs067}, author = {Mary E Bowen} } @article {7651, title = {The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes.}, journal = {J Behav Med}, volume = {35}, year = {2012}, month = {2012 Apr}, pages = {190-9}, abstract = {

Although nearly one-third of older diabetics are cognitively impaired, their diabetes management remains poorly understood. To examine the relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Cross-sectional observational analysis. 1,398 persons with diabetes, aged 60~years or older, who responded to the 2003 Health and Retirement Study Diabetes Survey. We conducted logistic regressions on the effects of cognitive impairment on respondents{\textquoteright} self-management ability after controlling for diabetes comorbidities, demographics, and clinical characteristics. Participants with greater cognitive impairment were less likely to adhere to exercise (Adjusted Odds ratio [AOR]~=~0.725 and 0.712 for moderate and severe cognitive impairment, both P~<~0.05), and to diet (AOR~=~0.906 and 0.618 for moderate and severe cognitive impairment, both P~<~0.01). Cognitive impairment is associated with worse self-care and may pose challenges to diabetic older persons, notably in diet and exercise. Cognitive screening may be indicated in this high risk group.

}, keywords = {Aged, Aged, 80 and over, Blood Glucose, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Exercise, Female, Health Surveys, Humans, Male, Middle Aged, Self Care}, issn = {1573-3521}, doi = {10.1007/s10865-011-9344-6}, author = {Denise G Feil and Carolyn Wei Zhu and David L Sultzer} } @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 {7781, title = {Risk factors of falls in community-dwelling older adults: logistic regression tree analysis.}, journal = {Gerontologist}, volume = {52}, year = {2012}, month = {2012 Dec}, pages = {822-32}, publisher = {52}, abstract = {

PURPOSE OF THE STUDY: A novel logistic regression tree-based method was applied to identify fall risk factors and possible interaction effects of those risk factors.

DESIGN AND METHODS: A nationally representative sample of American older adults aged 65 years and older (N = 9,592) in the Health and Retirement Study 2004 and 2006 modules was used. Logistic Tree with Unbiased Selection, a computer algorithm for tree-based modeling, recursively split the entire group in the data set into mutually exclusive subgroups and fit a logistic regression model in each subgroup to generate an easily interpreted tree diagram.

RESULTS: A subgroup of older adults with a fall history and either no activities of daily living (ADL) limitation and at least one instrumental activity of daily living or at least one ADL limitation was classified as at high risk of falling. Additionally, within each identified subgroup, the best predictor of falls varied over subgroups and was also evaluated.

IMPLICATIONS: Application of tree-based methods may provide useful information for intervention program design and resource allocation planning targeting subpopulations of older adults at risk of falls.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Decision Trees, Female, Geriatric Assessment, Health Surveys, Humans, Logistic Models, Male, Predictive Value of Tests, Residence Characteristics, Risk Assessment, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gns043}, author = {Takashi Yamashita and Noe, Douglas A. and John A. Bailer} } @article {7715, title = {Self- and other-oriented potential lifetime traumatic events as predictors of loneliness in the second half of life.}, journal = {Aging Ment Health}, volume = {16}, year = {2012}, month = {2012}, pages = {423-30}, publisher = {16}, abstract = {

OBJECTIVES: This study examined the relationship between self- and other-oriented potential lifetime traumatic events (PLTE) and loneliness at the second half of life.

METHOD: The sample was comprised of 7446 respondents who completed the Health and Retirement Study (HRS) 2006 psychosocial questionnaire. PLTE were classified into self-oriented PLTE, defined as traumatic events that primarily inflict the self (e.g., being abused by parents) and other-oriented PLTE, defined as events that affect the self by primarily targeting others (e.g., death of one{\textquoteright}s child). We evaluated the role of self- and other-oriented PLTE as predictors of loneliness, as evaluated by the short R-UCLA. Analyses were stratified by age at which trauma happened categorized into four life periods (0-17, 18-30, 31-49, 50+).

RESULTS: The results showed that PLTE is positively related to loneliness. Moreover, the number of other-oriented PLTE, and even more pronouncedly self-oriented PLTE, that happened up until adulthood were the strongest predictors of loneliness at the second half of life.

CONCLUSION: The study suggests that self- and other-oriented PLTE reported to have occurred early in life are associated with perceived loneliness in the second half of life.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Child, Child Abuse, Cross-Sectional Studies, depression, Female, Forecasting, Humans, Life Change Events, Loneliness, Male, Middle Aged, Self Psychology, Wounds and Injuries}, issn = {1364-6915}, doi = {10.1080/13607863.2011.638903}, author = {Yuval Palgi and Amit Shrira and Menachem Ben-Ezra and Sharon Shiovitz-Ezra and Liat Ayalon} } @article {7632, title = {Self-care and health outcomes of diabetes mellitus.}, journal = {Clin Nurs Res}, volume = {21}, year = {2012}, month = {2012 Aug}, pages = {309-26}, abstract = {

Studies show that self-care improves diabetes mellitus (DM) outcomes; however, previous studies have focused on self-care maintenance, and little is known about self-care management. The objective of this study is to examine the influence of DM self-care maintenance and management on number of hospitalizations and hospitalization days. A cohort design with secondary analysis of data from the Health and Retirement Study 2002-2004 was used. Data from 726 adults with DM were analyzed with logistic regression and negative binomial regression adjusting for covariates. Self-care maintenance and management were significant determinants of hospitalization outcomes. Establishing a goal for HbA1c (self-care management) and eating >=2 snacks or desserts per day (self-care maintenance) were associated with a decrease in hospitalizations (IRR = 0.860, p = .001; IRR = 0.914, p = .043, respectively). DM self-care maintenance and management influence health outcomes but in different ways. These data provide evidence that both elements are needed in the education of patients about DM.

}, keywords = {Adult, Aged, Aged, 80 and over, Clinical Nursing Research, Diabetes Mellitus, Female, Follow-Up Studies, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Self Care, Treatment Outcome}, issn = {1552-3799}, doi = {10.1177/1054773811422604}, author = {MinKyoung Song and Sarah J Ratcliffe and Nancy C Tkacs and Barbara Riegel} } @article {7677, title = {Self-rated health and the "first move" around retirement: a longitudinal study of older Americans.}, journal = {J Rural Health}, volume = {28}, year = {2012}, month = {2012 Spring}, pages = {183-91}, publisher = {28}, abstract = {

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

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

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

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

}, keywords = {Aged, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Population Dynamics, Retirement}, issn = {1748-0361}, doi = {10.1111/j.1748-0361.2011.00388.x}, author = {Nan E. Johnson} } @article {7725, title = {Self-reported and measured hypertension among older US- and foreign-born adults.}, journal = {J Immigr Minor Health}, volume = {14}, year = {2012}, note = {Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Location - United States--US Pages - 721-6 ProQuest ID - 1022672464 Document feature - References SubjectsTermNotLitGenreText - United States--US Last updated - 2012-07-11 Place of publication - New York Corporate institution author - White, Kellee; Avenda o, Mauricio; Capistrant, Benjamin D; Robin Moon, J; Liu, Sze Y; Maria Glymour, M DOI - 2699707771; 70149852; 53471; JIMH; 22109587; SPVLJIMH109031449549}, month = {2012 Aug}, pages = {721-6}, publisher = {14}, abstract = {

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n~=~13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9\%), whites (82.8\%), and Hispanics (84.0\%), and both foreign-born (83.2\%) and US-born (84.0\%). Specificity was above 90\% for both US-born and foreign-born, but higher for whites (92.8\%) than blacks (86.0\%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

}, keywords = {Aged, Black or African American, Blood Pressure Determination, Emigrants and Immigrants, Female, Hispanic or Latino, Humans, Hypertension, Male, Middle Aged, Nutrition Surveys, Reproducibility of Results, Self Report, United States, White People}, issn = {1557-1920}, doi = {10.1007/s10903-011-9549-3}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl}, author = {White, Kellee and Mauricio Avendano and Benjamin D Capistrant and J Robin Moon and Sze Y Liu and M. Maria Glymour} } @article {7719, title = {The significance of education for mortality compression in the United States.}, journal = {Demography}, volume = {49}, year = {2012}, month = {2012 Aug}, pages = {819-40}, publisher = {49}, abstract = {

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population{\textquoteright}s socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.

}, keywords = {Aged, Aged, 80 and over, Aging, Educational Status, Female, Health Status Disparities, Humans, Life Expectancy, Male, Middle Aged, Mortality, Mortality, Premature, Sex Distribution, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1007/s13524-012-0104-1}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2712630621andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Dustin C. Brown and Mark D Hayward and Jennifer Karas Montez and Robert A Hummer and Chi-Tsun Chiu and Mira M Hidajat} } @article {7777, title = {Social isolation, loneliness and health among older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, month = {2012 Dec}, pages = {1346-63}, publisher = {24}, abstract = {

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

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

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

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

}, keywords = {Aged, Cross-Sectional Studies, Diagnostic Self Evaluation, Female, Health Status, Humans, Logistic Models, Loneliness, Male, Mental Disorders, Middle Aged, Risk Factors, social isolation}, issn = {1552-6887}, doi = {10.1177/0898264312460275}, author = {Caitlin E. Coyle and Dugan, Elizabeth} } @article {7772, title = {Spousal caregiving and incident hypertension.}, journal = {Am J Hypertens}, volume = {25}, year = {2012}, month = {2012 Apr}, pages = {437-43}, publisher = {25}, abstract = {

BACKGROUND: Caring for one{\textquoteright}s spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults.

METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing >=14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs.

RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95\% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95\% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings.

CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.

}, keywords = {Activities of Daily Living, Aged, Cardiovascular Diseases, Caregivers, Female, Follow-Up Studies, Humans, Hypertension, Male, Memory Disorders, Middle Aged, Odds Ratio, Spouses, Stress, Psychological}, issn = {1941-7225}, doi = {10.1038/ajh.2011.232}, author = {Benjamin D Capistrant and J Robin Moon and M. Maria Glymour} } @article {7712, title = {Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions.}, journal = {Am J Respir Crit Care Med}, volume = {185}, year = {2012}, note = {Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9.}, month = {2012 Apr 15}, pages = {835-41}, publisher = {185}, abstract = {

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors{\textquoteright} own pre-sepsis levels assessed before hospitalization, or survivors{\textquoteright} own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients{\textquoteright} pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Chronic pain, Cohort Studies, Comorbidity, Critical Illness, Disabled Persons, disease progression, Female, Geriatric Assessment, Hearing Disorders, Hospitalization, Humans, Incidence, Male, Musculoskeletal Diseases, Prognosis, Retrospective Studies, Risk Assessment, Sepsis, Survival Analysis, Survivors, Thinness, Time, Treatment Outcome, Urinary incontinence, Vision Disorders}, issn = {1535-4970}, doi = {10.1164/rccm.201109-1660OC}, author = {Theodore J Iwashyna and Netzer, Giora and Kenneth M. Langa and Christine T Cigolle} } @article {7732, title = {Spurring enrollment in Medicare savings programs through a substitute for the asset test focused on investment income.}, journal = {Health Aff (Millwood)}, volume = {31}, year = {2012}, note = {Copyright - Copyright The People to People Health Foundation, Inc., Project HOPE Feb 2012 Language of summary - English Location - United States--US Pages - 367-75 ProQuest ID - 921992803 Document feature - Tables; References SubjectsTermNotLitGenreText - United States--US Last updated - 2012-06-05 Place of publication - Chevy Chase Corporate institution author - Dorn, Stan; Shang, Baoping DOI - 2588825981; 67448192; 15986; HAF; 22323167; INNNHAF0000865869}, month = {2012 Feb}, pages = {367-75}, publisher = {31}, abstract = {

Fewer than one-third of eligible Medicare beneficiaries enroll in Medicare savings programs, which pay premiums and, in some cases, eliminate out-of-pocket cost sharing for poor and near-poor enrollees. Many beneficiaries don{\textquoteright}t participate in savings programs because they must complete a cumbersome application process, including a burdensome asset test. We demonstrate that a streamlined alternative to the asset test-allowing seniors to qualify for Medicare savings programs by providing evidence of limited assets or showing a lack of investment income-would permit 78 percent of currently eligible seniors to bypass the asset test entirely. This simplified approach would increase the number of beneficiaries who qualify for Medicare savings programs from the current 3.6 million seniors to 4.6 million. Such an alternative would keep benefits targeted to people with low assets, eliminate costly administrative expenses and obstacles to enrollment associated with the asset test, and avoid the much larger influx of seniors that would occur if the asset test were eliminated entirely.

}, keywords = {Cost Savings, Eligibility Determination, Financing, Personal, Humans, Medicare, Poverty, United States}, issn = {1544-5208}, doi = {10.1377/hlthaff.2011.0443}, author = {Dorn, Stan and Shang, Baoping} } @article {7780, title = {Stability and change in financial transfers from adult children to older parents.}, journal = {Can J Aging}, volume = {31}, year = {2012}, month = {2012 Dec}, pages = {367-78}, publisher = {31}, abstract = {

We sought to identify the extent and predictors of longitudinal changes in adult children{\textquoteright}s financial assistance to parents and in transfer networks over a two-year period. Analyses rely on pooled data from 1994 to 2000 of the Health and Retirement Study, using families in which adult children with no more than four siblings financially supported parents over two years. Change in the help network occurred in about 40 per cent of these families over the two-year period. When change occurred, it most commonly involved cessation of support by a child, followed by addition of another child to the network, whereas exchange of supporting children was relatively rare. Change reflected children{\textquoteright}s ability to provide care and the burden created by parents{\textquoteright} needs. However, the size and composition of the adult-child network and of the initial support group also played an important role. Results highlight the dynamic and systemic nature of intergenerational financial networks.

}, keywords = {Adult children, Aged, Female, Financial Support, Humans, Male, Middle Aged, Parent-Child Relations, Parents}, issn = {1710-1107}, doi = {10.1017/S0714980812000372}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {7745, title = {Stroke incidence in older US Hispanics: is foreign birth protective?}, journal = {Stroke}, volume = {43}, year = {2012}, note = {Moon, J Robin Capistrant, Benjamin D Kawachi, Ichiro Avendano, Mauricio Subramanian, S V Bates, Lisa M Glymour, M Maria T32-HL098048-01/HL/NHLBI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke. 2012 May;43(5):1224-9. Epub 2012 Feb 21.}, month = {2012 May}, pages = {1224-9}, publisher = {43}, abstract = {

BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.

METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.

RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95\% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95\% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95\% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.

CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.

}, keywords = {Age Factors, Aged, Cohort Studies, Emigration and Immigration, Female, Hispanic or Latino, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic factors, Stroke, United States, White People}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.111.643700}, author = {J Robin Moon and Benjamin D Capistrant and Ichiro Kawachi and Mauricio Avendano and Subramanian, S V and Lisa M. Bates and M. Maria Glymour} } @article {7680, title = {Subjective social status and functional decline in older adults.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 Jun}, pages = {693-9}, abstract = {

BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults.

DESIGN: Longitudinal cohort study.

SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS: Mean age was 64; 46\% were male, 85\% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4~years, 50\% in the lowest SSS group declined in function, compared to the middle and highest groups (28\% and 26\%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73).

CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

}, keywords = {Activities of Daily Living, Aged, Aging, Female, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Risk Factors, Self Report, Social Class}, issn = {1525-1497}, doi = {10.1007/s11606-011-1963-7}, author = {Bonnie Chen and Kenneth E Covinsky and Irena Cenzer and Nancy E Adler and Brie A Williams} } @article {7768, title = {Tests and expenditures in the initial evaluation of peripheral neuropathy.}, journal = {Arch Intern Med}, volume = {172}, year = {2012}, month = {2012 Jan 23}, pages = {127-32}, publisher = {172}, abstract = {

BACKGROUND: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing.

METHODS: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods.

RESULTS: Of the 12, 673 patients, 1031 (8.1\%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2\% of patients, whereas a glucose tolerance test was rarely obtained (1.0\%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001).

CONCLUSIONS: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.

}, keywords = {Aged, Antibodies, Antinuclear, Blood Cell Count, Blood Protein Electrophoresis, Blood Sedimentation, Brain, Diagnostic Tests, Routine, Electromyography, Female, Glucose Tolerance Test, Glycated Hemoglobin, Health Expenditures, Humans, International Classification of Diseases, Magnetic Resonance Imaging, Male, Medicare, Neural Conduction, Peripheral Nervous System Diseases, Quality Assurance, Health Care, Spine, Thyrotropin, United States, Vitamin B 12}, issn = {1538-3679}, doi = {10.1001/archinternmed.2011.1032}, author = {Brian C. Callaghan and Ryan J McCammon and Kevin Kerber and Xiao Xu and Kenneth M. Langa and Eva L Feldman} } @article {7702, title = {Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study.}, journal = {Soc Sci Med}, volume = {75}, year = {2012}, month = {2012 Aug}, pages = {526-30}, publisher = {75}, abstract = {

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95\% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95\% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95\% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

}, keywords = {Age Factors, Aged, Cardiovascular Diseases, Female, Health Behavior, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, Survival Analysis, Time Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2012.04.004}, author = {J Robin Moon and M. Maria Glymour and Subramanian, S V and Mauricio Avendano and Ichiro Kawachi} } @article {7711, title = {Triggers of hospitalization for venous thromboembolism.}, journal = {Circulation}, volume = {125}, year = {2012}, note = {Rogers, Mary A M Levine, Deborah A Blumberg, Neil Flanders, Scott A Chopra, Vineet Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ R01 HL095467/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Circulation. 2012 May 1;125(17):2092-9. Epub 2012 Apr 3.}, month = {2012 May 01}, pages = {2092-9}, publisher = {125}, abstract = {

BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE.

METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4\% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95\% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95\% confidence interval: 1.19, 73.42; IRR=2.57, 95\% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7\%) of exposures before VTE hospitalization as opposed to 35.3\% in the comparison periods.

CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.

}, keywords = {Aged, Ambulatory Care Facilities, Comorbidity, Cross-Over Studies, Emergency Service, Hospital, Female, Hematinics, Home Care Services, Hospitalization, Humans, Immobilization, Incidence, Infections, Male, Medicare, Middle Aged, Office Visits, Postoperative Complications, Pulmonary Embolism, Risk Factors, Skilled Nursing Facilities, Transfusion Reaction, United States, Venous Thrombosis}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.111.084467}, url = {http://www.ncbi.nlm.nih.gov/pubmed/22474264}, author = {Mary A M Rogers and Deborah A Levine and Neil Blumberg and Scott A Flanders and Vineet Chopra and Kenneth M. Langa} } @article {7744, title = {Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke.}, journal = {Epidemiology}, volume = {23}, year = {2012}, note = {Nandi, Arijit Glymour, M Maria Kawachi, Ichiro VanderWeele, Tyler J HD060696/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Epidemiology. 2012 Mar;23(2):223-32.}, month = {2012 Mar}, pages = {223-32}, publisher = {23}, abstract = {

BACKGROUND: Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors.

METHODS: First-reported heart disease, diabetes, and stroke diagnoses were assessed in a national sample of 9760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father{\textquoteright}s occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent{\textquoteright}s education, occupation, labor force status, household income, and household wealth. Using marginal structural models, we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease.

RESULTS: During follow-up, 24\%, 18\%, and 9\% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged with the least disadvantaged quartile, early-life SES was associated with coronary heart disease (risk ratio = 1.30 [95\% confidence interval = 1.12-1.51]) and diabetes (1.23 [1.02-1.48]) and marginally associated with stroke via pathways not mediated by adult SES.

CONCLUSIONS: Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.

}, keywords = {Age Factors, Age of Onset, Child, Diabetes Mellitus, Educational Status, Female, Heart Diseases, Humans, Income, Linear Models, Male, Middle Aged, Models, Statistical, Risk Factors, Social Class, Social Conditions, Socioeconomic factors, Stroke, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0b013e31824570bd}, author = {Nandi, Arijit and M. Maria Glymour and Ichiro Kawachi and Tyler J VanderWeele} } @article {7716, title = {Variation in cognitive functioning as a refined approach to comparing aging across countries.}, journal = {Proc Natl Acad Sci U S A}, volume = {109}, year = {2012}, note = {Skirbekk, Vegard Loichinger, Elke Weber, Daniela 2R01AG017644/AG/NIA NIH HHS/United States 2R01AG7644-01A1/AG/NIA NIH HHS/United States P01 AG005842/AG/NIA NIH HHS/United States P01 AG08291/AG/NIA NIH HHS/United States P30 AG12815/AG/NIA NIH HHS/United States R21 AG025169/AG/NIA NIH HHS/United States U01 AG09740-13S2/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Y1-AG-4553-01/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Proc Natl Acad Sci U S A. 2012 Jan 17;109(3):770-4. Epub 2011 Dec 19.}, month = {2012 Jan 17}, pages = {770-4}, publisher = {109}, abstract = {

Comparing the burden of aging across countries hinges on the availability of valid and comparable indicators. The Old Age Dependency Ratio allows only a limited assessment of the challenges of aging, because it does not include information on any individual characteristics except age itself. Existing alternative indicators based on health or economic activity suffer from measurement and comparability problems. We propose an indicator based on age variation in cognitive functioning. We use newly released data from standardized tests of seniors{\textquoteright} cognitive abilities for countries from different world regions. In the wake of long-term advances in countries{\textquoteright} industrial composition, and technological advances, the ability to handle new job procedures is now of high and growing importance, which increases the importance of cognition for work performance over time. In several countries with older populations, we find better cognitive performance on the part of populations aged 50+ than in countries with chronologically younger populations. This variation in cognitive functioning levels may be explained by the fact that seniors in some regions of the world experienced better conditions during childhood and adult life, including nutrition, duration and quality of schooling, lower exposure to disease, and physical and social activity patterns. Because of the slow process of cohort replacement, those countries whose seniors already have higher cognitive levels today are likely to continue to be at an advantage for several decades to come.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Aging, Cognition, Data collection, Databases as Topic, Humans, Internationality, Male, Middle Aged}, issn = {1091-6490}, doi = {10.1073/pnas.1112173109}, author = {Skirbekk, V. and Loichinger, E. and Daniela Weber} } @article {7600, title = {Aging in a cultural context: cross-national differences in disability and the moderating role of personal control among older adults in the United States and England.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {457-67}, publisher = {66B}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cross-Cultural Comparison, Culture, Disabled Persons, England, Female, Gait, Health Status, Humans, Internal-External Control, Longitudinal Studies, Male, Mobility Limitation, Politics, Social Values, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr054}, author = {Philippa J Clarke and Jacqui Smith} } @article {7638, title = {Anticipatory ex ante moral hazard and the effect of Medicare on prevention.}, journal = {Health Econ}, volume = {20}, year = {2011}, note = {de Preux, Laure B Comparative Study England Health economics Health Econ. 2011 Sep;20(9):1056-72. doi: 10.1002/hec.1778.}, month = {2011 Sep}, pages = {1056-72}, publisher = {20}, abstract = {

This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.

}, keywords = {Age Factors, Aged, Alcohol Drinking, Female, Health Behavior, Health Services, Humans, Insurance Coverage, Male, Medically Uninsured, Medicare, Middle Aged, Morals, Motor Activity, Proportional Hazards Models, Regression Analysis, Smoking, United States}, issn = {1099-1050}, doi = {10.1002/hec.1778}, author = {de Preux, Laure B} } @article {7671, title = {Is the apolipoprotein e genotype a biomarker for mild cognitive impairment? Findings from a nationally representative study.}, journal = {Neuropsychology}, volume = {25}, year = {2011}, note = {Brainerd, Charles J Reyna, Valerie F Petersen, Ronald C Smith, Glenn E Taub, Emily S 1RC1AG036915-01/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Neuropsychology. 2011 Nov;25(6):679-89.}, month = {2011 Nov}, pages = {679-89}, publisher = {25}, abstract = {

OBJECTIVE: Although the ε4 allele of the apolipoprotein E (APOE) genotype is a known risk factor for Alzheimer{\textquoteright}s dementia (AD), prior findings on whether it is also a risk factor for mild cognitive impairment (MCI) have been inconsistent. We tested two contrasting explanations: (a) an ε4-AD specificity hypothesis, and (b) a measurement insensitivity hypothesis.

METHOD: The frequency of the ε4 allele was investigated in older adults (mean age > 70) with various types of cognitive impairment (including MCI) and various types of dementia (including AD) with the aging, demographics, and memory study (ADAMS) of the National Institute on Aging{\textquoteright}s Health and Retirement Study (HRS). The ADAMS controls sources of Type I and Type II error that are posited in the ε4-AD specificity hypothesis and the measurement insensitivity hypothesis, and it is the only nationally representative data set on aging and cognitive impairment.

RESULTS: ε4 was a reliable predictor of MCI, with a frequency of 32\% in MCI subjects versus 20\% in healthy control subjects. This link was specific to MCI because ε4 was not a risk factor for other forms of cognitive impairment without dementia.

CONCLUSIONS: The results support the measurement insensitivity hypothesis rather than the ε4-AD specificity hypothesis and are consistent with recent research showing modest reductions in cognitive performance among normal functioning ε4 carriers.

}, keywords = {Aged, Aged, 80 and over, Aging, Analysis of Variance, Apolipoprotein E4, Cognitive Dysfunction, Dementia, Female, Gene Frequency, Genetic Markers, Genetic Testing, Genotype, Humans, Male, National Institute on Aging (U.S.), Neuropsychological tests, Reference Values, Reproducibility of Results, Risk Factors, United States}, issn = {1931-1559}, doi = {10.1037/a0024483}, author = {Brainerd, Charles J and V. F. Reyna and Ronald C Petersen and Glenn E Smith and Taub, Emily S} } @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 {7658, title = {Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study (ADAMS).}, journal = {Alzheimer Dis Assoc Disord}, volume = {25}, year = {2011}, note = {Okura, Toru Langa, Kenneth M R01 AG027010/AG/NIA NIH HHS/United States R01 AG030155-01/AG/NIA NIH HHS/United States R01 AG030155-02/AG/NIA NIH HHS/United States R01 AG030155-03/AG/NIA NIH HHS/United States R01 AG030155-04/AG/NIA NIH HHS/United States R01 AG030155-05/AG/NIA NIH HHS/United States U01 AG09740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Alzheimer disease and associated disorders Nihms259646 Alzheimer Dis Assoc Disord. 2011 Apr-Jun;25(2):116-21.}, month = {2011 Apr-Jun}, pages = {116-21}, publisher = {25}, abstract = {

OBJECTIVES: To estimate the quantity of informal care associated with neuropsychiatric symptoms in older adults with cognitive impairment.

DESIGN: Cross-sectional analysis.

SETTING: The Aging, Demographics, and Memory Study.

PARTICIPANTS: A sample (n=450) of adults aged 71 years and older with cognitive impairment drawn form the Health and Retirement Study.

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. Cognitive category [normal, cognitive impairment without dementia (CIND), or dementia] was assigned by a consensus panel. The hours per week of active help and supervision were ascertained by informant questionnaire.

RESULTS: Among older adults with CIND or dementia, those with no neuropsychiatric symptoms received an average of 10.2 hours of active help and 10.9 hours of supervision per week from informal caregivers. Those with 1 or 2 neuropsychiatric symptoms received an additional 10.0 hours of active help and 12.4 hours of supervision per week, while those with 3 or more symptoms received an additional 18.2 hours of active help and 28.7 hours of supervision per week (P<0.001). The presence of irritation (14.7 additional hours) was associated with the greatest number of additional hours of active help. The presence of aberrant motor behaviors (17.7 additional hours) and disinhibition (17.5 additional hours) were associated with the greatest number of additional hours of supervision.

CONCLUSIONS: Neuropsychiatric symptoms among those with CIND or dementia are associated with a significant increase in the provision of informal care. This care represents a significant time commitment for families and a significant economic cost to society.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cognition Disorders, Cost of Illness, Cross-Sectional Studies, Female, Humans, Male, Neuropsychological tests}, issn = {1546-4156}, doi = {10.1097/WAD.0b013e318203f208}, author = {Okura, Toru and Kenneth M. Langa} } @article {7570, title = {Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, month = {2011 Mar}, pages = {488-94}, publisher = {59}, abstract = {

OBJECTIVES: To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND).

DESIGN: Cross-sectional.

SETTING: In-home assessment for cognitive impairment and self-administered caregiving questionnaire.

PARTICIPANTS: One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study.

MEASUREMENTS: Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics.

RESULTS: Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5\% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01).

CONCLUSION: Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.

}, keywords = {Activities of Daily Living, Aged, Analysis of Variance, Caregivers, Cognition Disorders, Cross-Sectional Studies, Dementia, Female, Humans, Linear Models, Male, Neuropsychological tests, Time Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03304.x}, url = {http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.03304.x/full}, author = {Gwenith G Fisher and Melissa M Franks and Brenda L Plassman and Stephanie Brown and Guy G Potter and David J Llewellyn and Mary A M Rogers and Kenneth M. Langa} } @article {7643, title = {Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: overall trends and differences by race/ethnicity.}, journal = {Am J Epidemiol}, volume = {174}, year = {2011}, note = {Sheffield, Kristin M Peek, M Kristen T32-AG00270/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States American journal of epidemiology Am J Epidemiol. 2011 Aug 1;174(3):274-83. Epub 2011 May 27.}, month = {2011 Aug 01}, pages = {274-83}, publisher = {174}, abstract = {

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

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

The authors use data from the Health and Retirement Study{\textquoteright}s Earnings Benefit File, which links Health and Retirement Study to Social Security Administration records, to estimate the impact of childhood health on earnings curves between the ages of 25 and 50 years. They also investigate the extent to which diminished educational attainment, earlier onset of chronic health conditions, and labor force participation mediate this relationship. Those who experience poor childhood health have substantially diminished labor market earnings over the work career. For men, earnings differentials grow larger over the early to middle career and then slow down and begin to converge as they near 50 years of age. For women, earnings differentials emerge later in the career and show no evidence of convergence. Part of the child health earnings differential is accounted for by selection into diminished educational attainment, the earlier onset of chronic disease in adulthood, and, particularly for men, labor force participation.

}, keywords = {Child, Employment, Female, Health Status, Humans, Income, Male, Middle Aged, Models, Econometric, Retirement, Social Class, Social Security, Socioeconomic factors, United States}, issn = {2150-6000}, doi = {10.1177/0022146511410431}, author = {Steven A Haas and M. Maria Glymour and Lisa F Berkman} } @article {7548, title = {Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study.}, journal = {J Occup Environ Med}, volume = {53}, year = {2011}, month = {2011 Apr}, pages = {372-80}, publisher = {53}, abstract = {

OBJECTIVES: To examine the health status of older construction workers in the United States, and how occupation and the aging process affect health in workers{\textquoteright} later years.

METHODS: We analyzed six waves (1998 to 2008) of the Health and Retirement Study, a longitudinal survey of US residents age 50+. The study sample totaled 7200 male workers (510 in construction trades) in the baseline. Multiple logistic regression and paired t tests were conducted to compare health outcomes across occupations and within individuals over time.

RESULTS: Compared with white-collar workers, construction workers had increased odds of arthritis, back problems, chronic lung disease, functional limitations, work disability, and work-related injuries after controlling for possible confounders.

CONCLUSIONS: Safety and health interventions, as well as retirement and pension policy, should meet the needs of older construction workers, who face increasingly chronic health conditions over time.

}, keywords = {Aged, Aging, Arthritis, Chronic disease, Disabled Persons, Facility Design and Construction, Follow-Up Studies, Humans, Lung Diseases, Male, Middle Aged, Occupational Diseases, Occupations, United States}, issn = {1536-5948}, doi = {10.1097/JOM.0b013e3182122286}, author = {Xiuwen S Dong and Wang, Xuanwen and Daw, Christina and Ringen, Knut} } @article {7644, title = {Conscientiousness and longevity: an examination of possible mediators.}, journal = {Health Psychol}, volume = {30}, year = {2011}, note = {Hill, Patrick L Turiano, Nicholas A Hurd, Michael D Mroczek, Daniel K Roberts, Brent W R01 AG021178-09/AG/NIA NIH HHS/United States United States Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol. 2011 Sep;30(5):536-41.}, month = {2011 Sep}, pages = {536-41}, publisher = {30}, abstract = {

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

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

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

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

}, keywords = {Adult, Aged, Chronic disease, Cognition, Educational Status, Female, Health Behavior, Health Status, Humans, Longevity, Longitudinal Studies, Male, Middle Aged, Personality, Proportional Hazards Models, Psychological Tests}, issn = {1930-7810}, doi = {10.1037/a0023859}, author = {Patrick L Hill and Nicholas A. Turiano and Michael D Hurd and Daniel K. Mroczek and Brent W Roberts} } @article {7646, title = {Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008.}, journal = {Stroke}, volume = {42}, year = {2011}, note = {Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19.}, month = {2011 Jul}, pages = {1821-5}, publisher = {42}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33\%), sleep problems (up to 33\%), falls (30\%), urinary incontinence (19\%), and memory deficits (9\%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95\% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95\% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95\% CI, 1.16 to 2.24), falls (OR, 1.5; 95\% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95\% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95\% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

}, keywords = {Activities of Daily Living, Aged, Case-Control Studies, Cohort Studies, Comorbidity, Female, Geriatrics, Humans, Male, Quality of Life, Retirement, Risk, Social Environment, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.110.607630}, author = {Afshin A Divani and Shahram Majidi and Anna M Barrett and Noorbaloochi, Siamak and Andreas R Luft} } @article {7665, title = {Depression and the onset of chronic illness in older adults: a 12-year prospective study.}, journal = {J Behav Health Serv Res}, volume = {38}, year = {2011}, month = {2011 Jul}, pages = {373-82}, publisher = {38}, abstract = {

The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Chronic disease, depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Sex Distribution, Socioeconomic factors, United States}, issn = {1556-3308}, doi = {10.1007/s11414-011-9234-2}, author = {Mustafa C. Karakus and Lisa C Patton} } @article {7624, title = {Determinants of death in the hospital among older adults.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, note = {Kelley, Amy S Ettner, Susan L Wenger, Neil S Sarkisian, Catherine A United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2321-5. doi: 10.1111/j.1532-5415.2011.03718.x. Epub 2011 Nov 8.}, month = {2011 Dec}, pages = {2321-5}, publisher = {59}, abstract = {

OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.

DESIGN: Using multivariable regression, the relationship between in-hospital death and participants{\textquoteright} social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.

SETTING: The Health and Retirement Study, a longitudinal nationally representative cohort of older adults.

PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N~=~3,539) were sampled.

MEASUREMENTS: In-hospital death.

RESULTS: Thirty-nine percent (n~=~1,380) of participants died in the hospital (range 34\% in Midwest to 45\% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.

CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.

}, keywords = {Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Male, Multivariate Analysis, Risk Factors, Socioeconomic factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03718.x}, author = {Amy Kelley and Susan L Ettner and Neil S. Wenger and Catherine A Sarkisian} } @article {10887, title = {Determinants of medical expenditures in the last 6 months of life.}, journal = {Annals of Internal Medicine}, volume = {154}, year = {2011}, pages = {235-242}, abstract = {

BACKGROUND: End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs.

OBJECTIVE: To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation.

DESIGN: Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics.

SETTING: United States, 2000 to 2006.

PARTICIPANTS: 2394 Health and Retirement Study decedents aged 65.5 years or older.

MEASUREMENTS: Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics.

RESULTS: Decline in function (rate ratio [RR], 1.64 [95\% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10\% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for.

LIMITATION: The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation.

CONCLUSION: Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics.

PRIMARY FUNDING SOURCE: The Brookdale Foundation.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Ethnic Groups, Female, Health Expenditures, Humans, Income, Independent Living, Male, Medicare, Regression Analysis, Social Support, Socioeconomic factors, Terminal Care, United States}, issn = {1539-3704}, doi = {10.7326/0003-4819-154-4-201102150-00004}, author = {Amy Kelley and Susan L Ettner and R Sean Morrison and Qingling Du and Neil S. Wenger and Catherine A Sarkisian} } @article {7529, title = {Development and validation of a brief cognitive assessment tool: the sweet 16.}, journal = {Arch Intern Med}, volume = {171}, year = {2011}, month = {2011 Mar 14}, pages = {432-7}, publisher = {171}, abstract = {

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80\% and a specificity of 70\%, whereas an MMSE score of less than 24 showed a sensitivity of 64\% and a specificity of 86\% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99\% and a specificity of 72\% in contrast to an MMSE score with a sensitivity of 87\% and a specificity of 89\%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, Female, Humans, Male, Neuropsychological tests, Surveys and Questionnaires}, issn = {1538-3679}, doi = {10.1001/archinternmed.2010.423}, author = {Tamara G Fong and Richard N Jones and James L Rudolph and Frances Margaret Yang and Tommet, Douglas and Habtemariam, Daniel and Edward R Marcantonio and Kenneth M. Langa and Sharon K Inouye} } @article {7645, title = {Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults?}, journal = {J Diabetes}, volume = {3}, year = {2011}, note = {Yamashita, Takashi Kart, Cary S Australia Journal of diabetes J Diabetes. 2011 Jun;3(2):138-46. doi: 10.1111/j.1753-0407.2011.00112.x.}, month = {2011 Jun}, pages = {138-46}, publisher = {3}, abstract = {

BACKGROUND: The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults.

METHODS: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean ({\textpm}SD) 67.96 {\textpm} 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927).

RESULTS: Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week.

CONCLUSIONS: No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients{\textquoteright} assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

}, keywords = {Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Health Literacy, Humans, Logistic Models, Middle Aged, Multivariate Analysis, Self Care, Socioeconomic factors, Surveys and Questionnaires, United States}, issn = {1753-0407}, doi = {10.1111/j.1753-0407.2011.00112.x}, author = {Takashi Yamashita and Cary S Kart} } @article {7675, title = {Differences in health between Americans and Western Europeans: Effects on longevity and public finance.}, journal = {Soc Sci Med}, volume = {73}, year = {2011}, month = {2011 Jul}, pages = {254-63}, publisher = {73}, abstract = {

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

}, keywords = {Activities of Daily Living, Adult, Aged, Body Mass Index, Cross-Cultural Comparison, Disabled Persons, Europe, Female, Health Expenditures, health policy, Health Status Disparities, Health Surveys, Humans, Internationality, Life Expectancy, Male, Middle Aged, Models, Economic, Models, Statistical, Mortality, Public Health, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.05.027}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7641, title = {Dispositional optimism protects older adults from stroke: the Health and Retirement Study.}, journal = {Stroke}, volume = {42}, year = {2011}, note = {Kim, Eric S Park, Nansook Peterson, Christopher Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke; a journal of cerebral circulation Stroke. 2011 Oct;42(10):2855-9. Epub 2011 Jul 21.}, month = {2011 Oct}, pages = {2855-9}, publisher = {42}, abstract = {

BACKGROUND AND PURPOSE: Although higher optimism has been linked to an array of positive health outcomes, the association between optimism and incidence of stroke remains unclear, especially among older adults. We examined whether higher optimism was associated with a lower incidence of stroke.

METHOD: Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults aged>50 years--were used. Analyses were conducted for a 2-year follow-up on the subset of 6044 adults (2542 men, 3502 women) who were stroke-free at baseline. Analyses adjusted for chronic illnesses, self-rated health, and relevant sociodemographic, behavioral, biological, and psychological factors.

RESULTS: Higher optimism was associated with a lower risk of stroke. On an optimism measure ranging from 3 to 18, each unit increase in optimism was associated with an age-adjusted OR of 0.90 for stroke (95\% CI, 0.84 to 0.97; P<0.01). The effect of optimism remained significant even after fully adjusting for a comprehensive set of sociodemographic, behavioral, biological, and psychological stroke risk factors.

CONCLUSIONS: Optimism may play an important role in protecting against stroke among older adults.

}, keywords = {Affect, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Personality, Prospective Studies, Risk Factors, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.111.613448}, author = {Eric S Kim and Nansook Park and Christopher Peterson} } @article {7561, title = {Do biological measures mediate the relationship between education and health: A comparative study.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Jan}, pages = {307-15}, publisher = {72}, abstract = {

Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.

}, keywords = {Biomarkers, Blood pressure, Body Mass Index, Cholesterol, Costa Rica, Educational Status, Female, Health Status Disparities, Health Status Indicators, Health Surveys, Humans, Male, Middle Aged, Qualitative Research, Taiwan, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.11.004}, author = {Goldman, Noreen and Cassio M. Turra and Rosero-Bixby, Luis and David R Weir and Eileen M. Crimmins} } @article {7587, title = {Does fall history influence residential adjustments?}, journal = {Gerontologist}, volume = {51}, year = {2011}, month = {2011 Apr}, pages = {190-200}, publisher = {51}, abstract = {

PURPOSE OF THE STUDY: To determine whether reported falls at baseline are associated with an older adult{\textquoteright}s decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years.

DESIGN AND METHODS: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of community-living older adults, 65 years of age and older. At baseline, fall history (no fall, 1 fall no injury, 2 or more falls no injury, or 1 or more falls with an injury) and factors potentially associated with RA were used to predict the initiation of an RA (i.e., moving, home modifications, increased use of adaptive equipment, family support, or personal care assistance) during the subsequent 2 years.

RESULTS: Compared with those with no history of falls, individuals with a history of falls had higher odds of making any RA. Among those making an RA, individuals with an injurious fall were more likely than those with no history of a fall to start using adaptive equipment or increase their use of personal care assistance.

IMPLICATIONS: The higher initiation of RAs among fallers may indicate proactive steps to prevent future falls and may be influenced by interactions with the health care system. To optimize fall prevention efforts, older adults would benefit from education and interventions addressing optimal use of RAs before falls occur.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Decision making, Environment Design, Female, Geriatric Assessment, Humans, Male, Residential Facilities, Risk Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq086}, author = {Leland, Natalie and Frank Porell and Susan L Murphy} } @article {7608, title = {Does informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {585-94}, publisher = {66B}, abstract = {

OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS: Although older adults{\textquoteright} disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers{\textquoteright} well-being.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost of Illness, depression, Disability Evaluation, Female, Humans, Longitudinal Studies, Male, Models, Psychological, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr060}, author = {Lin, I-Fen and Wu, Hsueh-Sheng} } @article {7601, title = {Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {478-89}, publisher = {66B}, abstract = {

OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression).

METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent{\textquoteright}s rating of each vignette character{\textquoteright}s health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent{\textquoteright}s cut-points from the vignettes and the severity of the respondent{\textquoteright}s own health problems based on these vignette cut-points.

RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity.

DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Bias, Black People, Disability Evaluation, Educational Status, Female, Geriatric Assessment, Health Status Indicators, Health Surveys, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Socioeconomic factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbr050}, author = {Jennifer B Dowd and Todd, Megan} } @article {7604, title = {Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Aug}, pages = {806-21}, publisher = {23}, abstract = {

OBJECTIVE: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS: Over the follow-up periods, 38.6\% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged >=65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Alcohol Drinking, Female, Humans, Logistic Models, Male, Middle Aged, Retirement}, issn = {1552-6887}, doi = {10.1177/0898264310397541}, author = {James C. Lin and Guerrieri, Joy Gioia and Alison A . Moore} } @article {7660, title = {Dynamic Inefficiencies in an Employment-Based Health Insurance System: Theory and Evidence.}, journal = {Am Econ Rev}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {3047-77}, publisher = {101}, abstract = {

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Memory, Memory Disorders, Memory, Episodic, Models, Statistical, Neuropsychological tests}, issn = {1939-1498}, doi = {10.1037/a0023023}, author = {Frank J Infurna and Denis Gerstorf and Lindsay H Ryan and Jacqui Smith} } @article {7657, title = {Education and health: evidence on adults with diabetes.}, journal = {Int J Health Care Finance Econ}, volume = {11}, year = {2011}, note = {Ayyagari, Padmaja Grossman, Daniel Sloan, Frank 2R37-AG-17473-05A1/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States International journal of health care finance and economics Int J Health Care Finance Econ. 2011 Mar;11(1):35-54. Epub 2011 Jan 7.}, month = {2011 Mar}, pages = {35-54}, publisher = {11}, abstract = {

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

}, keywords = {Aged, Cognition, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Health Services, Humans, Male, Patient Education as Topic, Self Efficacy, Sex Factors, Socioeconomic factors, Time Factors}, issn = {1573-6962}, doi = {10.1007/s10754-010-9087-x}, author = {Padmaja Ayyagari and Grossman, Daniel and Frank A Sloan} } @article {7556, title = {The effect of job loss on overweight and drinking.}, journal = {J Health Econ}, volume = {30}, year = {2011}, month = {2011 Mar}, pages = {317-27}, publisher = {30}, abstract = {

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.

}, keywords = {Alcohol Drinking, Body Mass Index, Female, Humans, Longitudinal Studies, Male, Middle Aged, Overweight, Unemployment, United States}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2010.12.009}, author = {Deb, Partha and William T Gallo and Padmaja Ayyagari and Jason M. Fletcher and Jody L Sindelar} } @article {7649, title = {Effects of smoking cessation on pain in older adults.}, journal = {Nicotine Tob Res}, volume = {13}, year = {2011}, note = {Shi, Yu Hooten, W Michael Warner, David O U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t England Nicotine and tobacco research : official journal of the Society for Research on Nicotine and Tobacco Nicotine Tob Res. 2011 Oct;13(10):919-25. Epub 2011 May 12.}, month = {2011 Oct}, pages = {919-25}, publisher = {13}, abstract = {

INTRODUCTION: Smokers are at increased risk of developing chronic pain and suffering higher pain intensity. However, nicotine has analgesic properties, and smokers may view smoking as a means to cope with pain. Smoking cessation is clearly beneficial to the long-term health of smokers. However, it is not known how abstinence from smoking affects pain. The aim of this study was to determine the association between smoking cessation and changes in pain symptoms by secondary analysis of a large longitudinal dataset of older adults.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992 through 2006) from the nationally representative Health and Retirement Study of United States adults older than 50 years. Multivariate logistic regressions were utilized to determine the relationship between the changes in smoking status and changes in pain symptoms, controlling for demographics, depression, self-rated health, history of arthritis, and body mass index.

RESULTS: In multivariate analyses, among the 4,695 smokers who reported no pain or mild pain at enrollment, smoking status was not independently associated with exacerbation of pain (odds ratio [OR]: 0.95, 95\% CI: 0.84, 1.08). Among the 1,118 smokers who reported moderate to severe pain at enrollment, smoking status was not independently associated with improvement of pain (OR: 0.87, 95\% CI: 0.70, 1.08).

CONCLUSIONS: Smoking cessation was not independently associated with changes in pain symptoms in older adults. These results suggest that concerns regarding the effects of abstinence from smoking on pain should not pose a barrier to offering tobacco use interventions to smokers with chronic pain.

}, keywords = {Aged, Body Mass Index, depression, Female, Follow-Up Studies, Humans, Interviews as Topic, Logistic Models, Longitudinal Studies, Male, Middle Aged, Odds Ratio, pain, Pain Perception, Smoking, Smoking cessation, Smoking Prevention}, issn = {1469-994X}, doi = {10.1093/ntr/ntr097}, author = {Yu Shi and Hooten, W Michael and David O. Warner} } @article {7606, title = {The evolution of advance directives.}, journal = {JAMA}, volume = {306}, year = {2011}, month = {2011 Oct 05}, pages = {1485-6}, publisher = {306}, keywords = {Advance directives, Cost Savings, Decision making, Health Expenditures, Humans, Medicare, Palliative care, Terminal Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1430}, author = {Douglas B. White and Robert M. Arnold} } @article {7573, title = {Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators.}, journal = {Ann Behav Med}, volume = {41}, year = {2011}, month = {2011 Feb}, pages = {71-82}, publisher = {41}, abstract = {

BACKGROUND: Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men.

PURPOSE: This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender-functional limitations relationship in adults with type 2 diabetes.

METHODS: We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling.

RESULTS: Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender-functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender-functional limitations relationship.

CONCLUSIONS: Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health.

}, keywords = {Adult, Aged, Aged, 80 and over, Biomarkers, Blood Glucose Self-Monitoring, Body Mass Index, Diabetes Mellitus, Type 2, Exercise, Female, Health Behavior, Humans, Male, Middle Aged, Models, Psychological, Prospective Studies, Risk Factors, Self Report, Sex Characteristics, Socioeconomic factors, United States}, issn = {1532-4796}, doi = {10.1007/s12160-010-9226-0}, author = {Chiu, Ching-Ju and Linda A. Wray} } @article {7503, title = {Gender differences in health: results from SHARE, ELSA and HRS.}, journal = {Eur J Public Health}, volume = {21}, year = {2011}, month = {2011 Feb}, pages = {81-91}, abstract = {

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

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

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

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

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

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

}, keywords = {Female, Health Status, Health Surveys, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Power, Psychological, Quality of Life, Regression Analysis, Sex Distribution, Socioeconomic factors, United States, Women, Working}, issn = {1540-7322}, doi = {10.1080/08952841.2011.540481}, author = {Jennifer R. Bulanda} } @article {7534, title = {Generational jeopardy? Parents{\textquoteright} marital transitions and the provision of financial transfers to adult children.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jan}, pages = {99-108}, publisher = {66}, abstract = {

OBJECTIVES: Transitions into and out of marriage are becoming more commonplace among persons in middle and later life. We assess the extent to which parental marital transitions influence inter vivos financial transfers to adult children at the family level.

METHODS: Panel data from 6,017 households with adult children in the 1992-1998 waves of the Health and Retirement Study are analyzed in this study.

RESULTS: Net of familial characteristics, those families experiencing a parental marriage were less likely than stably married households to make a financial transfer to an adult child. The effects of divorce or widowhood were modest. Divorce was associated with a slight increase in the probability of providing a transfer. Widowhood was associated with a slight increase in the total amount transferred to children.

DISCUSSION: The study adds weight to the growing argument that marital transitions may alter intergenerational exchanges. The results prompt us to further question how broader demographic and marriage patterns will influence relationships between parents and children in aging societies.

}, keywords = {Adolescent, Adult, Adult children, Aged, Divorce, Female, Financial Support, Humans, Intergenerational Relations, Male, Marriage, Middle Aged, Prejudice, Retirement, Widowhood, Young Adult}, issn = {1758-5368}, doi = {10.1093/geronb/gbq010}, author = {Shapiro, Adam and R Corey Remle} } @article {7572, title = {Geriatric conditions develop in middle-aged adults with diabetes.}, journal = {J Gen Intern Med}, volume = {26}, year = {2011}, month = {2011 Mar}, pages = {272-9}, publisher = {26}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Case-Control Studies, Chronic disease, depression, Female, Geriatric Assessment, Health Services, Health Services for the Aged, Health Status, Home Care Services, Hospitalization, Humans, Interview, Psychological, Male, Middle Aged, Multivariate Analysis, Psychometrics, Retirement}, issn = {1540-4048}, doi = {10.1080/01634372.2011.595476}, author = {Gaines, Jean M and Judith L Poey and Marx, Katherine A and J. M. Parrish and Resnick, Barbara} } @article {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 {7669, title = {How does health insurance affect the retirement behavior of women?}, journal = {Inquiry}, volume = {48}, year = {2011}, month = {2011 Spring}, pages = {51-67}, publisher = {48}, abstract = {

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

}, keywords = {Decision making, Female, Health Benefit Plans, Employee, Humans, Male, Models, Econometric, Multivariate Analysis, Pensions, Retirement, Spouses, United States, Women, Working}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_48.01.04}, author = {Kanika Kapur and Jeannette Rogowski} } @article {7629, title = {How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, note = {Quinones, Ana R Liang, Jersey Bennett, Joan M Xu, Xiao Ye, Wen F31-AG029783/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States Comparative Study 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 Nov;66(6):739-49. Epub 2011 Oct 3.}, month = {2011 Nov}, pages = {739-49}, publisher = {66}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Chronic disease, Female, Follow-Up Studies, Health Behavior, Health Status Disparities, Hispanic or Latino, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbr106}, author = {Ana R Qui{\~n}ones and Jersey Liang and Joan M. Bennett and Xiao Xu and Wen Ye} } @article {7590, title = {The impact of private long-term care insurance on the use of long-term care.}, journal = {Inquiry}, volume = {48}, year = {2011}, month = {2011 Spring}, pages = {34-50}, publisher = {48}, abstract = {

This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.

}, keywords = {Aged, Aged, 80 and over, Decision making, Female, Health Services Accessibility, Home Care Services, Home Nursing, Humans, Insurance, Long-Term Care, Likelihood Functions, Long-term Care, Male, Models, Econometric, Nursing homes, Private Sector, Regression Analysis, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_48.01.05}, author = {Yong Li and Gail A Jensen} } @article {7640, title = {Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage.}, journal = {JAMA}, volume = {306}, year = {2011}, note = {McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov{\textquoteright}t United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9.}, month = {2011 Jul 27}, pages = {402-9}, publisher = {306}, abstract = {

CONTEXT: Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear.

OBJECTIVE: To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005.

MAIN OUTCOME MEASURE: Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services).

RESULTS: Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95\% confidence interval {CI}, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95\% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95\% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95\% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95\% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage.

CONCLUSION: Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

}, keywords = {Aged, Aged, 80 and over, Cost Control, Costs and Cost Analysis, Data collection, Female, Health Expenditures, Health Services, Humans, Insurance Claim Review, Longitudinal Studies, Male, Medicare Part D, Patient Care, Physicians, Skilled Nursing Facilities, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1026}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Haiden A. Huskamp} } @article {7586, title = {Incidence of dementia and cognitive impairment, not dementia in the United States.}, journal = {Ann Neurol}, volume = {70}, year = {2011}, month = {2011 Sep}, pages = {418-26}, abstract = {

OBJECTIVE: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND.

METHODS: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in-home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population-weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia.

RESULTS: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person-years and 22.9 (SE, 2.9) per 1,000 person-years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person-years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person-years progressed from CIND to dementia. Over a 5.9-year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND.

INTERPRETATION: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cognition Disorders, Cohort Studies, Dementia, Diagnostic and Statistical Manual of Mental Disorders, disease progression, Female, Humans, Logistic Models, Longitudinal Studies, Male, Models, Statistical, United States}, issn = {1531-8249}, doi = {10.1002/ana.22362}, author = {Brenda L Plassman and Kenneth M. Langa and Ryan J McCammon and Gwenith G Fisher and Guy G Potter and James R Burke and David C Steffens and Norman L Foster and Bruno J Giordani and Frederick W Unverzagt and Kathleen A Welsh-Bohmer and Steven G Heeringa and David R Weir and Robert B Wallace} } @article {7633, title = {Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval.}, journal = {Int J Environ Res Public Health}, volume = {8}, year = {2011}, note = {Bobo, Janet Kay Greek, April A AA016534/AA/NIAAA NIH HHS/United States R24 HD042828-10/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Switzerland International journal of environmental research and public health Int J Environ Res Public Health. 2011 Aug;8(8):3263-76. Epub 2011 Aug 5.}, month = {2011 Aug}, pages = {3263-76}, publisher = {8}, abstract = {

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed >= 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3\% of sample), "Decreasing Drinkers" (5.9\%), "Stable Drinkers" (24.2\%), and "Non/Infrequent Drinkers" (64.6\%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

}, keywords = {Aged, Alcohol Drinking, Alcoholic Intoxication, Alcoholism, Cohort Studies, depression, Ethanol, Female, Follow-Up Studies, Humans, Longitudinal Studies, Middle Aged, Retirement, Risk Factors, Smoking, Surveys and Questionnaires, United States}, issn = {1660-4601}, doi = {10.3390/ijerph8083263}, author = {Janet Kay Bobo and April A Greek} } @article {7678, title = {The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, note = {Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V.}, month = {2011 Oct}, pages = {1882-91}, publisher = {101}, abstract = {

OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.

METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.

RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.

}, keywords = {Age Factors, Aged, Dental Care, Employment, Female, Health Care Surveys, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300227}, author = {Richard J. Manski and John F Moeller and Patricia A St Clair and Jody Schimmel and Haiyan Chen and John V Pepper} } @article {7546, title = {Job loss and depression: the role of subjective expectations.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Feb}, pages = {576-83}, publisher = {72}, abstract = {

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual{\textquoteright}s subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

}, keywords = {Adaptation, Psychological, Aged, Bias, depression, Empirical Research, Health Surveys, Humans, Mental Health, Middle Aged, Stress, Psychological, Unemployment, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.11.014}, author = {Mandal, Bidisha and Padmaja Ayyagari and William T Gallo} } @article {7602, title = {Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {426-34}, publisher = {66B}, abstract = {

OBJECTIVE: To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults.

METHOD: Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse.

RESULTS: High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95\% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age.

DISCUSSION: Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.

}, keywords = {Age Factors, Aged, Alcoholism, Cohort Studies, Depressive Disorder, Female, Health Behavior, Health Surveys, Humans, Job Satisfaction, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Retirement, Sex Factors, Statistics as Topic, Stress, Psychological, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr021}, author = {Briana Mezuk and Amy S B Bohnert and Scott M Ratliff and Zivin, Kara} } @article {7650, title = {Lifecourse socioeconomic circumstances and multimorbidity among older adults.}, journal = {BMC Public Health}, volume = {11}, year = {2011}, note = {Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313.}, month = {2011 May 14}, pages = {313}, publisher = {11}, abstract = {

BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8\% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5\% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

}, keywords = {Aged, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Social Class, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-11-313}, author = {Reginald D. Tucker-Seeley and Li, Yi and Sorensen, Glorian and Subramanian, S V} } @article {7579, title = {Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, month = {2011 Aug 16}, pages = {43}, publisher = {11}, abstract = {

BACKGROUND: Most prior studies have focused on short-term (<= 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6\% on ADL abilities, 32.3\% on IADL abilities, and 30.9\% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Health Surveys, Humans, Insurance Benefits, Longitudinal Studies, Male, Medicare, Mobility Limitation, Prospective Studies, Time Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-43}, author = {Frederic D Wolinsky and Suzanne E Bentler and Jason Hockenberry and Michael P Jones and Maksym Obrizan and Paula A Weigel and Kaskie, Brian and Robert B Wallace} } @article {7609, title = {Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {571-81}, publisher = {66B}, abstract = {

OBJECTIVES: Although research indicates that depressive symptoms and memory performance are related in older adults, the temporal associations between these variables remain unclear. This study examined whether depressive symptoms predicted later memory change and whether memory predicted later change in depressive symptoms.

METHODS: The sample consisted of more than 14,000 adults from the Health and Retirement Study, a biannual longitudinal study of health and retirement in Americans older than age 50 years. Measures of delayed recall and depressive symptoms served as the main study variables. We included age, sex, education, and history of vascular diseases as covariates.

RESULTS: Using dynamic change models with latent difference scores, we found that memory performance predicted change in depressive symptoms 2 years later. Depressive symptoms did not predict later change in memory. The inclusion of vascular health variables diminished the size of the observed relationship, suggesting that biological processes may partially explain the effect of memory on depressive symptoms.

IMPLICATIONS: Future research should explore both biological and psychological processes that may explain the association between worse memory performance and subsequent increases in depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Comorbidity, Dementia, Vascular, depression, Female, Geriatric Assessment, Humans, Longitudinal Studies, Male, Mental Recall, Middle Aged, Models, Psychological, Retirement, Statistics as Topic, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr035}, author = {Jajodia, Archana and Borders, Ashley} } @article {7659, title = {Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, month = {2011 Dec}, pages = {2293-8}, publisher = {101}, abstract = {

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

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

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

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

}, keywords = {depression, Drug Costs, Economic Recession, Female, Health Services Accessibility, Health Status, Housing, Humans, Male, Medication Adherence, Middle Aged, Socioeconomic factors, Stress, Psychological, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300245}, author = {Dawn E Alley and Jennifer Lloyd and Jos{\'e} A Pag{\'a}n and Craig E Pollack and Michelle Shardell and Carolyn Cannuscio} } @article {7636, title = {Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations.}, journal = {Psychol Aging}, volume = {26}, year = {2011}, note = {Liang, Jersey Xu, Xiao Quinones, Ana R Bennett, Joan M Ye, Wen 5P30AG024824/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States UL1RR024986/RR/NCRR NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S. United States Psychology and aging Psychol Aging. 2011 Dec;26(4):761-77. Epub 2011 Aug 29.}, month = {2011 Dec}, pages = {761-77}, publisher = {26}, abstract = {

This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9\%), (b) low depressive symptoms (36.3\%), (c) moderate and stable depressive symptoms (29.2\%), (d) high but decreasing depressive symptoms (6.6\%), (e) moderate but increasing depressive symptoms (8.3\%), and (f) persistently high depressive symptoms (3.6\%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.

}, keywords = {Age Factors, Aged, Black or African American, depression, disease progression, Female, Health Status Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Socioeconomic factors, Time Factors, United States, White People}, issn = {1939-1498}, doi = {10.1037/a0023945}, author = {Jersey Liang and Xiao Xu and Ana R Qui{\~n}ones and Joan M. Bennett and Wen Ye} } @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 {7560, title = {Neighborhoods and chronic disease onset in later life.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, month = {2011 Jan}, pages = {79-86}, publisher = {101}, abstract = {

OBJECTIVES: To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults.

METHODS: Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting the onset of heart problems, hypertension, stroke, diabetes, cancer, and arthritis by 2004 were estimated.

RESULTS: In adjusted models, living in more economically disadvantaged areas predicted the onset of heart problems for women (odds ratio [OR] = 1.20; P < .05). Living in more highly segregated, higher-crime areas was associated with greater chances of developing cancer for men (OR = 1.31; P < .05) and women (OR = 1.25; P < .05).

CONCLUSIONS: The neighborhood economic environment is associated with heart disease onset for women, and neighborhood-level social stressors are associated with cancer onset for men and women. The social and biological mechanisms that underlie these associations require further investigation.

}, keywords = {Aged, Chronic disease, Environment Design, Factor Analysis, Statistical, Female, Health Resources, Health Status Disparities, Humans, Logistic Models, Male, Middle Aged, Poverty Areas, Residence Characteristics, Risk Factors, Small-Area Analysis, Social Environment, Social Problems, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.178640}, author = {Vicki A Freedman and Irina B Grafova and Jeannette Rogowski} } @article {7571, title = {Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, month = {2011 Mar}, pages = {473-81}, publisher = {59}, abstract = {

OBJECTIVES: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death.

DESIGN: Analysis of longitudinal data.

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

PARTICIPANTS: Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS).

MEASUREMENTS: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS.

RESULTS: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95\% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95\% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95\% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95\% CI=1.08-2.26 for depression; HR=2.59, 95\% CI=1.09-6.16 for clinically significant hallucinations).

CONCLUSION: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Behavioral Symptoms, Caregivers, Cognition Disorders, Female, Humans, Institutionalization, Male, Neuropsychological tests, Proportional Hazards Models}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03314.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 {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 {7653, title = {Partner caregiving in older cohabiting couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, note = {Noel-Miller, Claire M 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 May;66(3):341-53. Epub 2011 Apr 11.}, month = {2011 May}, pages = {341-53}, publisher = {66}, abstract = {

OBJECTIVES: Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors{\textquoteright} patterns of care receipt from a partner to that of frail spouses.

METHODS: Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors{\textquoteright} likelihood of receiving partner care compared with their married counterparts{\textquoteright}. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners{\textquoteright} caregiving hours and caregiving involvement relative to other helpers.

RESULTS: Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents{\textquoteright} care than marital partners.

DISCUSSION: Cohabitation and marriage have distinct implications for older adults{\textquoteright} patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults{\textquoteright} nontraditional union forms and of examining the ramifications of cohabitation for older adults{\textquoteright} well-being.

}, keywords = {Aged, Caregivers, Disabled Persons, Family Characteristics, Female, Frail Elderly, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Sex Factors, Single Person, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbr027}, author = {Claire No{\"e}l-Miller} } @article {7576, title = {Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education.}, journal = {Gerontologist}, volume = {51}, year = {2011}, month = {2011 Feb}, pages = {51-63}, publisher = {51}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Educational Status, ethnicity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Models, Theoretical, Racial Groups, Sex Distribution, Time Factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnq069}, author = {Chiu, Ching-Ju and Linda A. Wray} } @article {7580, title = {A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries.}, journal = {BMC Public Health}, volume = {11}, year = {2011}, month = {2011 Sep 20}, pages = {710}, publisher = {11}, abstract = {

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were >= 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6\%, 54.9\%, and 52.3\% declining and 25.4\%, 20.8\%, and 22.9\% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Cohort Studies, Female, Humans, Interviews as Topic, Male, Medicare, Mental Health, Outcome Assessment, Health Care, Prospective Studies, Regression Analysis, Risk Factors, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-11-710}, author = {Frederic D Wolinsky and Suzanne E Bentler and Jason Hockenberry and Michael P Jones and Paula A Weigel and Kaskie, Brian and Robert B Wallace} } @article {7637, title = {Recent trends in chronic disease, impairment and disability among older adults in the United States.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, note = {Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47.}, month = {2011 Aug 18}, pages = {47}, publisher = {11}, abstract = {

BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1\% (95\% Confidence Interval [CI], 12.4\%-13.8\%) in 1998 to 7.8\% (95\% CI, 7.2\%-8.4\%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9\% (95\% CI, 86.2\%-89.6\%) in 1998 to 92.2\% (95\% CI, 91.6\%-92.8\%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7\% (95\% CI, 11.0\%-12.4\%) in 1998 to 17.4\% (95\% CI, 16.6\%-18.2\%) in 2008. The proportion of older adults reporting no impairments was 47.3\% (95\% CI, 46.3\%-48.4\%) in 1998 and 44.4\% (95\% CI, 43.3\%-45.5\%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2\% (95\% CI, 6.7\%-7.7\%) in 1998 and 7.3\% (95\% CI, 6.8\%-7.9\%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3\% (95\% CI, 25.4\%-27.2\%) in 1998 and 25.4\% (95\% CI, 24.5\%-26.3\%) in 2008.

CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, United States, Visually Impaired Persons}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-47}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7647, title = {Recruitment and retention of minority participants in the health and retirement study.}, journal = {Gerontologist}, volume = {51 Suppl 1}, year = {2011}, note = {Ofstedal, Mary B Weir, David R U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The Gerontologist Gerontologist. 2011 Jun;51 Suppl 1:S8-20.}, month = {2011 Jun}, pages = {S8-20}, publisher = {51 Suppl 1}, abstract = {

PURPOSE: Minority oversamples of African Americans and Hispanics have been a key feature of the Health and Retirement Study (HRS) design from its origins in 1992. The objective of this article was to assess the quality of the HRS with respect to the recruitment and retention of minority respondents.

DESIGN AND METHODS: To evaluate minority recruitment efforts, we examine baseline response rates for the early baby boom cohort that was added in the 2004 wave and the representativeness of this cohort with regard to demographic, socioeconomic, and health characteristics. To evaluate retention, we focus on minority differentials in 2008 interview, nonresponse and mortality outcomes for the full HRS sample. We also examine minority differentials in participation in supplemental components of the HRS.

RESULTS: Minority response rates at baseline and in longitudinal follow-ups for the main HRS interview have been equal to or better than that of majority Whites. Conversely, response rates to some specific supplemental components have been lower for minority sample members.

IMPLICATIONS: The oversample strategies that the HRS has employed have been successful at identifying and recruiting minority participants at response rates very comparable with that of Whites and others. Minority differentials in participation in supplemental components have been overcome to some extent through interviewer training and targeted follow-up strategies. The HRS experience suggests that well-trained interviewers can overcome most if not all of whatever race and ethnic differentials exist in willingness to participate in surveys, including those involving biological data collection.

}, keywords = {Aged, Biomarkers, Black or African American, Female, Health Promotion, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Minority health, National Health Programs, Patient Dropouts, Patient Selection, Retirement, Sampling Studies, Surveys and Questionnaires, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnq100}, author = {Mary Beth Ofstedal and David R Weir} } @article {7566, title = {Reducing case ascertainment costs in U.S. population studies of Alzheimer{\textquoteright}s disease, dementia, and cognitive impairment-Part 1.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {94-109}, publisher = {7}, abstract = {

Establishing methods for ascertainment of dementia and cognitive impairment that are accurate and also cost-effective is a challenging enterprise. Large population-based studies often using administrative data sets offer relatively inexpensive and reliable estimates of severe conditions including moderate to advanced dementia that are useful for public health planning, but they can miss less severe cognitive impairment which may be the most effective point for intervention. Clinical and epidemiological cohorts, intensively assessed, provide more sensitive detection of less severe cognitive impairment but are often costly. In this article, several approaches to ascertainment are evaluated for validity, reliability, and cost. In particular, the methods of ascertainment from the Health and Retirement Study are described briefly, along with those of the Aging, Demographics, and Memory Study (ADAMS). ADAMS, a resource-intense sub-study of the Health and Retirement Study, was designed to provide diagnostic accuracy among persons with more advanced dementia. A proposal to streamline future ADAMS assessments is offered. Also considered are algorithmic and Web-based approaches to diagnosis that can reduce the expense of clinical expertise and, in some contexts, can reduce the extent of data collection. These approaches are intended for intensively assessed epidemiological cohorts where goal is valid and reliable case detection with efficient and cost-effective tools.

}, keywords = {Aging, Algorithms, Alzheimer disease, Cognition Disorders, Community Health Planning, Cost-Benefit Analysis, Dementia, Health Surveys, Humans, Internet, Reproducibility of Results, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.004}, url = {http://mgetit.lib.umich.edu/sfx_local?ctx_enc=info 3Aofi 2Fenc 3AUTF-8;ctx_id=10_1;ctx_tim=2011-03-28T16 3A26 3A0EDT;ctx_ver=Z39.88-2004;rfr_id=info 3Asid 2Fsfxit.com 3Acitation;rft.genre=article;rft_id=info 3Apmid 2F21255747;rft_val_fmt=info 3Aofi 2Ffmt }, author = {David R Weir and Robert B Wallace and Kenneth M. Langa and Brenda L Plassman and Robert S Wilson and David A Bennett and Duara, Ranjan and Loewenstein, David and Ganguli, Mary and Sano, Mary} } @article {7687, title = {Regional variation in the association between advance directives and end-of-life Medicare expenditures.}, journal = {JAMA}, volume = {306}, year = {2011}, month = {2011 Oct 05}, pages = {1447-53}, publisher = {112}, abstract = {

CONTEXT: It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments.

OBJECTIVE: To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments.

DESIGN, SETTING, AND PATIENTS: Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent{\textquoteright}s hospital referral region.

MAIN OUTCOME MEASURES: Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life.

RESULTS: Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (-$5585 per decedent; 95\% CI, -$10,903 to -$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (-9.8\%; 95\% CI, -16\% to -3\% in high-spending regions; -5.3\%; 95\% CI, -10\% to -0.4\% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17\%; 95\% CI, 11\% to 23\% in high-spending regions, 11\%; 95\% CI, 6\% to 16\% in medium-spending regions), but not in low-spending regions.

CONCLUSION: Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Data collection, Female, Health Expenditures, Hospice Care, Hospital Mortality, Hospitals, Humans, Kidney Failure, Chronic, Male, Medicare, Palliative care, Prospective Studies, Regression Analysis, Terminal Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1410}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2590187421andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Lauren Hersch Nicholas and Kenneth M. Langa and Theodore J Iwashyna and David R Weir} } @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 {7621, title = {Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, note = {Ailshire, Jennifer A Beltran-Sanchez, Hiram Crimmins, Eileen M United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2241-8. doi: 10.1111/j.1532-5415.2011.03723.x.}, month = {2011 Dec}, pages = {2241-8}, publisher = {59}, abstract = {

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

DESIGN: Nationally representative longitudinal study of older Americans.

SETTING: United States.

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

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

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

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

}, keywords = {Age Factors, Aged, 80 and over, Female, Geriatric Assessment, Health Status, Humans, Longevity, Longitudinal Studies, Male, Social Class, Sociology, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03723.x}, author = {Jennifer A Ailshire and Hiram Beltr{\'a}n-S{\'a}nchez and Eileen M. Crimmins} } @article {7591, title = {Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Apr}, pages = {454-80}, publisher = {23}, abstract = {

OBJECTIVE: To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories.

METHOD: Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates.

RESULTS: BMI increased linearly over time. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found.

DISCUSSION: Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.

}, keywords = {Age Factors, Aged, Aging, Body Mass Index, ethnicity, Female, Health Status Disparities, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Obesity, Psychometrics, Risk Assessment, Self Report, Social Class, Socioeconomic factors, Time Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264310385930}, author = {Anda Botoseneanu and Jersey Liang} } @article {7666, title = {Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Jun}, pages = {1986-92}, publisher = {72}, abstract = {

Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.

}, keywords = {Aged, Aged, 80 and over, Analysis of Variance, Cross-Cultural Comparison, Denmark, Educational Status, Female, Health Expenditures, Humans, Income, Life Expectancy, Male, Middle Aged, Mortality, Political Systems, Social Class, Social Welfare, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.04.019}, author = {Rasmus Hoffmann} } @article {7547, title = {Socioeconomic inequalities in self-rated health among middle-aged and older adults.}, journal = {Soc Work Health Care}, volume = {50}, year = {2011}, month = {2011}, pages = {124-42}, publisher = {50}, abstract = {

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females{\textquoteright} decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.

}, keywords = {Aged, Female, Health Status Disparities, Humans, Insurance Coverage, Insurance, Health, Male, Middle Aged, Self Report, Sex Factors, Socioeconomic factors}, issn = {1541-034X}, doi = {10.1080/00981389.2010.527787}, author = {Kim, Jinhyun} } @article {7635, title = {Socioeconomic status and race/ethnicity independently predict health decline among older diabetics.}, journal = {BMC Public Health}, volume = {11}, year = {2011}, note = {Nicklett, Emily J Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t Research Support, U.S. Gov{\textquoteright}t, P.H.S. England BMC public health BMC Public Health. 2011 Sep 2;11:684.}, month = {2011 Sep 02}, pages = {684}, publisher = {11}, abstract = {

BACKGROUND: There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes.

METHODS: The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period.

RESULTS: Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics.

CONCLUSIONS: The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.

}, keywords = {Aged, Aged, 80 and over, Black People, Diabetes Mellitus, Type 2, Diagnostic Self Evaluation, Female, Follow-Up Studies, Health Status Disparities, Hispanic or Latino, Humans, Male, Social Class, United States, White People}, issn = {1471-2458}, doi = {10.1186/1471-2458-11-684}, author = {Emily J Nicklett} } @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 {7672, title = {Spousal associations between functional limitation and depressive symptom trajectories: Longitudinal findings from the study of Asset and Health Dynamics Among the Oldest Old (AHEAD).}, journal = {Health Psychol}, volume = {30}, year = {2011}, note = {Hoppmann, Christiane A Gerstorf, Denis Hibbert, Anita U01 AG009740-12/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Nihms256806 Health Psychol. 2011 Mar;30(2):153-62.}, month = {2011 Mar}, pages = {153-62}, publisher = {30}, abstract = {

OBJECTIVE: To examine spousal associations between functional limitation and depressive symptom trajectories in a national sample of older long-term married couples.

DESIGN: We used 14.5-year longitudinal data on functional limitations and depressive symptoms from 1,704 couples participating in the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD).

MAIN OUTCOME MEASURES: Activities of daily living and a short version of the Center for Epidemiologic Studies Depression scale were used.

RESULTS: Between-person difference findings corroborate previous research by showing that levels and changes in functional limitations and depressive symptoms are closely interrelated among wives and husbands. Our results further demonstrate sizable associations in levels and changes in functional limitations and depressive symptoms between spouses. For example, functional limitation levels in one spouse were associated with depressive symptom levels in the other spouse. Spousal associations remained after controlling for individual (age, education, cognition) and spousal covariates (marriage duration, number of children) and did not differ between women and men.

CONCLUSION: Our findings highlight the important role of marital relationships in shaping health trajectories in old age because they show that some of the well-documented between-person differences in functional limitations and depressive symptoms are in fact related to spouses.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Longitudinal Studies, Male, Psychometrics, Spouses, United States}, issn = {1930-7810}, doi = {10.1037/a0022094}, author = {Christiane A Hoppmann and Denis Gerstorf and Anita Hibbert} } @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 {7596, title = {Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Apr}, pages = {1236-48}, publisher = {72}, abstract = {

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings \& Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

}, keywords = {Age Factors, Black or African American, Disability Evaluation, Disabled Persons, Female, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Models, Statistical, Models, Theoretical, Sex Factors, Social Class, United States, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.02.034}, author = {David F Warner and Tyson H Brown} } @article {7611, title = {The urban neighborhood and cognitive functioning in late middle age.}, journal = {J Health Soc Behav}, volume = {52}, year = {2011}, month = {2011 Jun}, pages = {163-79}, publisher = {52}, abstract = {

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aging, Chi-Square Distribution, Cognition, Cognition Disorders, ethnicity, Female, Health Status Disparities, Humans, Male, Middle Aged, Psychometrics, Residence Characteristics, Risk Factors, Socioeconomic factors, United States, Urban Population}, issn = {2150-6000}, doi = {10.1177/0022146510393974}, author = {Carol S Aneshensel and Michelle J Ko and Joshua Chodosh and Richard G Wight} } @article {7585, title = {Utilization of blood transfusion among older adults in the United States.}, journal = {Transfusion}, volume = {51}, year = {2011}, month = {2011 Apr}, pages = {710-8}, publisher = {51}, abstract = {

BACKGROUND: While there have been epidemiologic studies of blood donors, the characteristics of individuals who receive transfusions have not been well described for the US population.

STUDY DESIGN AND METHODS: Subjects were from the nationally representative Health and Retirement Study whose data were linked to Medicare files from 1991 through 2007 (n = 16,377). A cohort study was conducted to assess the frequency of transfusion in older Americans over time and to describe the characteristics of blood recipients.

RESULTS: Thirty-one percent (95\% confidence interval [CI], 30\%-33\%) of older Americans received at least one transfusion within a 10-year period and 5.8\% (95\% CI, 5.4\%-6.2\%) experienced repeated transfusion-related visits within 30 days. The mean number of transfusion-related visits was 2.3 over a 10-year period (95\% CI, 2.2-2.4). Older Americans who lived in the South were most likely to receive a transfusion (34\%), independent of demographic and health-related factors, while those who lived in the western United States were the least likely (26\%). Predictors of transfusion included smoking, low body mass index, and a history of cancer, diabetes mellitus, end-stage renal disease, and heart disease. African-Americans and Mexican-Americans had greater rates of blood utilization than other races and other Hispanics (respectively). There were also differences in transfusion utilization by education, marital status, religion, and alcohol use.

CONCLUSIONS: Transfusion is common in older Americans. Regional variations in blood use are not explained by patient characteristics alone.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Black or African American, Blood Transfusion, Female, Humans, Male, United States, White People}, issn = {1537-2995}, doi = {10.1111/j.1537-2995.2010.02937.x}, author = {Mary A M Rogers and Neil Blumberg and Heal, Joanna M and Kenneth M. Langa} } @article {7603, title = {Volunteer transitions among older adults: the role of human, social, and cultural capital in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {490-501}, publisher = {66B}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

DESIGN: Observational prospective cohort.

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Automobile Driving, Female, Health Status, Humans, Male, Prospective Studies, Retirement, Risk Factors, Social Behavior, Survival Rate, United States, Volunteers}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03265.x}, author = {Sei J. Lee and Michael A Steinman and Erwin J Tan} } @article {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 {7425, title = {Activities of daily living, social support, and future health of older Americans.}, journal = {J Psychol}, volume = {144}, year = {2010}, note = {Using Smart Source Parsing Jan-Feb Index Medicus}, month = {2010 Jan-Feb}, pages = {1-14}, publisher = {144}, abstract = {

The authors investigated the relation of activities of daily living (ADL) and social support satisfaction to illness status 10 years later among 4,870 married older adults in the Health and Retirement Study (F. Juster \& R. Suzman, 1995). The authors tested the direct and indirect effects of 1992 ADL, as well as family and friends support satisfaction and spousal social support satisfaction on 2002 illness status. The hierarchical multiple regressions found, controlling for 1992 illness status, ADL protected against future illness, and family and friends and spousal support satisfaction had small, surprisingly positive, effects on greater 2002 illness. The ADL x Family and Friends Support Satisfaction and the ADL x Spousal Support Satisfaction crossproduct interactions were also small positive predictors of later illness. The authors discuss several possible mechanisms that explained this unexpected result. The authors concluded that, depending on whether the recipient is in need of support and depending on the source of the support, the older adults do or do not benefit from the support.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Aging, Caregivers, Chronic disease, Female, Friends, Humans, Longitudinal Studies, Male, Middle Aged, Personal Satisfaction, Retirement, Risk Factors, Sick Role, Social Support, Spouses}, issn = {0022-3980}, doi = {10.1080/00223980903356032}, author = {Bozo, Ozlem and Charles A Guarnaccia} } @article {7459, title = {Advance directives and outcomes of surrogate decision making before death.}, journal = {N Engl J Med}, volume = {362}, year = {2010}, month = {2010 Apr 01}, pages = {1211-8}, publisher = {362}, abstract = {

BACKGROUND: Recent discussions about health care reform have raised questions regarding the value of advance directives.

METHODS: We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making.

RESULTS: Of 3746 subjects, 42.5\% required decision making, of whom 70.3\% lacked decision-making capacity and 67.6\% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7\%) or comfort care (96.2\%) than all care possible (1.9\%); 83.2\% of subjects who requested limited care and 97.1\% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95\% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95\% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95\% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95\% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care.

CONCLUSIONS: Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Decision making, Female, Humans, Living Wills, Logistic Models, Male, Mental Competency, Middle Aged, Proxy, Terminal Care, United States}, issn = {1533-4406}, doi = {10.1056/NEJMsa0907901}, author = {Maria J Silveira and Scott Y H Kim and Kenneth M. Langa} } @article {7521, title = {Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Dec}, pages = {2375-80}, publisher = {58}, abstract = {

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9\% of cohort), infrequent and nondrinkers (61.8\%), consistent drinkers (25.9\%), and decreasing drinkers (7.4\%). Corresponding NLS values from the drinks per day model were 8.8\%, 61.4\%, 21.2\%, and 8.6\%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

}, keywords = {Aged, Aging, Alcohol Drinking, Alcoholism, Cohort Studies, Female, Follow-Up Studies, Humans, Life Change Events, Middle Aged, Retirement, Risk Factors, Surveys and Questionnaires, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03180.x}, author = {Janet Kay Bobo and April A Greek and Daniel H. Klepinger and Jerald R Herting} } @article {7460, title = {Alcohol-consumption trajectories and associated characteristics among adults older than age 50.}, journal = {J Stud Alcohol Drugs}, volume = {71}, year = {2010}, month = {2010 Mar}, pages = {169-79}, publisher = {71}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Delivery of Health Care, Health Status, Humans, Self Concept}, issn = {1646-0758}, url = {https://pubmed.ncbi.nlm.nih.gov/20353712/}, author = {F Alo{\'\i}sio Pimenta and Santos Amaral, Carlos and Da Gama Torres, Henrique and Rezende, Nilton} } @article {7517, title = {Can racial disparity in health between black and white Americans be attributed to racial disparities in body weight and socioeconomic status?}, journal = {Health Soc Work}, volume = {35}, year = {2010}, month = {2010 Nov}, pages = {257-66}, publisher = {35}, abstract = {

Few studies have examined to what extent racial disparities in chronic health conditions (CHCs) are attributable to racial differences in body weight (measured as body mass index [BMI]) and socioeconomic status (SES) among older adults. To address this gap, using longitudinal data from the Health and Retirement Study, the current study examined risk factors of CHC trajectory including race, BMI, and SES. The sample consists of 22,560 in 1998, 20,825 in 2000, and 19,004 in 2002. Data analysis was done through latent growth curve modeling. As expected, older adults presented an increasing trajectory of CHCs over time. Black Americans presented a significantly more negative CHC trajectory than did their white counterparts, confirming racial disparity in health over time. Consequent hierarchical analyses revealed that racial disparity in CHC trajectory can be explained by racial disparity in BMI and that racial disparity in BMI can be attributed to racial disparity in SES. Because low SES is closely related to unhealthy diet and negative health behaviors that may subsequently lead to obesity and chronic health conditions, the findings suggest that to address racial disparity in CHCs, it is important for social workers to continuously try to mitigate racial inequality in SES.

}, keywords = {Aged, Black or African American, Body Mass Index, Body Weight, Female, Health Surveys, Healthcare Disparities, Humans, Male, Middle Aged, Social Class, United States, White People}, issn = {0360-7283}, doi = {10.1093/hsw/35.4.257}, author = {Kahng, Sang Kyoung} } @article {7530, title = {The case for involving adult children outside of the household in the self-management support of older adults with chronic illnesses.}, journal = {Chronic Illn}, volume = {6}, year = {2010}, month = {2010 Mar}, pages = {34-45}, publisher = {6}, abstract = {

OBJECTIVES: This study sought to (1) identify barriers to spousal support for chronic illness self-care among community-dwelling older adults; and (2) describe the potential availability of self-care support from adult children living outside of the household.

METHODS: Nationally representative US sample of chronically ill adults aged 51+ were interviewed as part of the Health and Retirement Study (N = 14,862). Both participants and their spouses (when available) reported information about their health and functioning. Participants also reported information about their contact with adult children and the quality of those relationships.

RESULTS: More than one-third (38\%) of chronically ill older adults in the US are unmarried; and when spouses are available, the majority of them have multiple chronic diseases and functional limitations. However, the vast majority of chronically ill older adults (93\%, representing roughly 60 million Americans) have adult children, with half having children living over 10 miles away. Most respondents with children (78\%) reported at least weekly telephone contact and that these relationships were positive. Roughly 19 million older chronically ill Americans have adult children living at a distance but none nearby; these children are in frequent telephone contact and respondents (including those with multiple chronic diseases) report that the relationships are positive.

DISCUSSION: As the gap between available health services for disease management and the need among community-dwelling patients continues to grow, adult children-including those living at a distance-represent an important resource for improving self-care support for people with chronic diseases.

}, keywords = {Adult, Chronic disease, Family Relations, Female, Humans, Male, Middle Aged, Self Care, Social Support}, issn = {1745-9206}, doi = {10.1177/1742395309347804}, author = {John D Piette and Ann Marie Rosland and Maria J Silveira and Mohammed U Kabeto and Kenneth M. Langa} } @article {7512, title = {Causes and consequences of early-life health.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, month = {2010}, pages = {S65-85}, publisher = {47}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Age Factors, Aged, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Physical Examination, Socioeconomic factors}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181adcbd3}, author = {Joseph W Sakshaug and Mick P. Couper and Mary Beth Ofstedal} } @article {7453, title = {Childhood socioeconomic position and disability in later life: results of the health and retirement study.}, journal = {Am J Public Health}, volume = {100 Suppl 1}, year = {2010}, month = {2010 Apr 01}, pages = {S197-203}, publisher = {100}, abstract = {

OBJECTIVES: We used a life course approach to assess the ways in which childhood socioeconomic position may be associated with disability in later life.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study (1998-2006) to examine associations between parental education, paternal occupation, and disabilities relating to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents whose fathers had low levels of education and those whose fathers were absent or had died while they were growing up were at increased risk of disability in later life, net of social, behavioral, and pathological health risks in adulthood. Social mobility and health behaviors were also important factors in the association between low childhood socioeconomic position and ADL and IADL disabilities.

CONCLUSIONS: Our findings highlight the need for policies and programs aimed at improving the well-being of both children and families. A renewed commitment to such initiatives may help reduce health care costs and the need for people to use health and social services in later life.

}, keywords = {Activities of Daily Living, Cohort Studies, Disabled Persons, Female, Humans, Male, Michigan, Middle Aged, Prospective Studies, Retirement, Risk Assessment, Social Class}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.160986}, author = {Mary E Bowen and Hector M Gonz{\'a}lez} } @article {7452, title = {Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Apr}, pages = {327-34}, publisher = {48}, abstract = {

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

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

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

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

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

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

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

}, keywords = {Aged, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Type 2, Female, Glycemic Index, Health Status, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Self Care, Severity of Illness Index, Treatment Failure, United States}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181ca4035}, author = {Caroline S Blaum and Christine T Cigolle and Cynthia Boyd and Jennifer L. Wolff and Zhiyi Tian and Kenneth M. Langa and David R Weir} } @article {7461, title = {Comparison study on functional outcomes and perceived quality of life between all-inclusive and fee-for-service continuing care retirement communities.}, journal = {J Am Med Dir Assoc}, volume = {11}, year = {2010}, month = {2010 May}, pages = {257-62}, publisher = {11}, abstract = {

OBJECTIVE: To examine the associations between 2 types of continuing care retirement communities{\textquoteright} (CCRC) residents regarding physical function and perceived quality of life.

METHODS: Cross-sectional study (n=406). Eligibility criteria include age 65 years or older, residents of independent living units, and intact cognition (MMSE>or=24). All-inclusive CCRCs provide unlimited access to home health services and nursing home care as needed in return for the entry and monthly fee. Fee-for-service CCRCs offer home health and nursing home services at a full fee-for-service rate. Outcomes were functional status (ADLs and IADLs) and perceived quality of life. Multivariate regressions were used to examine the associations between residents of different types of CCRCs on selected outcomes while adjusting for covariates.

RESULTS: The all-inclusive CCRC sample was more likely to be married (53.8\% versus 33.4\%; P < .001), with more years of education (17.9 versus 14.4; P < .0001), and had few physician visits in the previous year in comparison to the FFS CCRC sample. Multivariate results indicate that the FFS group had worse ADL (beta=0.95; P=.0003), IADL (beta=0.57; P=.02) function than the all-inclusive group. There was no significant difference in perceived quality of life scores between the 2 groups.

CONCLUSIONS: Residents of both CCRCs reported equally good quality of life scores. Residents of the all-inclusive CCRC seem to have had better ADL and IADL function than the FFS CCRC residents. Prepaid home health services and nursing home care in the all-inclusive CCRC may facilitate ADL and IADL functional independence.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cross-Sectional Studies, Fee-for-Service Plans, Female, Humans, Male, New York, Outcome Assessment, Health Care, Quality of Life, Residential Facilities}, issn = {1538-9375}, doi = {10.1016/j.jamda.2009.09.004}, author = {Young, Yuchi} } @article {7443, title = {Continuity of care with a primary care physician and mortality in older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {421-8}, publisher = {65A}, abstract = {

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54\%) participants died during the follow-up period. Using the cumulative exposure measure, 27\% never had continuity of care, whereas 31\%, 20\%, 14\%, and 8\%, respectively, had continuity for 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

}, keywords = {Aged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family}, issn = {1758-535X}, doi = {10.1093/gerona/glp188}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and John F Geweke and Elizabeth A Cook and Maksym Obrizan and Elizabeth A Chrischilles and Kara B Wright and Michael P Jones and Gary E Rosenthal and Robert L. Ohsfeldt and Robert B Wallace} } @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 {7502, title = {Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.}, journal = {Eur J Epidemiol}, volume = {25}, year = {2010}, month = {2010 Jul}, pages = {471-80}, publisher = {25}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Denmark, Disability Evaluation, Female, Health Status, Humans, Japan, Male, Middle Aged, Mortality, Sex Distribution, United States}, issn = {1573-7284}, doi = {10.1007/s10654-010-9460-6}, author = {Oksuzyan, Anna and Eileen M. Crimmins and Saito, Yasuhiko and Angela M O{\textquoteright}Rand and James W Vaupel and Christensen, Kaare} } @article {7526, title = {Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries.}, journal = {BMC Health Serv Res}, volume = {10}, year = {2010}, month = {2010 Jun 21}, pages = {173}, publisher = {8}, abstract = {

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Emergency Service, Hospital, Humans, Insurance Claim Review, Medicare, Prospective Studies, Severity of Illness Index, United States}, issn = {1472-6963}, doi = {10.1186/1472-6963-10-173}, author = {Kaskie, Brian and Maksym Obrizan and Elizabeth A Cook and Michael P Jones and Li Liu and Suzanne E Bentler and Robert B Wallace and John F Geweke and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Gary E Rosenthal and Frederic D Wolinsky} } @article {7536, title = {Dental care coverage and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Winter}, pages = {1-12}, publisher = {70}, abstract = {

OBJECTIVES: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).

METHODS: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.

CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

}, keywords = {Aged, Employment, ethnicity, Female, Humans, Income, Insurance, Dental, Male, Middle Aged, Models, Statistical, Multivariate Analysis, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00137.x}, author = {Richard J. Manski and John F Moeller and Jody Schimmel and Patricia A St Clair and Haiyan Chen and Larry S. Magder and John V Pepper} } @article {7535, title = {Dental care expenditures and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Spring}, pages = {148-55}, publisher = {70}, abstract = {

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

}, keywords = {Age Factors, Aged, Dental Care, Educational Status, ethnicity, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Dental, Male, Marital Status, Middle Aged, Mouth, Edentulous, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00156.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7545, title = {Dental care utilization and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, note = {Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75.}, month = {2010 Winter}, pages = {67-75}, publisher = {70}, abstract = {

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

}, keywords = {Aged, Confounding Factors, Epidemiologic, Dental Care, Employment, ethnicity, Female, health policy, Humans, Income, Insurance, Dental, Leisure activities, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retirement, Socioeconomic factors, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00145.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @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 {7468, title = {Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Mar}, pages = {551-6}, publisher = {58}, abstract = {

OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.

PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.

MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.

RESULTS: Eight hundred eighty-seven (12\%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45\% vs 23\%, Cox hazard ratio (HR)=2.33, 95\% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95\% CI=1.25-1.66).

CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.

}, keywords = {Activities of Daily Living, depression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mobility Limitation, Proportional Hazards Models, Prospective Studies, Risk Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.02723.x}, author = {Kenneth E Covinsky and Kristine Yaffe and Lindquist, Karla and Cherkasova, Elena and Yelin, Edward and Dan G. Blazer} } @article {7541, title = {Depressive symptoms predict incident stroke independently of memory impairments.}, journal = {Neurology}, volume = {75}, year = {2010}, note = {Glymour, M M Maselko, J Gilman, S E Patton, K K Avendano, M 1R01MH087544/MH/NIMH NIH HHS/United States 1R21 AG34385-01A1/AG/NIA NIH HHS/United States 1R21AG037889-01/AG/NIA NIH HHS/United States 1R21HD066312-01/HD/NICHD NIH HHS/United States 1RC4MH092707-01/MH/NIMH NIH HHS/United States 5R03MH083335/MH/NIMH NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Neurology Neurology. 2010 Dec 7;75(23):2063-70.}, month = {2010 Dec 07}, pages = {2063-70}, publisher = {75}, abstract = {

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of <=6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95\% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95\% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Health Surveys, Humans, Incidence, Kaplan-Meier Estimate, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Neuropsychological tests, Predictive Value of Tests, Risk Factors, Statistics, Nonparametric, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0b013e318200d70e}, author = {M. Maria Glymour and J Maselko and Gilman, S E and Kristen K Patton and Mauricio Avendano} } @article {7339, title = {Diabetes-related support, regimen adherence, and health decline among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 May}, pages = {390-9}, publisher = {10}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Diabetes Mellitus, Type 2, Disability Evaluation, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Quality of Life, Social Support, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp050}, author = {Emily J Nicklett and Jersey Liang} } @article {7464, title = {Differences in functional impairment across subtypes of dementia.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {434-41}, publisher = {65A}, abstract = {

BACKGROUND: Dementia is a cause of disability in later life. Despite the importance of functional status to the diagnosis of dementia, limited information exists on differences in functional limitations by dementia subtype. We conducted a cross-sectional analysis using the Aging, Demographics, and Memory Study (ADAMS) to determine the extent of functional impairment among older adults with dementia due to different etiologies.

METHODS: The ADAMS sample consisted of 856 individuals aged 71 years and older originally surveyed as part of the Health and Retirement Study. Based on a comprehensive in-person cognitive evaluation, respondents were assigned to diagnostic categories of normal cognition, cognitive impairment not demented, and demented. Dementia subtypes were grouped into three categories: vascular dementia (VaD), Alzheimer{\textquoteright}s dementia (AD), and dementia due to other etiologies. For 744 of the 856 respondents, a proxy informant completed a questionnaire asking whether the respondent had difficulty completing instrumental activities of daily living and activities of daily living (ADLs).

RESULTS: Of 744 ADAMS participants, 263 had dementia: 199 (70.5\%) with AD, 42 (16.9\%) with VaD, and 22 (12.6\%) were demented due to other etiologies. After adjustment for demographics, chronic illnesses, and dementia severity, participants with VaD (odds ratio [OR] 5.74; 95\% confidence interval [CI] 2.60-12.69) and other etiologies of dementia (OR 21.23; 95\% CI 7.25-62.16) were more likely to have greater than or equal to four ADL limitations compared with those with AD.

CONCLUSIONS: VaD is associated with significantly more ADL limitations than AD. These physical limitations should be considered when designing adult day care programs, which adequately accommodate the needs of non-AD patients.

}, keywords = {Activities of Daily Living, Aged, Alzheimer disease, Dementia, Dementia, Vascular, Humans}, issn = {1758-535X}, doi = {10.1093/gerona/glp197}, author = {Tanya R Gure and Mohammed U Kabeto and Brenda L Plassman and John D Piette and Kenneth M. Langa} } @article {7493, title = {Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {405-413}, publisher = {71}, abstract = {

In this paper, we study the impact of obesity on labor market decisions of older working age adults in USA. Labor market outcomes are defined as any one of three: working; not working due to a disability; or not working due to an early retirement. Based on existing medical literature, we deduce that obesity can largely impact labor market decisions directly through impairment of bodily functions and indirectly by being a risk factor for various diseases like hypertension, arthritis, etc. We use data from the US Health and Retirement Study on older adults who were no more than 64 years of age in 2002. In our modeling effort, we employ two estimation strategies. We first estimate a model in which employment outcome in 2002 is a function of weight status in 1992. In the second strategy, controlling for time-invariant individual heterogeneity, we first consider the impact of obesity on bodily impairments and chronic illnesses; then, we consider the impact of such impairments and illnesses on labor market outcomes. Our results indicate that, for men, obesity class 2 and 3 increases both the probability of taking an early retirement and the incidence of disability by 1.5 percentage points. For women, we find that obesity class 2 and 3 increases the probability of taking an early retirement by 2.5 percentage points and the incidence of disability by 1.7 percentage points.

}, keywords = {Chronic disease, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Obesity, Retirement, Risk Factors, Sex Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.03.038}, author = {F. Renna and Thakur, Nidhi} } @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 {7432, title = {Does major illness cause financial catastrophe?}, journal = {Health Serv Res}, volume = {45}, year = {2010}, month = {2010 Apr}, pages = {418-36}, publisher = {45}, abstract = {

OBJECTIVE: We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance.

DATA SOURCES: We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.(1)

STUDY DESIGN: Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill.

RESULTS: Controlling for the effects of insurance status and illness, we find that the median household with a newly ill, uninsured individual suffers a statistically significant decline in household assets of between 30 and 50 percent relative to households with matched insured individuals. Newly ill, insured individuals do not experience a decline in wealth.

CONCLUSIONS: Newly ill/uninsured households appear to be one illness away from financial catastrophe. Newly ill insured households who are matched to uninsured households appear to be protected against financial loss, at least in the near term.

}, keywords = {Bankruptcy, Cost of Illness, Databases as Topic, Financing, Personal, Humans, Medically Uninsured, Middle Aged, Severity of Illness Index}, issn = {1475-6773}, doi = {10.1111/j.1475-6773.2009.01049.x}, author = {Keziah Cook and David Dranove and Sfekas, Andrew} } @article {7454, title = {Dynamics and heterogeneity in the process of human frailty and aging: evidence from the U.S. older adult population.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 Mar}, pages = {246-55}, publisher = {CCCB CCCP}, abstract = {

OBJECTIVES: This study investigated the dynamics and heterogeneity of the frailty index (FI) conceived as a systemic indicator of biological aging in the community-dwelling older adult population in the United States.

METHODS: We used panel data on multiple birth cohorts from the Health and Retirement Survey 1993-2006 and growth curve models to estimate age trajectories of the FI and their differences by sex, race, and socioeconomic status (SES) within cohorts.

RESULTS: The FI for cohorts born before 1942 exhibit quadratic increases with age and accelerated increases in the accumulation of health deficits. More recent cohorts exhibit higher average levels of and rates of increment in the FI than their predecessors do at the same ages. Females, non-Whites, and individuals with low education and income exhibit greater degrees of physiological deregulation than their male, White, and high-SES counterparts at any age. Patterns of sex, race, and SES differentials in rates of aging vary across cohorts.

DISCUSSION: Adjusting for social behavioral factors, the analysis provides evidence for physiological differences in the aging process among recent cohorts of older adults, points to the need for biological explanations of female excess in general system damage, and reveals the insufficiency of any single mechanism for depicting the racial and SES differences in the process of physiological deterioration.

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, Female, Frail Elderly, Humans, Male, Surveys and Questionnaires, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp102}, author = {Yang, Yang and Lee, Linda C} } @article {7481, title = {Early-life characteristics, psychiatric history, and cognition trajectories in later life.}, journal = {Gerontologist}, volume = {50}, year = {2010}, note = {Using Smart Source Parsing pp. Oct Gerontological Society of America, Washington DC}, month = {2010 Oct}, pages = {646-56}, publisher = {50}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Black People, Body Mass Index, Brief Psychiatric Rating Scale, Cognition Disorders, Educational Status, Exercise, Female, Health Status, Hispanic or Latino, Humans, Longitudinal Studies, Male, Memory Disorders, Middle Aged, United States, White People}, issn = {1465-3419}, doi = {10.1080/13557851003681273}, author = {Meredith C. Masel and Raji, Mukaila and M. Kristen Peek} } @article {7488, title = {The effects of positive and negative support from children on widowed older adults{\textquoteright} psychological adjustment: a longitudinal analysis.}, journal = {Gerontologist}, volume = {50}, year = {2010}, note = {Using Smart Source Parsing pp. Aug Gerontological Society of America, Washington DC}, month = {2010 Aug}, pages = {471-81}, publisher = {50}, abstract = {

PURPOSE: This article examines the extent to which positive and negative support from children prior to and after spousal loss and changes in support from pre- to post-loss affect widowed older adults{\textquoteright} depressive symptoms, anxiety, and anger 18 months following widowhood.

DESIGN AND METHODS: Analyses are based on the Changing Lives of Older Couples, a prospective study of 1,532 married individuals aged 65 years and older. The analytic sample includes 148 widowed persons who have at least one living child and participated in the baseline and two follow-up interviews conducted 6 and 18 months following widowhood.

RESULTS: The analyses revealed that higher levels of positive support from children 6 months following widowhood were associated with fewer depressive symptoms at the 18-month follow-up, whereas higher levels of negative support 18 months after loss and a decrease in positive support following loss were associated with more depressive symptoms. Greater negative support both prior to and after loss was associated with greater anxiety, whereas greater negative support 6 months after loss and an increase in negative support following loss were related to greater anger.

IMPLICATIONS: Given their differential impact on widowed persons{\textquoteright} psychological adjustment, both positive and negative aspects of social support as well as its changing nature should be considered in working with bereaved older adults.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Female, Humans, Longitudinal Studies, Male, Middle Aged, Parent-Child Relations, Widowhood}, issn = {1758-5341}, doi = {10.1093/geront/gnp163}, author = {Jung-Hwa Ha} } @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 {7406, title = {Ethnicity and changing functional health in middle and late life: a person-centered approach.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {470-81}, publisher = {65}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Black or African American, Disabled Persons, disease progression, ethnicity, Female, Health Status, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Likelihood Functions, Male, Marital Status, Middle Aged, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbp114}, author = {Jersey Liang and Xiao Xu and Joan M. Bennett and Wen Ye and Ana R Qui{\~n}ones} } @article {7543, title = {Evolving self-rated health in middle and old age: how does it differ across Black, Hispanic, and White Americans?}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Feb}, pages = {3-26}, publisher = {22}, abstract = {

OBJECTIVE: This research focuses on ethnic variations in the intraindividual changes in self-rated health.

METHOD: Data came from the Health and Retirement Study involving up to 6 repeated observations between 1995 and 2006 of a national sample of 18,486 Americans above 50 years of age. Hierarchical linear models were employed in depicting variations in self-rated health across White, Black, and Hispanic Americans.

RESULTS: Subjective health worsened over time albeit moderately. Relative to younger persons, older individuals rated their health poorer with a greater rate of deteriorating health. With reference to ethnic variations in the intercept and slope of perceived health, White Americans rated their health most positively, followed by Black Americans, with Hispanics rating their health least positively. This pattern held even when socioeconomic status, social networks, and prior health were adjusted.

DISCUSSION: Significant ethnic differences exist in the evolvement of self-rated health in middle and late life. Further inquiries may include analyzing ethnic heterogeneities from a person-centered perspective, health disparities across subgroups of Hispanics, effects of neighborhood attributes, and implications of left truncation.

}, keywords = {Age Factors, Aged, Aging, Black or African American, Diagnostic Self Evaluation, Female, Health Status Disparities, Hispanic or Latino, Humans, Linear Models, Male, Middle Aged, United States, White People}, issn = {1552-6887}, doi = {10.1177/0898264309348877}, url = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833212/}, author = {Jersey Liang and A. R. Quinones and Joan M. Bennett and Wen Ye and Xiao Xu and Benjamin A Shaw and Mary Beth Ofstedal} } @article {7435, title = {An examination of older immigrants{\textquoteright} use of dental services in the United States.}, journal = {J Aging Soc Policy}, volume = {22}, year = {2010}, month = {2010 Jan}, pages = {18-32}, publisher = {22}, abstract = {

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants{\textquoteright} dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants{\textquoteright} growing dental services needs.

}, keywords = {Age Factors, Aged, Dental Care for Aged, Educational Status, Emigrants and Immigrants, Female, Health Services Accessibility, Humans, Insurance, Dental, Logistic Models, Longitudinal Studies, Male, Marital Status, Middle Aged, Multivariate Analysis, Sex Factors, Socioeconomic factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420903385593}, author = {Christina N Anderson and Hyungsoo Kim} } @article {7476, title = {Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach.}, journal = {Value Health}, volume = {13}, year = {2010}, month = {2010 Jun-Jul}, pages = {338-45}, publisher = {13}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Female, Financing, Personal, Health Status, Humans, Logistic Models, Male, Medication Adherence, Models, Econometric, Multivariate Analysis, Prescription Fees, Risk Factors, Socioeconomic factors, United States}, issn = {1524-4733}, doi = {10.1111/j.1524-4733.2009.00679.x}, author = {Zivin, Kara and Scott M Ratliff and Michele M Heisler and Kenneth M. Langa and John D Piette} } @article {7424, title = {Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes.}, journal = {Prev Chronic Dis}, volume = {7}, year = {2010}, note = {Using Smart Source Parsing Jan, :A08 Index Medicus}, month = {2010 Jan}, pages = {A08}, publisher = {7}, abstract = {

INTRODUCTION: Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults.

METHODS: We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged >or=65 y) who self-reported having type 2 diabetes at baseline.

RESULTS: Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point.

CONCLUSION: Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control.

}, keywords = {Age Factors, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Retrospective Studies, Socioeconomic factors}, issn = {1545-1151}, author = {Chiu, Ching-Ju and Linda A. Wray} } @article {7477, title = {Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?}, journal = {Soc Sci Med}, volume = {70}, year = {2010}, month = {2010 Apr}, pages = {1050-8}, publisher = {70}, abstract = {

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.

}, keywords = {Activities of Daily Living, Aged, Cognition, Community Health Services, depression, Disabled Persons, Female, Home Care Services, Humans, Logistic Models, Male, Mental Health, Multilevel Analysis, Risk Factors, Social Support, Spouses, State Government, Stress, Psychological, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2009.12.005}, author = {Muramatsu, Naoko and yin, Hongjun and Hedeker, Donald} } @article {7489, title = {Health outcomes of Experience Corps: a high-commitment volunteer program.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {414-420}, publisher = {71}, abstract = {

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Middle Aged, Multivariate Analysis, Regression Analysis, Social Class, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310375985}, author = {Janet M Wilmoth} } @article {7450, title = {Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis.}, journal = {Med Care}, volume = {48}, year = {2010}, note = {Using Smart Source Parsing Feb Comment In: Med Care. 2010 Feb;48(2):85-6 20057326 Index Medicus}, month = {2010 Feb}, pages = {87-94}, publisher = {48}, abstract = {

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Financing, Personal, Health Care Costs, Health Services Accessibility, Health Status Disparities, Hospitalization, Humans, Logistic Models, Longitudinal Studies, Male, Medication Adherence, Middle Aged, Multivariate Analysis, Risk Factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181c12e53}, author = {Michele M Heisler and Choi, Hwajung and Allison B Rosen and Sandeep Vijan and Mohammed U Kabeto and Kenneth M. Langa and John D Piette} } @article {7497, title = {Impact of cognitive impairment on screening mammography use in older US women.}, journal = {Am J Public Health}, volume = {100}, year = {2010}, month = {2010 Oct}, pages = {1917-23}, publisher = {100}, abstract = {

OBJECTIVES: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.

METHODS: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.

RESULTS: Women with severe cognitive impairment had lower rates of mammography (18\%) compared with women with normal cognition (45\%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group{\textquoteright}s median survival of 3.3 years (95\% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50\%.

CONCLUSIONS: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Humans, Incidence, Longitudinal Studies, Mammography, Medicare, Patient Acceptance of Health Care, Social Class, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.158485}, author = {Kala M. Mehta and Kathy Z Fung and Christine E Kistler and Chang, Anna and Louise C Walter} } @article {7499, title = {Length of stay for older adults residing in nursing homes at the end of life.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Sep}, pages = {1701-6}, publisher = {58}, abstract = {

OBJECTIVES: To describe lengths of stay of nursing home decedents.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older.

PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006.

MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission.

RESULTS: The mean age of decedents was 83.3 {\textpm} 9.0; 59.1\% were female, and 81.5\% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 {\textpm} 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke).

CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support.

}, keywords = {Advance care planning, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Length of Stay, Male, Middle Aged, Nursing homes, Palliative care, Retrospective Studies, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03005.x}, author = {Kelly, Anne and Conell-Price, Jessamyn and Kenneth E Covinsky and Irena Cenzer and Chang, Anna and W John Boscardin and Alexander K Smith} } @article {7520, title = {Lifetime marital history and mortality after age 50.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Dec}, pages = {1198-212}, publisher = {22}, abstract = {

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

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

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

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

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

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

}, keywords = {Cognition, Gene Expression, Health Status, Humans, Hypothalamo-Hypophyseal System, Immune System, Loneliness, Mental Health, Mortality, Pituitary-Adrenal System}, issn = {1532-4796}, doi = {10.1007/s12160-010-9210-8}, author = {Louise C Hawkley and John T. Cacioppo} } @article {7423, title = {The longevity gap between Black and White men in the United States at the beginning and end of the 20th century.}, journal = {Am J Public Health}, volume = {100}, year = {2010}, month = {2010 Feb}, pages = {357-63}, publisher = {100}, abstract = {

OBJECTIVES: We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century.

METHODS: We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914.

RESULTS: In our survival analysis, the Black-White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17\% difference in Black-White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black-White differences in mortality for the earlier cohort was 18\%.

CONCLUSIONS: In spite of overall improvements in longevity, a major difference in Black-White male mortality persists.

}, keywords = {Aged, Black or African American, Health Status Disparities, Humans, Longevity, Longitudinal Studies, Male, Men{\textquoteright}s health, Middle Aged, Mortality, Proportional Hazards Models, Survival Analysis, United States, Veterans, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.158188}, author = {Frank A Sloan and Padmaja Ayyagari and Salm, Martin and Grossman, Daniel} } @article {7506, title = {Longitudinal changes in disabled husbands{\textquoteright} and wives{\textquoteright} receipt of care.}, journal = {Gerontologist}, volume = {50}, year = {2010}, month = {2010 Oct}, pages = {681-93}, publisher = {50}, abstract = {

PURPOSE OF THE STUDY: This study contrasts 2-year adjustments in disabled husbands{\textquoteright} and wives{\textquoteright} amount of received care following both worsening and recovery in personal (activities of daily living [ADLs]) and routine care (instrumental activities of daily living [IADLs]) disability.

DESIGN AND METHODS: Using longitudinal data on 789 husbands and 778 wives from the Health and Retirement Study (2000 and 2002), changes in marital partners{\textquoteright} monthly hours of spousal and nonspousal care were jointly modeled using bivariate Tobit models. In addition, asymmetry in the magnitude of responses to worsening and improvement of function was examined.

RESULTS: Disabled husbands receive more hours of spousal and nonspousal care following worsening in ADL function than wives. Conversely, disabled wives lose more spousal and nonspousal care hours following improvements in ADL disability than husbands. Moreover, wives recovering in ADL function lose more hours of spousal care than they receive following worsening in personal care disability. There is no evidence of corresponding gender differences in the dynamics of assistance received following changes in IADL function.

IMPLICATIONS: Compared with husbands, disabled wives are disadvantaged in the adjustment of their personal care hours. Although disabled married community residents receive more hours of care than their unmarried counterparts, there are important gender differences in the advantages offered by marriage.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Disabled Persons, Female, Humans, Long-term Care, Longitudinal Studies, Male, Marriage, Middle Aged, Models, Theoretical, Sex Factors, Social Support, Socioeconomic factors, Spouses, Surveys and Questionnaires, Time Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq028}, author = {Claire No{\"e}l-Miller} } @article {7528, title = {Long-term cognitive impairment and functional disability among survivors of severe sepsis.}, journal = {JAMA}, volume = {304}, year = {2010}, month = {2010 Oct 27}, pages = {1787-94}, publisher = {304}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aging, Health Status, Humans, Korean War, Male, Middle Aged, Military Personnel, Multivariate Analysis, Racial Groups, Self-Assessment, Veterans, Vietnam Conflict, World War II}, issn = {1758-5368}, doi = {10.1093/geronb/gbq072}, author = {Janet M Wilmoth and Andrew S London and Wendy M Parker} } @article {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 {12659, title = {Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study.}, journal = {Ann Epidemiol}, volume = {20}, year = {2010}, month = {2010 Nov}, pages = {856-61}, abstract = {

PURPOSE: By using a longitudinal cohort, we assessed the association between neighborhood disadvantage and incidence of poor health and function in three domains.

METHODS: More than 4,000 enrollees aged 55 to 65 years in the national Health and Retirement Study were assessed biennially from 1998 through 2006 for incidence of fair/poor self-rated health, elevated depressive symptoms, and limitations in six basic activities of daily living (disability). Each analysis was restricted to subjects without that condition in 1994 or 1996. Neighborhoods (census tracts, time-updated for moves), were considered disadvantaged if they fell below the 25th percentile in an index comprising six socioeconomic status indicators. Repeated measures logistic regressions, inverse probability weighted to account for individual confounders, selective survival, and loss to follow-up were used to estimate odds ratios (ORs) for incidence of each outcome in the wave after exposure to disadvantaged neighborhood.

RESULTS: After covariate adjustment, neighborhood disadvantage predicted onset of fair/poor SRH (OR, 1.36; 95\% confidence interval, 1.15-1.59) but not disability (OR, 0.97; 0.81-1.16) or elevated depressive symptoms (OR, 0.97; 0.81-1.16).

CONCLUSIONS: Results confirmed previous findings that neighborhood disadvantage predicts self-rated health in a longitudinal context but did not support an association between neighborhood disadvantage and onset of disability or elevated depressive symptoms.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Confidence Intervals, depression, Disabled Persons, Female, Health Status Disparities, Humans, Incidence, Logistic Models, Longitudinal Studies, Male, Middle Aged, Odds Ratio, Poverty, Residence Characteristics, Risk, Self-Assessment, Socioeconomic factors, Time Factors}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2010.08.003}, author = {M. Maria Glymour and Mujahid, Mahasin and Wu, Qiong and White, Kellee and Tchetgen Tchetgen, Eric J} } @article {7440, title = {Obesity and excess mortality among the elderly in the United States and Mexico.}, journal = {Demography}, volume = {47}, year = {2010}, month = {2010 Feb}, pages = {79-96}, publisher = {47}, abstract = {

Increasing levels of obesity could compromise future gains in life expectancy in low- and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BAI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U.S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Chronic disease, Female, Humans, Logistic Models, Male, Mexico, Middle Aged, Mortality, Multivariate Analysis, Obesity, Risk Factors, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.0.0085}, author = {Monteverde, Malena and Noronha, Kenya and Alberto Palloni and Beatriz Novak} } @article {7445, title = {Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Apr}, pages = {384-98}, publisher = {22}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aging, Chi-Square Distribution, Cohort Studies, Confidence Intervals, depression, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Multivariate Analysis, Obesity, Odds Ratio, Psychometrics, Self Report, Sex Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264309359421}, author = {Dianna D Carroll and Heidi M Blanck and Mary K. Serdula and David R Brown} } @article {7462, title = {Older adults{\textquoteright} expectations to move: do they predict actual community-based or nursing facility moves within 2 years?}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {1029-53}, abstract = {

OBJECTIVE: This study examined the relationship between older adults{\textquoteright} expectations to move and actual residential relocation in the community or to a nursing facility within 2 years.

METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services.

RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves.

DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults{\textquoteright} preferences to remain living in their homes.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Community Health Services, Decision making, Female, Humans, Logistic Models, Male, Odds Ratio, Residence Characteristics, Skilled Nursing Facilities, Social Support, Statistics as Topic, Time Factors, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310368296}, author = {Julie F. Sergeant and David J Ekerdt and Chapin, Rosemary K} } @article {7455, title = {Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Jun}, pages = {503-9}, publisher = {48}, abstract = {

BACKGROUND: Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.

OBJECTIVE: : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.

RESEARCH DESIGN: Nationally representative cross-sectional study.

SUBJECTS: Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.

METHODS: We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40\% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.

RESULTS: In the year before Part D, more than half of Medicare families [56.0\%; 95\% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1\% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0\% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64\%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26\% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.

CONCLUSIONS: Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

}, keywords = {Adult, Aged, Confidence Intervals, Cost of Illness, Deductibles and Coinsurance, Drug Prescriptions, Female, Financing, Personal, Health Expenditures, Humans, Income, Male, Medicare Part D, Middle Aged, Odds Ratio, Poverty, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181dbd8d3}, author = {Becky A. Briesacher and Ross-Degnan, Dennis and Anita K Wagner and Hassan Fouayzi and Fang Zhang and Jerry Gurwitz and Soumerai, Stephen B} } @article {7458, title = {Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {438-48}, abstract = {

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, depression, Female, Health Status, Humans, Male, Marriage, Middle Aged, Personal Satisfaction, Predictive Value of Tests, Quality of Life, Regression Analysis, Religion and Psychology, Self Concept, Sex Distribution, Social Behavior, Surveys and Questionnaires, Volunteers}, issn = {0091-4150}, doi = {10.2190/AG.70.3.a}, author = {Erin L. Waddell and Joy M Jacobs-Lawson} } @article {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 {7484, title = {Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {769-77}, publisher = {65}, abstract = {

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8\%) suffered postbaseline heart attacks, with 423 participants (7.7\%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366\% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3\%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

}, keywords = {Aged, Educational Status, Female, Hospitalization, Humans, Male, Marital Status, Medicare, Myocardial Infarction, Patient Discharge, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glq003}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Michael P Jones and Kaskie, Brian and Jason Hockenberry and Elizabeth A Chrischilles and Kara B Wright and John F Geweke and Maksym Obrizan and Robert L. Ohsfeldt and Gary E Rosenthal and Robert B Wallace} } @article {7500, title = {The Process of Retirement Planning Scale (PRePS): development and validation.}, journal = {Psychol Assess}, volume = {22}, year = {2010}, month = {2010 Sep}, pages = {520-31}, publisher = {22}, abstract = {

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

}, keywords = {Age Factors, Aged, Educational Status, Factor Analysis, Statistical, Female, Financing, Personal, Goals, Health Status, Humans, Internal-External Control, Male, Middle Aged, Pilot Projects, Planning Techniques, Psychological Tests, Psychology, Reproducibility of Results, Retirement, Surveys and Questionnaires}, issn = {1939-134X}, doi = {10.1037/a0019512}, author = {Jack H Noone and Christine Stephens and Fiona M. Alpass} } @article {7518, title = {The prospective relationship between binge drinking and physician visits among older adults.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Dec}, pages = {1099-113}, publisher = {22}, abstract = {

OBJECTIVES: The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics.

METHOD: Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits.

RESULTS: In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled.

DISCUSSION: The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Alcoholic Intoxication, Female, Health Resources, Health Services Accessibility, Health Services Needs and Demand, Health Status Indicators, Humans, Linear Models, Male, Michigan, Multivariate Analysis, Patient Satisfaction, Physicians, Prospective Studies, Psychometrics, Risk Assessment, Risk Factors, Self Report}, issn = {1552-6887}, doi = {10.1177/0898264310376539}, author = {Kristi Rahrig Jenkins and Robert A. Zucker} } @article {7540, title = {Recent developments in longitudinal studies of aging in the United States.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, note = {Hauser, Robert M Weir, David AG-21079/AG/NIA NIH HHS/United States AG-9775/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Demography Demography. 2010;47 Suppl:S111-30.}, month = {2010}, pages = {S111-30}, publisher = {47 Suppl}, abstract = {

We review recent developments in longitudinal studies of aging, focusing on the Wisconsin Longitudinal Study (WLS) and the Health and Retirement Study (HRS). Both studies are part of a trend toward biosocial surveys in which biological measurement is joined with traditional survey techniques, and a related trend toward greater harmonization across studies. Both studies have collected DNA samples and are working toward genotyping that would allow broadly based association studies. Increased attention to psychological measurement of personality and of cognitive ability using adaptive testing structures has also been shared across the studies. The HRS has expanded its economic measurement to longitudinal studies of consumption and to broader-based measurement of pension and Social Security wealth. It has added biomarkers of cardiovascular risk. The WLS has developed an integrated approach to the study of death and bereavement and an innovative use of high school yearbook photographs to capture information about health in early life of its participants.

}, keywords = {Aging, Data collection, Demography, Genome-Wide Association Study, Health Status Indicators, Health Surveys, Humans, Longitudinal Studies, Research Design, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2010.0012}, author = {Hauser, Robert M. and David R Weir} } @article {7533, title = {Reforming beneficiary cost sharing to improve Medicare performance.}, journal = {Inquiry}, volume = {47}, year = {2010}, month = {2010 Fall}, pages = {215-25}, publisher = {47}, abstract = {

This paper explores options for reforming Medicare cost sharing in an effort to provide better financial protection for those beneficiaries with the greatest health care needs. Using data from the Health and Retirement Study (HRS) and the Medicare Current Beneficiary Survey (MCBS), we consider how unified annual deductibles, alternative coinsurance rates, and a limit on out-of-pocket spending would alter program spending, beneficiary cost sharing, and premiums for supplemental coverage. We show that adding an out-of-pocket limit and raising deductibles and coinsurance slightly would provide better safeguards to beneficiaries with high costs than the current Medicare benefit structure. Our estimates also suggest that policies protecting these beneficiaries could be structured in a way that would add little to overall program costs.

}, keywords = {Aged, Aged, 80 and over, Cost Sharing, Health Expenditures, Humans, Medicare, Middle Aged, Models, Economic, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_47.03.215}, author = {Zuckerman, Stephen and Shang, Baoping and Timothy A Waidmann} } @article {7437, title = {The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach.}, journal = {Soc Psychiatry Psychiatr Epidemiol}, volume = {45}, year = {2010}, month = {2010 Jan}, pages = {67-76}, publisher = {45}, abstract = {

OBJECTIVES: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.

METHODS: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants{\textquoteright} depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.

RESULTS: Nearly one in four of participants (23\%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13\% of the link between depressive symptoms and glycemic control.

CONCLUSIONS: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

}, keywords = {Adult, Aged, Blood Glucose, Body Weight, Comorbidity, depression, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Glycemic Index, Health Behavior, Health Surveys, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Self Care, Smoking, United States}, issn = {1433-9285}, doi = {10.1007/s00127-009-0043-3}, author = {Chiu, Ching-Ju and Linda A. Wray and Elizabeth A Beverly and Oralia G Dominic} } @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 {7467, title = {Situational versus chronic loneliness as risk factors for all-cause mortality.}, journal = {Int Psychogeriatr}, volume = {22}, year = {2010}, month = {2010 May}, pages = {455-62}, publisher = {22}, abstract = {

BACKGROUND: Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality.

METHODS: To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004.

RESULTS: Those identified as "situationally lonely" (HR = 1.56; 95\% CI: 1.52-1.62) as well as those identified as "chronically lonely" (HR = 1.83; 95\% CI: 1.71-1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as "situationally lonely," individuals classified as "chronically lonely" had a slightly greater mortality risk.

CONCLUSIONS: The current study emphasizes the important role loneliness plays in older adults{\textquoteright} health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Cause of Death, Female, Geriatric Assessment, Health Surveys, Humans, Israel, Life Change Events, Loneliness, Male, Middle Aged, Risk Factors, social isolation, Surveys and Questionnaires, Time Factors}, issn = {1741-203X}, doi = {10.1017/S1041610209991426}, author = {Sharon Shiovitz-Ezra and Liat Ayalon} } @article {7457, title = {Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of U.S. older adults.}, journal = {Res Gerontol Nurs}, volume = {3}, year = {2010}, month = {2010 Apr}, pages = {113-25}, publisher = {3}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, Humans, Logistic Models, Loneliness, Male, Middle Aged, Multivariate Analysis, Risk Factors, Socioeconomic factors, United States}, issn = {1940-4921}, doi = {10.3928/19404921-20091103-99}, author = {Laurie A. Theeke} } @article {7463, title = {Spousal loss, children, and the risk of nursing home admission.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65B}, year = {2010}, month = {2010 May}, pages = {370-80}, publisher = {65B}, abstract = {

UNLABELLED: OBJECTIVES. Informed by a life course perspective, this study investigates the effects of spousal loss and availability of adult children on elderly husbands{\textquoteright} and wives{\textquoteright} risk of nursing home entry.

METHODS: Based on longitudinal data from the Health and Retirement Study, we studied 2,116 couples who were community residents in 1998. We estimate proportional hazards models for husbands{\textquoteright} and wives{\textquoteright} duration to first nursing home admission during 8 years of follow-up.

RESULTS: Overall, 438 (20.7\%) husbands and 382 (18.1\%) wives were institutionalized, and 362 (17.1\%) husbands and 701 (33.1\%) wives lost their spouse. Accounting for measured covariates, the risk of nursing home entry doubled for men following spousal death, but was unchanged for women. Results indicate that adult children reduced wives{\textquoteright} risk of nursing home admission regardless of husbands{\textquoteright} vital status, but buffered husbands{\textquoteright} risk only after the death of their wives. We uncover suggestive evidence of parent-child gender concordance in children{\textquoteright}s buffering effect of widowed parents{\textquoteright} risk of institutionalization. Discussion. Our findings are consistent with gender variations in spousal caregiving and in husbands{\textquoteright} and wives{\textquoteright} relative reliance on care from a partner and children. This study provides new evidence on the relationship between institutionalization and family structure among married elderly persons.

}, keywords = {Activities of Daily Living, Adult children, Aged, Aged, 80 and over, Aging, Bereavement, Caregivers, Family Characteristics, Female, Gender Identity, Homes for the Aged, Humans, Long-term Care, Male, Nursing homes, Parent-Child Relations, Patient Admission, Proportional Hazards Models, Social Support, Spouses, Utilization Review}, issn = {1758-5368}, doi = {10.1093/geronb/gbq020}, author = {Claire No{\"e}l-Miller} } @article {7465, title = {Stability and changes in living arrangements: relationship to nursing home admission and timing of placement.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Nov}, pages = {783-91}, publisher = {65}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Affect, Aged, Aging, Female, Health Status, Humans, Male, Middle Aged, Prevalence, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp101}, author = {Sara J McLaughlin and Cathleen M. Connell and Steven G Heeringa and Lydia W Li and J Scott Roberts} } @article {7433, title = {Surgery as a teachable moment for smoking cessation.}, journal = {Anesthesiology}, volume = {112}, year = {2010}, month = {2010 Jan}, pages = {102-7}, publisher = {112}, abstract = {

BACKGROUND: A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery.

RESULTS: Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5\%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95\% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95\% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8\% of all quit events in the United States annually can be attributed to the surgical procedures analyzed.

CONCLUSIONS: Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Analysis of Variance, Cohort Studies, Female, Follow-Up Studies, General Surgery, Humans, Longitudinal Studies, Male, Middle Aged, Patient Education as Topic, Regression Analysis, Smoking cessation, Treatment Outcome, United States}, issn = {1528-1175}, doi = {10.1097/ALN.0b013e3181c61cf9}, author = {Yu Shi and David O. Warner} } @article {7495, title = {Take-up of Medicare Part D: results from the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, note = {Times Cited: 6}, month = {2010 Jul}, pages = {492-501}, publisher = {65}, abstract = {

OBJECTIVES: To estimate the impact of Medicare Part D on prescription drug coverage among elderly Medicare beneficiaries and to analyze the predictors of program enrollment ("take-up") among those with no prior drug coverage.

METHODS: Multivariate analyses of data from the 2002, 2004, and 2006 waves of the Health and Retirement Study.

RESULTS: Take-up of Part D among those without drug coverage in 2004 was high; about 50\%-60\% of this group had Part D coverage in 2006. Only 7\% of senior citizens lacked drug coverage in 2006 compared with 24\% in 2004. Demand for prescription drugs was the most important determinant of the decision to enroll in Part D among those with no prior coverage. Many of those who remained without coverage in 2006 reported that they do not use prescribed medicines, and the majority had relatively low out-of-pocket spending.

CONCLUSION: For the most part, Medicare beneficiaries seem to have been able to make economically rational decisions about Part D enrollment despite the complexity of the program.

}, keywords = {Aged, ethnicity, Humans, Longitudinal Studies, Medically Uninsured, Medicare Part D, Multivariate Analysis, Poverty, prescription drugs, Prescription Fees, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp107}, author = {Helen G Levy and David R Weir} } @article {7475, title = {Trading years for perfect health: results from the health and retirement study.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Dec}, pages = {1184-97}, publisher = {22}, abstract = {

OBJECTIVE: To evaluate the preferences of an ethnically diverse national sample of older Americans regarding length of life versus health quality.

METHOD: A time trade-off task administered as part of the 2002 wave of the Health and Retirement Study.

RESULTS: Respondents equated 6.86 (SD = 3.46) years of perfect health with 10 years of life in imperfect health. Women and those who ranked their health less favorably were more likely to give up years of life for perfect health. Relative to Whites, Blacks were more willing to live longer in imperfect health. Those of lower levels of education were more likely to prefer 10 years of life in imperfect health.

DISCUSSION: There is wide variability in responses to the time trade-off task that is partially associated with self-rated health, gender, ethnicity, and education.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Community Participation, Confidence Intervals, Culture, Epidemiologic Methods, ethnicity, Female, Health Surveys, Humans, Longevity, Male, Multivariate Analysis, Psychometrics, Retirement, Self Report, Surveys and Questionnaires, Time Factors}, issn = {1552-6887}, doi = {10.1177/0898264310371980}, author = {Liat Ayalon and King-Kallimanis, Bellinda L} } @article {7466, title = {Untreated poor vision: a contributing factor to late-life dementia.}, journal = {Am J Epidemiol}, volume = {171}, year = {2010}, month = {2010 Mar 15}, pages = {728-35}, publisher = {171}, abstract = {

Ophthalmologic abnormalities have been described in patients with dementia, but the extent to which poor vision and treatment for visual disorders affect cognitive decline is not well defined. Linked data from the Health and Retirement Study and Medicare files (1992-2005) were used to follow the experiences of 625 elderly US study participants with normal cognition at baseline. The outcome was a diagnosis of dementia, cognitively impaired but no dementia, or normal cognition. Poor vision was associated with development of dementia (P = 0.0048); individuals with very good or excellent vision at baseline had a 63\% reduced risk of dementia (95\% confidence interval (CI): 20, 82) over a mean follow-up period of 8.5 years. Participants with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease (95\% CI: 2.3, 39.5) and a 5-fold increased risk of cognitively impaired but no dementia (95\% CI: 1.6, 15.9). Poorer vision without a previous eye procedure increased the risk of Alzheimer disease 5-fold (95\% CI: 1.5, 18.8). For Americans aged 90 years or older, 77.9\% who maintained normal cognition had received at least one previous eye procedure compared with 51.7\% of those with Alzheimer disease. Untreated poor vision is associated with cognitive decline, particularly Alzheimer disease.

}, keywords = {Aged, 80 and over, Cognition Disorders, Dementia, Female, Humans, Logistic Models, Male, Medicare, Ophthalmology, Patient Acceptance of Health Care, Risk Factors, United States, Vision Disorders}, issn = {1476-6256}, doi = {10.1093/aje/kwp453}, author = {Mary A M Rogers and Kenneth M. Langa} } @article {7446, title = {Urban neighborhood context and mortality in late life.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Mar}, pages = {197-218}, publisher = {22}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Aging, Cognition, Confidence Intervals, depression, Female, Health Status, Humans, Los Angeles, Male, Middle Aged, Mortality, Odds Ratio, Poverty, Psychometrics, Residence Characteristics, Self Report, Socioeconomic factors, Statistics as Topic, Urban Population}, issn = {1552-6887}, doi = {10.1177/0898264309355980}, author = {Richard G Wight and Janet R. Cummings and Arun S Karlamangla and Carol S Aneshensel} } @article {7326, title = {A 12-year prospective study of stroke risk in older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 09}, pages = {17}, publisher = {9}, abstract = {

BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted.

METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used.

RESULTS: Post-baseline strokes occurred for 545 (9.9\%; high sensitivity approach) and 374 (6.8\%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200\% or more.

CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Insurance Benefits, Male, Medicare, Prospective Studies, Risk Factors, Socioeconomic factors, Stroke, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-17}, author = {Frederic D Wolinsky and Suzanne E Bentler and Elizabeth A Cook and Elizabeth A Chrischilles and Li Liu and Kara B Wright and John F Geweke and Maksym Obrizan and Claire E Pavlik and Robert L. Ohsfeldt and Michael P Jones and Robert B Wallace and Gary E Rosenthal} } @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 {7379, title = {The aftermath of hip fracture: discharge placement, functional status change, and mortality.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Nov 15}, pages = {1290-9}, publisher = {170}, abstract = {

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Health Status, Health Status Indicators, Hip Fractures, Humans, Interviews as Topic, Iowa, Length of Stay, Logistic Models, Medicare, Patient Discharge, Prospective Studies, Psychometrics, Socioeconomic factors, Time Factors, Treatment Outcome, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp266}, author = {Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert B Wallace and Robert L. Ohsfeldt and Michael P Jones and Gary E Rosenthal and Frederic D Wolinsky} } @article {7332, title = {Are mature smokers misinformed?}, journal = {J Health Econ}, volume = {28}, year = {2009}, month = {2009 Mar}, pages = {385-97}, publisher = {28}, abstract = {

While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation. In this paper we investigate the relative accuracy of mature smokers{\textquoteright} risk perceptions about future survival, and a range of morbidities and disabilities. Using data from the survey on smoking (SOS) conducted for this research, we compare subjective beliefs elicited from the SOS with corresponding individual-specific objective probabilities estimated from the health and retirement study. Overall, consumers in the age group studied, 50-70, are not overly optimistic in their perceptions of health risk. If anything, smokers tend to be relatively pessimistic about these risks. The finding that smokers are either well informed or pessimistic regarding a broad range of health risks suggests that these beliefs are not pivotal in the decision to continue smoking. Although statements by the tobacco companies may have been misleading and thus encouraged some to start smoking, we find no evidence that systematic misinformation about the health consequences of smoking inhibits quitting.

}, keywords = {Aged, Deception, Female, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Male, Middle Aged, Risk Assessment, Smoking, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2008.12.004}, author = {Ahmed Khwaja and Daniel S. Silverman and Frank A Sloan and Wang, Yang} } @article {7366, title = {Association between cognitive function and social support with glycemic control in adults with diabetes mellitus.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Oct}, pages = {1816-24}, publisher = {57}, abstract = {

OBJECTIVES: To examine whether cognitive impairment in adults with diabetes mellitus is associated with worse glycemic control and to assess whether level of social support for diabetes mellitus care modifies this relationship.

DESIGN: Cross-sectional analysis.

SETTING: The 2003 Health and Retirement Study (HRS) Mail Survey on Diabetes and the 2004 wave of the HRS.

PARTICIPANTS: Adults aged 50 and older with diabetes mellitus in the United States (N=1,097, mean age 69.2).

MEASUREMENTS: Glycosylated hemoglobin (HbA1c) level; cognitive function, measured with the 35-point HRS cognitive scale (HRS-cog); sociodemographic variables; duration of diabetes mellitus; depressed mood; social support for diabetes mellitus care; self-reported knowledge of diabetes mellitus; treatments for diabetes mellitus; components of the Total Illness Burden Index related to diabetes mellitus; and functional limitations.

RESULTS: In an ordered logistic regression model for the three ordinal levels of HbA1c (<7.0, 7.0-7.9, >or=8.0 mg/dL), respondents with HRS-cog scores in the lowest quartile had significantly higher HbA1c levels than those in the highest cognitive quartile (adjusted odds ratio=1.80, 95\% confidence interval=1.11-2.92). A high level of social support for diabetes mellitus care modified this association; for respondents in the lowest cognitive quartile, those with high levels of support had significantly lower odds of having higher HbA1c than those with low levels of support (1.11 vs 2.87, P=.02).

CONCLUSION: Although cognitive impairment was associated with worse glycemic control, higher levels of social support for diabetes mellitus care ameliorated this negative relationship. Identifying the level of social support available to cognitively impaired adults with diabetes mellitus may help to target interventions for better glycemic control.

}, keywords = {Aged, Blood Glucose, Cognition, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Social Support}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02431.x}, author = {Okura, Toru and Michele M Heisler and Kenneth M. Langa} } @article {7408, title = {"Below average" self-assessed school performance and Alzheimer{\textquoteright}s disease in the Aging, Demographics, and Memory Study.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Sep}, pages = {380-7}, publisher = {5}, abstract = {

BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer{\textquoteright}s disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants{\textquoteright} own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone.

METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.

RESULTS: The 725 participants (mean age, 81.8 years; 59\% female; 16\% African-American) varied in self-assessed educational performance: 29\% reported "above average," 64\% reported "average," and 7\% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11\% of participants with "above average" self-assessed performance had AD, as opposed to 12\% of participants with "average" performance and 26\% of participants with "below average" performance (P < 0.001). After controlling for subjects{\textquoteright} years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95\% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95\% confidence interval, 0.5-1.7).

CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.

}, keywords = {Aged, Aged, 80 and over, Aging, Alzheimer disease, Apolipoprotein E4, Cognition Disorders, Educational Status, Female, Geriatric Assessment, Humans, Male, Memory, Neuropsychological tests, Risk Factors}, issn = {1552-5279}, doi = {10.1016/j.jalz.2009.07.039}, url = {http://www.sciencedirect.com/science?_ob=ArticleURLand_udi=B7W6D-4X6VH7W-7and_user=99318and_coverDate=09 2F30 2F2009and_rdoc=1and_fmt=highand_orig=searchand_origin=searchand_sort=dand_docanchor=andview=cand_acct=C000007678and_version=1and_urlVersion=0and_}, author = {Kala M. Mehta and Anita L Stewart and Kenneth M. Langa and Kristine Yaffe and Sandra Y. Moody-Ayers and Brie A Williams and Kenneth E Covinsky} } @article {7410, title = {The benefits of risk factor prevention in Americans aged 51 years and older.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Nov}, pages = {2096-101}, publisher = {99}, abstract = {

OBJECTIVES: We assessed the potential health and economic benefits of reducing common risk factors in older Americans.

METHODS: A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking.

RESULTS: The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198,018 (diabetes), $137,964 (hypertension), $118,946 (smoking), and $51,750 (obesity).

CONCLUSIONS: Effective prevention could substantially improve the health of older Americans, and--despite increases in longevity--such benefits could be achieved with little or no additional lifetime medical spending.

}, keywords = {Diabetes Mellitus, Health Care Costs, health policy, Health Promotion, Humans, Hypertension, Middle Aged, Models, Biological, Models, Economic, Obesity, Quality-Adjusted Life Years, Risk Reduction Behavior, Smoking, Smoking Prevention, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.172627}, url = {http://sfx.lib.umich.edu:9003/sfx_local?sid=Entrez 3APubMedandid=pmid 3A19762651}, author = {Dana P Goldman and Yuhui Zheng and Girosi, Federico and Pierre-Carl Michaud and S Jay Olshansky and David M Cutler and John W Rowe} } @article {7375, title = {Bridge employment and retirees{\textquoteright} health: a longitudinal investigation.}, journal = {J Occup Health Psychol}, volume = {14}, year = {2009}, note = {PMID: 19839658}, month = {2009 Oct}, pages = {374-89}, publisher = {14}, abstract = {

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

}, keywords = {Employment, Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Retirement, United States}, issn = {1939-1307}, doi = {10.1037/a0015285}, author = {Zhan, Yujie and Wang, Mo and Liu, Songqi and Kenneth S. Shultz} } @article {7317, title = {Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study.}, journal = {Stroke}, volume = {40}, year = {2009}, month = {2009 Mar}, pages = {873-9}, publisher = {40}, abstract = {

BACKGROUND AND PURPOSE: Most stroke incidence studies use geographically localized (community) samples with few national data sources available. Such samples preclude research on contextual risk factors, but national samples frequently collect only self-reported stroke. We examine whether incidence estimates from clinically verified studies are consistent with estimates from a nationally representative US sample assessing self-reported stroke.

METHODS: Health and Retirement Study (HRS) participants (n=17 056) age 50+ years were followed for self- or proxy-reported first stroke (1293 events) from 1998 to 2006 (average, 6.8 years). We compared incidence rates by race, sex, and age strata with those previously documented in leading geographically localized studies with medically verified stroke. We also examined whether cardiovascular risk factor effect estimates in HRS are comparable to those reported in studies with clinically verified strokes.

RESULTS: The weighted first-stroke incidence rate was 10.0 events/1000 person-years. Total age-stratified incidence rates in whites were mostly comparable with those reported elsewhere and were not systematically higher or lower. However, among blacks in HRS, incidence rates generally appeared higher than those previously reported. HRS estimates were most comparable with those reported in the Cardiovascular Health Study. Incidence rates approximately doubled per decade of age and were higher in men and blacks. After demographic adjustment, all risk factors predicted stroke incidence in whites. Smoking, hypertension, diabetes, and heart disease predicted incident stroke in blacks.

CONCLUSIONS: Associations between known risk factors and stroke incidence were verified in HRS, suggesting that misreporting is nonsystematic. HRS may provide valuable data for stroke surveillance and examination of classical and contextual risk factors.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Epidemiologic Methods, ethnicity, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Stroke, Treatment Outcome, United States}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.108.529479}, author = {M. Maria Glymour and Mauricio Avendano} } @article {7310, title = {Cancer survivorship, health insurance, and employment transitions among older workers.}, journal = {Inquiry}, volume = {46}, year = {2009}, note = {PMID: 19489481}, month = {2009 Spring}, pages = {17-32}, publisher = {46}, abstract = {

This study examined the effect of job-related health insurance on employment transitions (labor force exits, reductions in hours, and job changes) of older working cancer survivors. Using multivariate models, we compared longitudinal data for the period 1997-2002 from the Penn State Cancer Survivor Study to similar data for workers with no cancer history in the Health and Retirement Study, who were also ages 55 to 64 at follow-up. The interaction of cancer survivorship with health insurance at diagnosis was negative and significant in predicting labor force exits, job changes, and transitions to part-time employment for both genders. The differential effect of job-related health insurance on the labor market dynamics of cancer survivors represents an additional component of the economic and psychosocial burden of cancer on survivors.

}, keywords = {Career Mobility, Cohort Studies, Female, Health Benefit Plans, Employee, Health Insurance Portability and Accountability Act, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Neoplasms, Retirement, Survivors, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.01.17}, author = {Tunceli, Kaan and Pamela F. Short and John R. Moran and Tunceli, Ozgur} } @article {7303, title = {Caregiving behavior is associated with decreased mortality risk.}, journal = {Psychol Sci}, volume = {20}, year = {2009}, month = {2009 Apr}, pages = {488-94}, publisher = {20}, abstract = {

Traditional investigations of caregiving link it to increased caregiver morbidity and mortality, but do not disentangle the effects of providing care from those of being continuously exposed to an ailing loved one with serious health problems. We explored this possible confound in a national, longitudinal survey of elderly married individuals (N= 3,376). Results showed that spending at least 14 hr per week providing care to a spouse predicted decreased mortality for the caregiver, independently of behavioral and cognitive limitations of the care recipient (spouse), and of other demographic and health variables. These findings suggest that it may be premature to conclude that health risks for caregivers are due to providing active help. Indeed, under some circumstances, caregivers may actually benefit from providing care.

}, keywords = {Altruism, Caregivers, Humans, Mortality}, issn = {1467-9280}, doi = {10.1111/j.1467-9280.2009.02323.x}, url = {http://pss.sagepub.com/content/20/4/4}, author = {Stephanie Brown and Dylan M Smith and Schulz, Richard and Mohammed U Kabeto and Peter A. Ubel and Poulin, Michael and Yi, Jaehee and Kim, Catherine and Kenneth M. Langa} } @article {7404, title = {Changes in functional status among persons over age sixty-five undergoing total knee arthroplasty.}, journal = {Med Care}, volume = {47}, year = {2009}, month = {2009 Jul}, pages = {742-8}, publisher = {47}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Arthroplasty, Replacement, Knee, Attitude to Health, Geriatric Assessment, Health Care Surveys, Health Status, Health Surveys, Humans, Insurance Claim Reporting, Logistic Models, Longitudinal Studies, Medicare, Mobility Limitation, Multivariate Analysis, Muscle Weakness, Osteoarthritis, Knee, pain, Sensitivity and Specificity, Surveys and Questionnaires, Treatment Outcome, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31819a5ae3}, author = {Frank A Sloan and Ruiz, David and Alyssa C Platt} } @article {7342, title = {Childhood socioeconomic status and racial differences in disability: evidence from the Health and Retirement Study (1998-2006).}, journal = {Soc Sci Med}, volume = {69}, year = {2009}, note = {PMID: 19541400}, month = {2009 Aug}, pages = {433-41}, publisher = {69}, abstract = {

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998-2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N=14,588), were used in nonlinear multilevel models. Parental education and father{\textquoteright}s occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Disabled Persons, Female, Health Behavior, Humans, Male, Middle Aged, Models, Statistical, Prejudice, Prospective Studies, Racial Groups, Social Justice, Socioeconomic factors, Statistics as Topic, United States, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2009.06.006}, author = {Mary E Bowen} } @article {7340, title = {Cognitive decline among patients with chronic obstructive pulmonary disease.}, journal = {Am J Respir Crit Care Med}, volume = {180}, year = {2009}, note = {PMID: 19423714}, month = {2009 Jul 15}, pages = {134-7}, publisher = {180}, abstract = {

RATIONALE: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.

OBJECTIVES: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.

METHODS: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.

MEASUREMENTS AND MAIN RESULTS: A total of 4,150 adults were included in our study. Among them, 12\% reported a history of COPD (29\% severe, 71\% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0.001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.

CONCLUSIONS: Severe COPD was associated with lower cognitive performance on standardized measurement over time.

}, keywords = {Aged, Case-Control Studies, Cognition Disorders, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Pulmonary Ventilation, Risk Factors, Severity of Illness Index, Socioeconomic factors, United States}, issn = {1535-4970}, doi = {10.1164/rccm.200902-0276OC}, author = {William W. Hung and Juan P. Wisnivesky and Albert L Siu and Joseph S. Ross} } @article {7346, title = {Cognitive health among older adults in the United States and in England.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, note = {PMID: 19555494}, month = {2009 Jun 25}, pages = {23}, publisher = {9}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Cognition Disorders, Cohort Studies, Cross-Sectional Studies, England, Female, Health Status, Humans, Longitudinal Studies, Male, Neuropsychological tests, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-23}, author = {Kenneth M. Langa and David J Llewellyn and Iain A Lang and David R Weir and Robert B Wallace and Mohammed U Kabeto and Felicia A Huppert} } @article {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 {7338, title = {Comparing models of frailty: the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 May}, pages = {830-9}, publisher = {57}, abstract = {

OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).

DESIGN: Cross-sectional analysis.

SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.

MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.

RESULTS: Almost one-third (30.2\%) of respondents were frail according to at least one model; 3.1\% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1\% of those classified as frail according to the Biologic Syndrome model and 72.1\% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95\% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95\% CI=1.2-2.5), and African-American ethnicity (OR=2.1, \% CI=1.0-4.4).

CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Demography, Disability Evaluation, Frail Elderly, Geriatric Assessment, Health Surveys, Humans, Interviews as Topic, Logistic Models, Models, Theoretical, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02225.x}, author = {Christine T Cigolle and Mary Beth Ofstedal and Zhiyi Tian and Caroline S Blaum} } @article {7309, title = {Compensatory conscientiousness and health in older couples.}, journal = {Psychol Sci}, volume = {20}, year = {2009}, month = {2009 May}, pages = {553-9}, publisher = {20}, abstract = {

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

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Aging, Conscience, Female, Health Status, Humans, Longevity, Longitudinal Studies, Male, Middle Aged, Neurotic Disorders, Personality Inventory, Social Conformity, Spouses}, issn = {1467-9280}, doi = {10.1111/j.1467-9280.2009.02339.x}, author = {Brent W Roberts and Jacqui Smith and Joshua J Jackson and Edmonds, Grant} } @article {7330, title = {The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Mar}, pages = {511-6}, publisher = {57}, abstract = {

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58\% were female, 8\% were African American, and 4\% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23\% had two or more. Of respondents with one condition, 20\% to 55\% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Angina Pectoris, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Geriatric Assessment, Health Surveys, Heart Failure, Humans, Male, Myocardial Infarction, Sick Role, Syndrome, United States, Urinary incontinence}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2008.02150.x}, author = {Pearl G. Lee and Christine T Cigolle and Caroline S Blaum} } @article {7315, title = {Correlates of improvement in walking ability in older persons in the United States.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Mar}, pages = {533-9}, publisher = {99}, abstract = {

OBJECTIVES: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study.

METHODS: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors.

RESULTS: Among the 25\% of the study population with baseline walking limitations, 29\% experienced improved walking ability, 40\% experienced no change in walking ability, and 31\% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status.

CONCLUSIONS: Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Confidence Intervals, Female, Health Promotion, Humans, Male, Middle Aged, Motor Activity, Multivariate Analysis, Odds Ratio, Overweight, Smoking Prevention, Social Marketing, Socioeconomic factors, United States, Walking}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.142927}, author = {Joseph Feinglass and Song, Jing and Larry M Manheim and Semanik, Pamela and Rowland W Chang and Dorothy D Dunlop} } @article {7376, title = {Dental care coverage transitions.}, journal = {Am J Manag Care}, volume = {15}, year = {2009}, month = {2009 Oct}, pages = {729-35}, publisher = {15}, abstract = {

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

}, keywords = {Aged, Career Mobility, Female, Health Benefit Plans, Employee, Humans, Insurance Coverage, Insurance, Dental, Interviews as Topic, Male, Middle Aged, United States}, issn = {1936-2692}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7355, title = {Does job loss cause ill health?}, journal = {Health Econ}, volume = {18}, year = {2009}, month = {2009 Sep}, pages = {1075-89}, publisher = {18}, abstract = {

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

}, keywords = {Activities of Daily Living, Age Factors, Cohort Studies, Cross-Sectional Studies, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Sex Factors, Smoking, Socioeconomic factors}, issn = {1099-1050}, doi = {10.1002/hec.1537}, author = {Salm, Martin} } @article {7387, title = {Doing well: a SEM analysis of the relationships between various activities of daily living and geriatric well-being.}, journal = {J Genet Psychol}, volume = {170}, year = {2009}, month = {2009 Sep}, pages = {213-26}, publisher = {170}, abstract = {

An existing large data set, the Health and Retirement Study (HRS) with the subsequent addition of the Consumption and Activities Mail Survey (CAMS) data, provides a rich data set for the examination of the activities of older adults. In this study HRS and CAMS data are used to examine relationships between various activities of daily living (ADLs) and well-being in older adults. Using structural equation modeling, influences of direct and indirect factors that affect older individuals{\textquoteright} cognitive and emotional well-being are analyzed. The data suggest ability to perform ADLs has little to do with cognitive well-being, but is an influential factor in determining emotional well-being.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Cognition, depression, Humans, Models, Psychological, Socioeconomic factors, United States}, issn = {0022-1325}, doi = {10.1080/00221320903218190}, author = {James A Katt and Speranza, Linda and Shore, Wendy and Karen H. Saenz and E. Lea Witta} } @article {7299, title = {Early Life Health and Cognitive Function in Old Age.}, journal = {Am Econ Rev}, volume = {99}, year = {2009}, month = {2009 May}, pages = {104-109}, publisher = {99}, keywords = {Adult, Aged, Child, Cognition Disorders, Communicable Diseases, Health Status, Humans, Infant, Infant Mortality, United States}, issn = {0002-8282}, doi = {10.1257/aer.99.2.104}, author = {Case, Anne and Paxson, Christina} } @article {7311, title = {The effect of depression and cognitive impairment on enrollment in Medicare Part D.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Aug}, pages = {1433-40}, publisher = {57}, abstract = {

OBJECTIVES: To examine concerns that vulnerable populations, such as depressed or cognitively impaired beneficiaries would have challenges accessing Part D coverage.

DESIGN: Logistic regression analysis was used to assess whether elderly Medicare beneficiaries with depression or cognitive impairment differentially planned to and actually signed up for Part D.

SETTING: 2004 and 2006 data from the Health and Retirement Study (HRS) were used, including a subsample that completed the Prescription Drug Study (PDS) in 2005.

PARTICIPANTS: Nine thousand five hundred ninety-three HRS respondents and 3,567 PDS respondents.

MEASUREMENTS: The outcome variables of interest were planned and actual enrollment in Part D. The independent variables were depression and cognitive impairment status. The analyses were adjusted using clinical and demographic predictors including age, sex, race or ethnicity, educational attainment, net worth, marital status, health status, number of health conditions being treated with prescription medications, and presence of a caregiver.

RESULTS: Although having depression or cognitive impairment was associated with a higher likelihood of planning to and actually signing up for Part D in unadjusted analyses, in adjusted analyses, having depression or cognitive impairment was not significantly associated with whether Medicare beneficiaries planned to enroll in or actually enrolled in Part D.

CONCLUSION: Vulnerable Medicare beneficiaries with depression or cognitive impairment were able to access Part D benefits to the same extent as nonvulnerable beneficiaries. More research is needed to determine how well Part D meets the needs of these populations.

}, keywords = {Aged, Aged, 80 and over, Chi-Square Distribution, Cognition Disorders, depression, Female, Humans, Logistic Models, Longitudinal Studies, Male, Medicare Part D, Middle Aged, Patient Participation, Risk Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02348.x}, author = {Zivin, Kara and Mohammed U Kabeto and Helen C Kales and Kenneth M. Langa} } @article {7407, title = {Effect of Medicare home health care payment on informal care.}, journal = {Inquiry}, volume = {46}, year = {2009}, month = {2009 Spring}, pages = {58-71}, publisher = {46}, abstract = {

This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden on some low-income families, but that many higher-income families were able to either forgo the care or finance it privately. Home care payment policies should recognize these effects, balancing costs of the program with the desire to protect families from the burdens associated with providing informal home care.

}, keywords = {Caregivers, Confidence Intervals, Female, Health Care Surveys, Home Care Services, Humans, Male, Medicare, Organizational Policy, Reimbursement Mechanisms, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_46.01.58}, author = {Ezra Golberstein and David C Grabowski and Kenneth M. Langa and M.E. Chernew} } @article {7292, title = {Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Jan}, pages = {4-13}, publisher = {64}, abstract = {

This study examined if reported physical activity has beneficial outcomes on disability through cognitive performance-mediated effects and if these mediation effects are comparable for White and African American elders. Longitudinal data from the Assets and Health Dynamics among the Oldest Old study (N = 4,472) are used to test mediation in multilevel models. During the 7-year follow-up, cognitive performance mediated the effects of reported physical activity on disability in the entire sample and in Whites but not in African Americans. Our results indicate that reported physical activity may delay the disability development through improvement in cognitive performance. Unmeasured education and comorbidity influences may have obscured the mediation effects in African Americans. Reported physical activity plays a key role in the independence of older adults and should be particularly promoted in African Americans and during the entire life course.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Cognition Disorders, Cohort Studies, Disability Evaluation, Exercise, Female, Follow-Up Studies, Health Status Disparities, Humans, Male, Motor Activity, Neuropsychological tests, Socioeconomic factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbn030}, author = {Mihaela A. Popa and Sandra L Reynolds and Brent J. Small} } @article {7351, title = {The effect of retirement on weight.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Sep}, pages = {656-65}, publisher = {64B}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Body Mass Index, Cohort Studies, Cross-Sectional Studies, Female, Geriatric Assessment, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Motor Activity, Obesity, Overweight, Pensions, Retirement, Social Security, Socioeconomic factors, United States, Weight Gain}, issn = {1758-5368}, doi = {10.1093/geronb/gbn044}, author = {Chung, Sukyung and Marisa E Domino and Sally C. Stearns} } @article {7386, title = {The effects of developing a dual sensory loss on depression in older adults: a longitudinal study.}, journal = {J Aging Health}, volume = {21}, year = {2009}, month = {2009 Dec}, pages = {1179-99}, publisher = {21}, abstract = {

OBJECTIVE: To determine the effect of developing a dual sensory loss (DSL) on depression over time and evaluate the impact of preexisting single sensory loss on this effect.

METHOD: Multilevel modeling was used to analyze data (N = 2,689) from the Health and Retirement Study.

RESULTS: A significant increase in depression at the first report of DSL occurred, and depression increased at a significantly faster rate following DSL, in a curvilinear pattern. In addition, persons who eventually developed DSL began the study with a depression score significantly higher than persons who did not experience sensory loss. A preexisting single sensory loss did not alter the effect of DSL on depression.

DISCUSSION: Two sources of disparity in depression between persons with and without DSL were identified: preexisting differences and differences that occurred due to the DSL. The relationship exhibited between depression and developing a DSL indicated an adjustment process.

}, keywords = {Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Black or African American, depression, Depressive Disorder, Female, Health Surveys, Hearing loss, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Multivariate Analysis, Rehabilitation, Retirement, Risk Factors, Sensation Disorders, United States, Vision Disorders, White People}, issn = {0898-2643}, doi = {10.1177/0898264309350077}, author = {Michele Capella McDonnall} } @article {7357, title = {Estimating the quantity and economic value of family caregiving for community-dwelling older persons in the last year of life.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Sep}, pages = {1654-9}, publisher = {57}, abstract = {

OBJECTIVES: To estimate the quantity and economic value of informal care provided to older persons during their final year of life in the community.

DESIGN: Retrospective analysis of publicly available nationally representative survey data.

SETTING: This retrospective study used data from the Health and Retirement Study, a nationally representative, longitudinal study of community-dwelling older people.

PARTICIPANTS: Older people who died between 2000 and 2002.

MEASUREMENTS: Data were extracted from the 2002 "exit survey" and linked with characteristics of caregivers from the helper file. Ordinary least squares regression was used to estimate hours of informal caregiving for community-dwelling older people (N=990). Adjusted hours were multiplied by the 2002 national average home aide wage (9.16 USD per hour). Sensitivity tests were performed using the 10th percentile wage rate (6.56 USD) and 90th percentile wage rate (12.34 USD).

RESULTS: Older people who died in the community received on average 65.8 hours per week of informal care in the last year of life. The estimated economic value ranges from 22,514 USD to 42,351 USD, which is equivalent to the annual direct replacement cost with a home aide in 2002.

CONCLUSION: Family members provide substantial assistance during the last year of life for older people who die in the community. If the informal care provided in the last year of life is replaced with a home aide, the total economic value for the United States would be approximately 1.4 billion USD (in 2002).

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Caregivers, Costs and Cost Analysis, Disability Evaluation, Female, Health Surveys, Home Health Aides, Home Nursing, Humans, Independent Living, Male, Middle Aged, Retrospective Studies, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02390.x}, author = {Rhee, YongJoo and Howard B Degenholtz and Anthony T. Lo Sasso and Linda L Emanuel} } @article {7373, title = {Ethnic differences in cognitive function over time.}, journal = {Ann Epidemiol}, volume = {19}, year = {2009}, month = {2009 Nov}, pages = {778-83}, publisher = {19}, abstract = {

PURPOSE: Minority group membership in old age has been implicated as a risk factor for lower scores on cognitive function tests, independent of education level. In addition, differential rates of cognitive decline by ethnic group have been identified in several epidemiologic studies. However, others have not been able to detect differences.

METHODS: In order to determine if health disparities in cognitive function scores extend to rates of decline, the current research examined rates of change in memory and mental status over the course of 9 years (1996-2004) in a nationally representative sample of late middle-aged and older white, black, and Hispanic adults who were part of the nationally representative Health and Retirement Study. Change in cognitive function was measured by separate indices of memory and mental status items and analyzed with multivariable mixed modeling.

RESULTS: Results indicated that, after controlling for demographic, social, and health-related variables, ethnicity was associated with cognitive function scores across waves (P<0.01), but did not greatly impact rates of decline. Furthermore, although education was associated with cognitive function scores across waves (P<0.01), education level did not impact decline rates.

CONCLUSIONS: Some health disparities in cognitive function exist even in late middle age, but ethnic differences in rates of decline are mixed.

}, keywords = {Black or African American, Brief Psychiatric Rating Scale, Cognition Disorders, Educational Status, Female, Hispanic or Latino, Humans, Logistic Models, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Odds Ratio, White People}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2009.06.008}, author = {Meredith C. Masel and M. Kristen Peek} } @article {7328, title = {Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work.}, journal = {Soc Work Health Care}, volume = {48}, year = {2009}, month = {2009}, pages = {154-68}, publisher = {48}, abstract = {

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

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

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

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Disabled Persons, Educational Status, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Musculoskeletal Physiological Phenomena, Risk, Risk Factors, Self-Assessment, Self-Help Devices, Surveys and Questionnaires, Vision, Low, Visual Acuity, White People}, issn = {0898-2643}, doi = {10.1177/0898264309338295}, author = {Bernard A Steinman and Pynoos, Jon and Anna Q D Nguyen} } @article {7389, title = {Financial hardship and mortality among older adults using the 1996-2004 Health and Retirement Study.}, journal = {Ann Epidemiol}, volume = {19}, year = {2009}, month = {2009 Dec}, pages = {850-7}, publisher = {19}, abstract = {

PURPOSE: We investigated the effect of financial hardship on mortality risk in a community-dwelling sample of adults 50 years of age and olderin the United States.

METHOD: The 1996 Health and Retirement Study cohorts were followed prospectively to 2004 (N = 8,377). Gender-stratified grouped Cox models were used to estimate the difference in the relative risk (RR) of mortality between a specific number of financial hardships (one, two, or three or more) and no hardships; and the predictive utility of each individual financial hardship for mortality during the follow-up period.

RESULTS: Gender-stratified models adjusted for demographics, socioeconomic characteristics, and functional limitations in 1996 showed that women reporting one (hazard ratio [HR] = 1.42; 95\% confidence interval [CI]: 1.05-1.92) or three or more (HR = 1.60; 95\% CI: 1.05-2.46) and men reporting two (HR = 1.80; 95\% CI: 1.21-2.69) financial hardships had a substantially higher probability of mortality compared to those reporting no financial hardships. Individual financial hardships that predicted mortality in fully adjusted models for women included receiving Medicaid (HR = 2.23; 95\% CI: 1.68-2.98) and for men receiving Medicaid (HR = 2.11; 95\% CI: 1.57-2.84) and receiving food stamps (HR = 1.59; 95\% CI: 1.09-2.33).

CONCLUSIONS: These findings suggest that over and above the influence of traditional measures of socioeconomic status, financial hardship exerts an influence on the risk of mortality among older adults and that the number and type of hardships important in predicting mortality may differ for men and women.

}, keywords = {Aged, Female, Geriatric Assessment, Health Surveys, Humans, Male, Medicaid, Middle Aged, Mortality, Poverty, Proportional Hazards Models, Prospective Studies, Retirement, Risk, Sex Factors, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2009.08.003}, author = {Reginald D. Tucker-Seeley and Li, Yi and Subramanian, S V and Sorensen, Glorian} } @article {7380, title = {Financial status, employment, and insurance among older cancer survivors.}, journal = {J Gen Intern Med}, volume = {24 Suppl 2}, year = {2009}, month = {2009 Nov}, pages = {S438-45}, publisher = {24}, abstract = {

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0\% vs. 17.7\%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4\% vs. 45.9\%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2\% vs. 29.7\%) and more likely to be retired (66.9\% vs. 62.2\%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5\% vs. 46.9\%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Data collection, Employment, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Middle Aged, Neoplasms, Socioeconomic factors, Survivors}, issn = {1525-1497}, doi = {10.1007/s11606-009-1034-5}, author = {Norredam, Marie and Meara, Ellen and Landrum, Mary Beth and Haiden A. Huskamp and Nancy L. Keating} } @article {7325, title = {Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Jun}, pages = {955-62}, publisher = {57}, abstract = {

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95\% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95\% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95\% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

}, keywords = {Activities of Daily Living, Aged, Alcohol Drinking, Comorbidity, Education, Female, Humans, Income, Male, Obesity, Risk Factors, Sex Factors, Smoking, Socioeconomic factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02184.x}, author = {Sei J. Lee and Rebecca L. Sudore and Brie A Williams and Lindquist, Karla and Helen L. Chen and Kenneth E Covinsky} } @article {7393, title = {Health and well-being in older married female cancer survivors.}, journal = {J Am Geriatr Soc}, volume = {57 Suppl 2}, year = {2009}, month = {2009 Nov}, pages = {S286-8}, publisher = {57}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Bereavement, Educational Status, Female, Follow-Up Studies, Health Status, Health Surveys, Humans, Lung Diseases, Obstructive, Male, Marriage, Middle Aged, Outcome Assessment, Health Care, Proportional Hazards Models, Smoking, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-9-412}, author = {Noda, Tatsuya and Ojima, Toshiyuki and Hayasaka, Shinya and Hagihara, Okihito and Takayanagi, Ryoichi and Nobutomo, Koichi} } @article {7293, title = {The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, note = {PMID 19196689}, month = {2009 Jan}, pages = {118-24}, publisher = {64}, abstract = {

BACKGROUND: The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals.

METHODS: We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working.

RESULTS: Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout.

CONCLUSIONS: Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

}, keywords = {Aged, Attitude to Health, Cohort Studies, Cross-Sectional Studies, Educational Status, Female, Health Status Indicators, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Mortality, Occupations, Odds Ratio, Retirement, Social Class, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbn006}, author = {Ralitza Gueorguieva and Jody L Sindelar and Tracy Falba and Jason M. Fletcher and Patricia S Keenan and Wu, Ran and William T Gallo} } @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 {7421, title = {Individual well-being in middle and older adulthood: do spousal beliefs matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Sep}, pages = {586-96}, publisher = {64B}, abstract = {

Associations between health, control beliefs, and well-being in later life are frequently conceptualized in terms of the characteristics of individuals. However, spousal interdependencies in psychosocial characteristics are also likely to be relevant for well-being. The present study investigated associations of self-rated health, control, and relationship closeness with life satisfaction and positive and negative affect in a sample of 2,235 spousal dyads. A significant proportion of variance in health, control, closeness, and well-being occurred between dyads. Individuals{\textquoteright} self-rated health, control, and relationship closeness were associated with higher well-being. Spouses{\textquoteright} self-rated health and control beliefs were consistently and positively associated with individuals{\textquoteright} well-being; however, effect sizes were small. Some evidence for individual{\textquoteright}s control beliefs buffering the association between health and well-being emerged, whereas spouses{\textquoteright} perceived control was not a significant moderator of the health-well-being association. Results highlight the importance of couple interdependencies for contextualizing health and well-being in older adulthood.

}, keywords = {Adult, Affect, Aged, Aged, 80 and over, Aging, Attitude to Health, Culture, Female, Humans, Individuality, Internal-External Control, Male, Marriage, Middle Aged, Quality of Life, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbp058}, author = {Tim D Windsor and Lindsay H Ryan and Jacqui Smith} } @article {7367, title = {The influence of long-term care insurance on the likelihood of nursing home admission.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Oct}, pages = {1862-7}, publisher = {57}, abstract = {

OBJECTIVES: To determine the effect of long-term care (LTC) insurance on nursing home use.

DESIGN: Longitudinal analysis, 1998 to 2006 waves of the Health Retirement Study.

SETTING: Community-dwelling nationally representative sample.

PARTICIPANTS: Nineteen thousand one hundred seventy adults aged 50 and older, 1998 wave.

METHODS: Two groups of respondents were created at baseline: those with and without an LTC insurance policy. Respondents admitted to the nursing home from 1998 to 2006 were identified. Propensity scores were used to control for known predictors of LTC insurance possession. A Cox proportional hazards model was used to compare the probability of nursing home admission over 8 years of follow-up for respondents possessing LTC insurance and those without a policy.

RESULTS: Of the 19,170 respondents aged 50 and older in 1998, 1,767 (9.2\%) possessed LTC insurance. A total of 1,778 (8.5\%) were admitted to a nursing home during the 8-year period: 149 (8.7\%) of those with LTC insurance and 1,629 (8.4\%) of those without LTC insurance. The hazard ratio, adjusted for propensity score, for those with LTC insurance entering a nursing home compared with those without was 1.07 (95\% confidence interval=0.83-1.38). Likelihood of nursing home admission was relatively low because the low-risk population included in the study, limiting the power to detect small differences in risk of nursing home utilization between groups.

CONCLUSION: There was no difference in nursing home utilization between low-risk older adults who did and did not possess an LTC insurance policy.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Insurance, Long-Term Care, Longitudinal Studies, Male, Middle Aged, Nursing homes}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02433.x}, author = {Tanya R Gure and Mohammed U Kabeto and Kenneth M. Langa} } @article {7392, title = {The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Dec}, pages = {2293-9}, publisher = {57}, abstract = {

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke.

DESIGN: Longitudinal cohort.

SETTING: U.S. national sample, community based.

PARTICIPANTS: U.S. adults aged 50 and older and their spouses.

MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married).

RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95\% confidence interval (CI)=1.11-1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95\% CI=1.12-1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women.

CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

}, keywords = {Aged, Cardiovascular Diseases, Female, Health Surveys, Humans, Incidence, Longitudinal Studies, Male, Marital Status, Middle Aged, Risk Factors, Sexuality, Stroke}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02555.x}, author = {J Maselko and Lisa M. Bates and Mauricio Avendano and M. Maria Glymour} } @article {7329, title = {Level and change in cognitive test scores predict risk of first stroke.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Mar}, pages = {499-505}, publisher = {57}, abstract = {

OBJECTIVES: To determine whether cognitive test scores and cognitive decline predict incidence of first diagnosed stroke.

DESIGN: Stroke-free Health and Retirement Study participants were followed on average 7.6 years for self- or proxy-reported first stroke (1,483 events). Predictors included baseline performance on a modified Telephone Interview for Cognitive Status (Mental Status) and Word Recall test and decline between baseline and second assessment in either measure. Hazard ratios (HRs) were estimated using Cox proportional hazards models for the whole sample and stratified according to five major cardiovascular risk factors.

SETTING: National cohort study of noninstitutionalized adults with a mean baseline age of 64+/-9.9.

PARTICIPANTS: Health and Retirement Study participants (n=19,699) aged 50 and older.

RESULTS: Word Recall (HR for 1 standard deviation difference=0.92, 95\% confidence interval (CI)=0.86-0.97)) and Mental Status (HR=0.89, 95\% CI=0.84-0.95) predicted incident stroke. Mental Status predicted stroke risk in those with (HR=0.93, 95\%=0.87-0.99) and without (HR=0.81, 95\% CI=0.72-.91) one or more vascular risk factors. Word Recall declines predicted a 16\% elevation in subsequent stroke risk (95\% CI=1.01-1.34). Declines in Mental Status predicted a 37\% elevation in stroke risk (95\% CI=1.11-1.70).

CONCLUSION: Cognitive test scores predict future stroke risk, independent of other major vascular risk factors.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, Vascular, Female, Follow-Up Studies, Humans, Interviews as Topic, Kaplan-Meier Estimate, Male, Mental Status Schedule, Middle Aged, Predictive Value of Tests, Psychometrics, Risk, Stroke, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2008.02132.x}, author = {Triveni DeFries and Mauricio Avendano and M. Maria Glymour} } @article {7381, title = {Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample.}, journal = {Am J Obstet Gynecol}, volume = {201}, year = {2009}, month = {2009 Nov}, pages = {490.e1-7}, publisher = {201}, abstract = {

OBJECTIVE: To determine whether: (1) major depression is associated with increased risk for onset of urinary incontinence, and (2) urinary incontinence is associated with increased risk for onset of depression.

STUDY DESIGN: Longitudinal cohort study of female Health and Retirement Study participants completing baseline interviews at Wave 3 (1996-1997) and follow-up interviews at Waves 4-6 (1998-2003).

RESULTS: In a cohort of 5820 women with a mean age 59.3 (+/- 0.5) years, 6-year cumulative incidences of depression and incontinence were 11\% and 21\%, respectively. Major depression was associated with increased odds of incident incontinence (adjusted odds ratio, 1.46; 95\% confidence interval, 1.08-1.97) during follow-up compared with those without major depression at baseline. Conversely, incontinence was not associated with increased odds of incident depression (adjusted odds ratio, 1.03; 95\% confidence interval, 0.75-1.42) compared with those without incontinence at baseline.

CONCLUSION: Major depression predicted onset of urinary incontinence in a population-based sample of at-risk, community-dwelling women. Incontinence did not predict onset of depression.

}, keywords = {Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Middle Aged, Risk Factors, Time Factors, Urinary incontinence}, issn = {1097-6868}, doi = {10.1016/j.ajog.2009.05.047}, author = {Jennifer L Melville and Fan, Ming-Yu and Rau, Holly and Ingrid E Nygaard and Wayne J Katon} } @article {7353, title = {Marital biography and health at mid-life.}, journal = {J Health Soc Behav}, volume = {50}, year = {2009}, month = {2009 Sep}, pages = {344-58}, publisher = {50}, abstract = {

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

}, keywords = {Female, Health Status, Humans, Interviews as Topic, Longitudinal Studies, Male, Marital Status, Middle Aged, United States}, issn = {0022-1465}, doi = {10.1177/002214650905000307}, author = {Mary Elizabeth Hughes and Linda J. Waite} } @article {7356, title = {Marital trajectories and mortality among US adults.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Sep 01}, pages = {546-55}, publisher = {170}, abstract = {

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

}, keywords = {Age Factors, Cohort Studies, Female, Health Behavior, Humans, Male, Marital Status, Middle Aged, Mortality, Retirement, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp194}, author = {Matthew E Dupre and Audrey N Beck and Sarah O. Meadows} } @article {7414, title = {Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age.}, journal = {Am J Public Health}, volume = {99 Suppl 3}, year = {2009}, month = {2009 Nov}, pages = {S693-701}, publisher = {99}, abstract = {

OBJECTIVES: We examined associations between material resources and late-life declines in health.

METHODS: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441).

RESULTS: Disadvantages in health care (odds ratio [OR] = 1.39; 95\% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95\% CI = 1.29, 2.22), and housing (OR = 1.20; 95\% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95\% CI = 1.29, 1.58) and food (OR = 1.64; 95\% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

CONCLUSIONS: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.

}, keywords = {Aged, Female, Food Supply, Health Status Disparities, Health Surveys, Healthcare Disparities, Housing, Humans, Logistic Models, Male, Middle Aged, Poverty, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.161877}, author = {Dawn E Alley and Beth J Soldo and Jos{\'e} A Pag{\'a}n and John McCabe and deBlois, Madeleine and Samuel H Field and David A Asch and Carolyn Cannuscio} } @article {7361, title = {Measuring socioeconomic differences in use of health care services by wealth versus by income.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Oct}, pages = {1849-55}, publisher = {99}, abstract = {

OBJECTIVES: We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

METHODS: We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

RESULTS: We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

CONCLUSIONS: We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

}, keywords = {Aged, Aged, 80 and over, Aging, Data collection, Europe, Female, Health Services, Health Services Accessibility, Health Status Disparities, Humans, Income, Male, Middle Aged, Odds Ratio, Pensions, Retirement, Socioeconomic factors, Statistics as Topic, United Kingdom}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.141499}, author = {Allin, Sara and Masseria, Cristina and Elias Mossialos} } @article {7400, title = {Medicare savings programs: analyzing options for expanding eligibility.}, journal = {Inquiry}, volume = {46}, year = {2009}, note = {Journal Article}, month = {2009-2010 Winter}, pages = {391-404}, publisher = {46}, abstract = {

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

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

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

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Aging, Cognition, depression, Female, Health Status, Humans, Interpersonal Relations, Longitudinal Studies, Male, Marriage, Mental Recall, Models, Psychological, Quality of Life, Spouses}, issn = {1939-0599}, doi = {10.1037/a0016346}, author = {Denis Gerstorf and Christiane A Hoppmann and Kelly M Kadlec and John J McArdle} } @article {7377, title = {Mortality attributable to obesity among middle-aged adults in the United States.}, journal = {Demography}, volume = {46}, year = {2009}, month = {2009 Nov}, pages = {851-72}, publisher = {46}, abstract = {

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40\% in females and 62\% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4\% of deaths among females and 3\% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36\% in females and 50\% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.

}, keywords = {Body Mass Index, Confidence Intervals, Confounding Factors, Epidemiologic, Female, Humans, Male, Middle Aged, Multivariate Analysis, Obesity, Proportional Hazards Models, Risk, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.0.0077}, author = {Neil K Mehta and Virginia W Chang} } @article {7348, title = {Neighborhood safety, socioeconomic status, and physical activity in older adults.}, journal = {Am J Prev Med}, volume = {37}, year = {2009}, month = {2009 Sep}, pages = {207-13}, publisher = {37}, abstract = {

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Florida, Health Status, Humans, Leisure activities, Male, Middle Aged, Motor Activity, Recreation, Residence Characteristics, Safety, Sex Distribution, Social Support, Socioeconomic factors, Surveys and Questionnaires}, issn = {1873-2607}, doi = {10.1016/j.amepre.2009.06.005}, author = {Reginald D. Tucker-Seeley and Subramanian, S V and Li, Yi and Sorensen, Glorian} } @article {7372, title = {A new measure of medication affordability.}, journal = {Soc Work Public Health}, volume = {24}, year = {2009}, month = {2009 Nov-Dec}, pages = {600-12}, publisher = {24}, abstract = {

This study developed a new measure of medication affordability that examines out-of-pocket drug expenses relative to available household resources. The authors assessed the spending patterns of approximately 2.1 million poor households (< or =100\% federal poverty level) of adults aged 51 and older by Medicaid status. The data were drawn from the 2000-2001 Health and Retirement Study. Household spending was categorized into three broad types: basic living, health care, and discretionary. Older (aged 51 or older) poor households without Medicaid allocated about 72\% of their total resources ($17,421, SE $783) to basic living needs. In comparison, those with Medicaid had scarcer total resources ($12,498, SE $423) and allocated 85\% to basic living needs. Medication costs consumed the largest proportion of health care expenses for both types of poor households (Medicaid: $463, SE $67; non-Medicaid: $970, SE $102). After paying for basic living needs and health care costs, these families had, on average, only $16 left each week. Poor families have very few resources available for anything beyond basic living needs, even when they have Medicaid coverage. There is no great reservoir of discretionary funds to pay for increases in cost-sharing under Medicaid and Medicare Part D.

}, keywords = {Aged, Data collection, Female, Financing, Personal, Humans, Male, Medicaid, Middle Aged, Poverty, Prescription Fees, United States}, issn = {1937-1918}, doi = {10.1080/19371910802672346}, author = {Becky A. Briesacher and Ross-Degnan, Dennis and Adams, Alyce and Anita K Wagner and Jerry Gurwitz and Soumerai, Stephan} } @article {7358, title = {Pain, functional limitations, and aging.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Sep}, pages = {1556-61}, publisher = {57}, abstract = {

OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.

DESIGN: Cross-sectional study.

SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.

PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS.

MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).

RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37\% were able to jog 1 mile, 91\% were able to walk several blocks, and 96\% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9\% were able to jog 1 mile, 50\% were able to walk several blocks, and 69\% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4\% were able to jog 1 mile, 55\% were able to walk several blocks, and 72\% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95\% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95\% CI=2.48-3.26, for stair climbing; AOR=3.96, 95\% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95\% CI=3.71-5.06, for ADL function).

CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Female, Geriatric Assessment, Health Behavior, Health Surveys, Humans, Life Style, Male, Middle Aged, Mobility Limitation, pain, Pain Measurement, Quality of Life, Risk Factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02388.x}, author = {Kenneth E Covinsky and Lindquist, Karla and Dorothy D Dunlop and Yelin, Edward} } @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 {7336, title = {Preferences, beliefs, and self-management of diabetes.}, journal = {Health Serv Res}, volume = {44}, year = {2009}, note = {PMID: 19674433}, month = {2009 Jun}, pages = {1068-87}, publisher = {44}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Black People, Cohort Studies, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status, Hispanic or Latino, Humans, Male, Neuropsychological tests, Personality Assessment, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1041-6102}, doi = {10.1017/S1041610209990044}, author = {David C Steffens and Gwenith G Fisher and Kenneth M. Langa and Guy G Potter and Brenda L Plassman} } @article {7345, title = {Proximity to death and participation in the long-term care market.}, journal = {Health Econ}, volume = {18}, year = {2009}, note = {PMID: 18770873}, month = {2009 Aug}, pages = {867-83}, publisher = {18}, abstract = {

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0\% and of formal home care use by 12.4\%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Female, Health Services Needs and Demand, Home Care Services, Humans, Interviews as Topic, Longevity, Male, Models, Statistical, Nursing homes, Terminal Care, United States}, issn = {1099-1050}, doi = {10.1002/hec.1409}, author = {Weaver, France and Sally C. Stearns and Edward C Norton and Spector, William} } @article {7405, title = {Recent hospitalization and the risk of hip fracture among older Americans.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {64}, year = {2009}, month = {2009 Feb}, pages = {249-55}, publisher = {64}, abstract = {

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9\%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

}, keywords = {Accidental Falls, Age Distribution, Aged, Aged, 80 and over, Aging, Cohort Studies, Female, Follow-Up Studies, Geriatric Assessment, Hip Fractures, Hospitalization, Humans, Logistic Models, Male, Multivariate Analysis, Probability, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Distribution, Survival Analysis, United States}, issn = {1758-535X}, doi = {10.1093/gerona/gln027}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Michael P Jones and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @article {7302, title = {Reconstructing childhood health histories.}, journal = {Demography}, volume = {46}, year = {2009}, month = {2009 May}, pages = {387-403}, publisher = {46}, abstract = {

This article provides evidence about the quality of retrospective childhood health histories given to respondents in the Health and Retirement Survey (HRS) and the Panel Study of Income Dynamics (PSID). Even though information on early life health events is critical, there is legitimate skepticism about the ability of older respondents to remember specific health problems that they had during childhood. The evidence presented in this article suggests that this view is too negative. Respondents appear to remember salient childhood events about themselves, such as the illnesses they had during childhood, quite well. Moreover, these physical and psychological childhood health events are important correlates of adult health during middle age.

}, keywords = {Humans, Income, Mental Health, Retirement, Retrospective Studies}, issn = {1533-7790}, doi = {10.1353/dem.0.0058}, author = {James P Smith} } @article {7334, title = {Retirement and physical activity: analyses by occupation and wealth.}, journal = {Am J Prev Med}, volume = {36}, year = {2009}, month = {2009 May}, pages = {422-8}, publisher = {36}, abstract = {

BACKGROUND: Older adults close to retirement age show the lowest level of physical activity. Changes in lifestyle with retirement may alter physical activity levels. This study investigated whether retirement changes physical activity and how the effect differs by occupation type and wealth level.

METHODS: This longitudinal study used the Health and Retirement Study (1996-2002), U.S. population-based data. Analyses were conducted in 2007 and 2008. Physical activity was measured by a composite indicator of participation in either work-related or leisure-time physical activity. Fixed-effects regression models were used to account for confounders and unobserved heterogeneity. The dependent variable was a composite indicator of participation in regular physical activity either at work or during nonworking hours.

RESULTS: Physical activity decreased with retirement from a physically demanding job but increased with retirement from a sedentary job. Occupation type interacted with wealth level, with the negative impact on physical activity of retirement exacerbated by lack of wealth and the positive effect of retirement on physical activity enhanced by wealth.

CONCLUSIONS: Substantial differences in the effect of retirement on physical activity occurred across subgroups. As the number of people approaching retirement age rapidly increases, findings suggest that a growing segment of the nation{\textquoteright}s population may not sustain an adequate level of physical activity.

}, keywords = {Cohort Studies, Female, Humans, Income, Life Style, Longitudinal Studies, Male, Middle Aged, Motor Activity, Occupations, Retirement, United States}, issn = {1873-2607}, doi = {10.1016/j.amepre.2009.01.026}, author = {Chung, Sukyung and Marisa E Domino and Sally C. Stearns and Barry M Popkin} } @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 {7388, title = {Risk perception and preference for prevention of Alzheimer{\textquoteright}s disease.}, journal = {Value Health}, volume = {12}, year = {2009}, month = {2009 Jun}, pages = {450-8}, publisher = {12}, abstract = {

OBJECTIVES: To understand how older adults perceive their risk of Alzheimer{\textquoteright}s Disease (AD) and how this may shape their medical care decisions, we examined whether presence of established risk factors of AD is associated with individuals{\textquoteright} perceived risk of AD, and with preference for preventing AD.

PARTICIPANTS: Data came from the US Health and Retirement Study participants who were asked questions on AD risk perception (N = 778).

MEASUREMENTS: Perceived risk of AD was measured by respondents{\textquoteright} estimate of their percent chance (0-100) developing AD in the next 10 years. Preference for AD prevention was measured with questions eliciting willingness to pay for a drug to prevent AD.

ANALYSIS: Multivariate linear regressions were used to estimate correlates of perceived risk and preference for prevention.

RESULTS: Better cognitive functioning and physical activity are associated with decreased perceived risk. Neither age nor cardiovascular disease is associated with perceived risk. African Americans have lower perceived risk than non-Latino whites; the difference is wider among people age 65 and above. Only 4\% to 7\% of the variation in perceived risk was explained by the model. Preference for prevention is stronger with increased perceived risk, but not with the presence of risk factors. Persons with better cognitive functioning, physical functioning, or wealth status have a stronger preference for prevention.

CONCLUSION: Some known risk factors appear to inform, but only modestly, individuals{\textquoteright} perceived risk of AD. Furthermore, decisions about AD prevention may not be determined by objective needs alone, suggesting a potential discrepancy between need and demand for AD preventive care.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alzheimer disease, Cognition, Female, Health education, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Linear Models, Male, Multivariate Analysis, Psychometrics, Risk Assessment, Risk Factors, Social Perception, Statistics as Topic, United States}, issn = {1524-4733}, doi = {10.1111/j.1524-4733.2008.00482.x}, author = {Chung, Sukyung and Kala M. Mehta and Shumway, Martha and Alvidrez, Jennifer and Eliseo J Perez-Stable} } @article {7296, title = {Smoking and weight change after new health diagnoses in older adults.}, journal = {Arch Intern Med}, volume = {169}, year = {2009}, month = {2009 Feb 09}, pages = {237-42}, publisher = {169}, abstract = {

BACKGROUND: Smoking and patterns of diet and activity are the 2 leading underlying causes of death in the United States, yet the factors that prompt individuals to adopt healthier habits are not well understood.

METHODS: This study was undertaken to determine whether individuals who have experienced recent adverse health events are more likely to quit smoking or to lose weight than those without recent events using Health and Retirement Study panel survey data for 20 221 overweight or obese individuals younger than 75 years and 7764 smokers from 1992 to 2000.

RESULTS: In multivariate analyses, adults with recent diagnoses of stroke, cancer, lung disease, heart disease, or diabetes mellitus were 3.2 times more likely to quit smoking than were individuals without new diagnoses (P < .001). Among overweight or obese individuals younger than 75 years, those with recent diagnoses of lung disease, heart disease, or diabetes mellitus lost -0.35 U of body mass index (calculated as weight in kilograms divided by height in meters squared) compared with those without these new diagnoses (P < .001). Smokers with multiple new diagnoses were 6 times more likely to quit smoking compared with those with no new diagnoses. The odds of quitting smoking were 5 times greater in individuals with a new diagnosis of heart disease, and body mass index declined by 0.6 U in overweight or obese individuals with a new diagnosis of diabetes mellitus (P < .001).

CONCLUSIONS: Across a range of health conditions, new diagnoses can serve as a window of opportunity that prompts older adults to change health habits, in particular, to quit smoking. Quality improvement efforts targeting secondary as well as primary prevention through the health care system are likely well founded.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Body Mass Index, Diabetes Mellitus, Type 2, Health Behavior, Health Surveys, Heart Diseases, Humans, Longitudinal Studies, Lung Diseases, Middle Aged, Multivariate Analysis, Neoplasms, Overweight, Racial Groups, Smoking, Smoking cessation, Stroke, United States, Weight Loss}, issn = {1538-3679}, doi = {10.1001/archinternmed.2008.557}, author = {Patricia S Keenan} } @article {7395, title = {Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey.}, journal = {Obesity (Silver Spring)}, volume = {17}, year = {2009}, month = {2009 Apr}, pages = {783-9}, publisher = {17}, abstract = {

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95\% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Mass Index, Disability Evaluation, Educational Status, Female, Health Surveys, Humans, Life Expectancy, Life Tables, Male, Middle Aged, Obesity, Proportional Hazards Models, Prospective Studies, Smoking, United States, White People}, issn = {1930-7381}, doi = {10.1038/oby.2008.640}, author = {Mieke Reuser and Luc G Bonneux and Frans J Willekens} } @article {7420, title = {Socioeconomic differentials in immune response.}, journal = {Epidemiology}, volume = {20}, year = {2009}, month = {2009 Nov}, pages = {902-8}, publisher = {20}, abstract = {

BACKGROUND: Lower socioeconomic status (SES) is strongly linked to health outcomes, though the mechanisms are poorly understood. Little is known about the role of the immune system in creating and sustaining health disparities. Here we test whether SES is related to cell-mediated immunity, as measured by the host{\textquoteright}s ability to keep persistent cytomegalovirus (CMV) antibody levels in a quiescent state.

METHODS: Censored regression models were used to test the cross-sectional relationship of education, income, and race/ethnicity with antibody response to CMV, using a nationally representative sample of 9721 respondents aged 25 years and older in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).

RESULTS: Among CMV-seropositive respondents, those with less education, lower income, and nonwhite race/ethnicity had higher levels of CMV antibodies at all ages. On average, each additional year of age was associated with CMV antibody levels that were 0.03 units higher (95\% confidence interval = 0.03 to 0.04), whereas each additional year of education was associated with antibody levels that were 0.05 units lower (0.02 to 0.09). A doubling of family income was associated with antibody levels that were 0.25 units lower (0.11 to 0.39), the equivalent of 8 fewer years of age-related CMV antibody response. These relationships remained strong after controlling for baseline health conditions, smoking status, and BMI.

CONCLUSIONS: SES is associated with an indirect marker of cell-mediated immunity in a nationally representative sample. SES differences in immune control over CMV may have fundamental implications for health disparities over the life course.

}, keywords = {Adult, Aged, Cytomegalovirus, Cytomegalovirus Infections, Female, Health Status Disparities, Humans, Male, Middle Aged, Nutrition Surveys, Regression Analysis, Social Class, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0b013e3181bb5302}, author = {Jennifer B Dowd and Allison E Aiello} } @article {7297, title = {Spouse-rated vs self-rated health as predictors of mortality.}, journal = {Arch Intern Med}, volume = {169}, year = {2009}, month = {2009 Dec 14}, pages = {2156-61}, publisher = {169}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Aging, Bias, Data collection, Data Interpretation, Statistical, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Mass Screening, Middle Aged, Research Design, Sampling Studies, Sexual Behavior, Social Behavior, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbp045}, author = {O{\textquoteright}Muircheartaigh, Colm and Eckman, Stephanie and Smith, Stephen} } @article {7318, title = {Surrogate consent for dementia research: a national survey of older Americans.}, journal = {Neurology}, volume = {72}, year = {2009}, note = {PMID 19139366}, month = {2009 Jan 13}, pages = {149-55}, publisher = {72}, abstract = {

BACKGROUND: Research in novel therapies for Alzheimer disease (AD) relies on persons with AD as research subjects. Because AD impairs decisional capacity, informed consent often must come from surrogates, usually close family members. But policies for surrogate consent for research remain unsettled after decades of debate.

METHODS: We designed a survey module for a random subsample (n = 1,515) of the 2006 wave of the Health and Retirement Study, a biennial survey of a nationally representative sample of Americans aged 51 and older. The participants answered questions regarding one of four randomly assigned surrogate-based research (SBR) scenarios: lumbar puncture study, drug randomized control study, vaccine study, and gene transfer study. Each participant answered three questions: whether our society should allow family surrogate consent, whether one would want to participate in the research, and whether one would allow one{\textquoteright}s surrogate some or complete leeway to override stated personal preferences.

RESULTS: Most respondents stated that our society should allow family surrogate consent for SBR (67.5\% to 82.5\%, depending on the scenario) and would themselves want to participate in SBR (57.4\% to 79.7\%). Most would also grant some or complete leeway to their surrogates (54.8\% to 66.8\%), but this was true mainly of those willing to participate. There was a trend toward lower willingness to participate in SBR among those from ethnic or racial minority groups.

CONCLUSIONS: Family surrogate consent-based dementia research is broadly supported by older Americans. Willingness to allow leeway to future surrogates needs to be studied further for its ethical significance for surrogate-based research policy.

}, keywords = {Advance directives, Age Factors, Aged, Aged, 80 and over, Alzheimer disease, Biomedical Research, Caregivers, Clinical Trials as Topic, Data collection, ethnicity, Female, Humans, Informed Consent, Legal Guardians, Male, Mental Competency, Middle Aged, Patient Participation, Proxy, Research Subjects, Surveys and Questionnaires, Therapeutic Human Experimentation, Third-Party Consent}, issn = {1526-632X}, doi = {10.1212/01.wnl.0000339039.18931.a2}, author = {Scott Y H Kim and H.M. Kim and Kenneth M. Langa and Jason H. Karlawish and David S Knopman and Appelbaum, P S} } @article {7320, title = {Telephone interview for cognitive status: Creating a crosswalk with the Mini-Mental State Examination.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Nov}, pages = {492-7}, publisher = {5}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cognition Disorders, Disability Evaluation, Female, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Male, Mass Screening, Models, Statistical, Neuropsychological tests, Predictive Value of Tests, Psychiatric Status Rating Scales, Remote Consultation, Reproducibility of Results, Sensitivity and Specificity}, issn = {1552-5279}, doi = {10.1016/j.jalz.2009.02.007}, author = {Tamara G Fong and Michael A Fearing and Richard N Jones and Peilin Shi and Edward R Marcantonio and James L Rudolph and Frances Margaret Yang and Dan K Kiely and Sharon K Inouye} } @article {7347, title = {Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Aug 01}, pages = {331-42}, publisher = {170}, abstract = {

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7{\textquoteright}s, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0-35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95\% confidence interval: 3.8, 4.4) and in recall score (range, 0-20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95\% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Cognition, Confidence Intervals, Education, Female, Geriatric Assessment, Hispanic or Latino, Humans, Income, Male, Marital Status, Mexican Americans, Poverty, Sampling Studies, Socioeconomic factors, Surveys and Questionnaires, United States, White People}, issn = {1476-6256}, doi = {10.1093/aje/kwp154}, author = {Arun S Karlamangla and Miller-Martinez, Dana and Carol S Aneshensel and Teresa Seeman and Richard G Wight and Joshua Chodosh} } @article {7331, title = {Urban neighborhood context and change in depressive symptoms in late life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Mar}, pages = {247-51}, publisher = {64B}, abstract = {

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms.

METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models.

RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics.

CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

}, keywords = {Aged, Aged, 80 and over, Aging, Cultural Diversity, depression, Disability Evaluation, Educational Status, Female, Humans, Longitudinal Studies, Los Angeles, Male, Personality Inventory, Poverty, Psychosocial Deprivation, Residence Characteristics, Risk Factors, Urban Population}, issn = {1758-5368}, doi = {10.1093/geronb/gbn016}, author = {Richard G Wight and Janet R. Cummings and Arun S Karlamangla and Carol S Aneshensel} } @article {7350, title = {Volunteer dynamics of older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Sep}, pages = {644-55}, publisher = {64B}, abstract = {

OBJECTIVES: The impending retirement of boomers has spurred interest in tapping their productive energies to benefit society. This study examined volunteer transitions among older adults to understand the factors that affect volunteer dynamics.

METHODS: Using data from the Health and Retirement Study, the analysis examined entries into and exits from formal volunteer activities between 1996 and 2004 by adults aged 55-65 at study baseline. The study showed the duration of volunteer activities, the probability that older adults start and stop volunteering, and the factors that significantly predict volunteer transitions.

RESULTS: The findings reveal considerable stability among both volunteers and nonvolunteers; however, older adults are more likely to stop volunteering than to start. Volunteers who contribute intensely and for many years and who are married to volunteers are the least likely to quit. And nonvolunteers are more likely to start volunteering if they have been uninvolved for few years and their spouses volunteer.

CONCLUSIONS: The results point to the need to focus efforts on retaining older volunteers to maximize volunteer engagement during later years. Recruiting older adults in volunteer activities early on, ideally before they retire, could also help meet volunteer needs.

}, keywords = {Aged, Aging, Cross-Sectional Studies, Female, Humans, Life Change Events, Male, Middle Aged, Probability, Retirement, United States, Volunteers}, issn = {1758-5368}, doi = {10.1093/geronb/gbn042}, author = {Barbara A Butrica and Richard W. Johnson and Sheila R Zedlewski} } @article {7374, title = {Weight change, initial BMI, and mortality among middle- and older-aged adults.}, journal = {Epidemiology}, volume = {20}, year = {2009}, month = {2009 Nov}, pages = {840-8}, publisher = {20}, abstract = {

BACKGROUND: It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change.

METHODS: We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units.

RESULTS: Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95\% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders.

CONCLUSIONS: Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.

}, keywords = {Aged, Body Mass Index, Humans, Middle Aged, Mortality, Proportional Hazards Models, Prospective Studies, United States, Weight Gain, Weight Loss}, issn = {1531-5487}, doi = {10.1097/EDE.0b013e3181b5f520}, author = {Mikko Myrskyl{\"a} and Virginia W Chang} } @article {7314, title = {Willingness to participate in Alzheimer disease research and attitudes towards proxy-informed consent: results from the Health and Retirement Study.}, journal = {Am J Geriatr Psychiatry}, volume = {17}, year = {2009}, month = {2009 Jan}, pages = {65-74}, publisher = {17}, abstract = {

OBJECTIVES: To evaluate public opinion about participation in Alzheimer disease (AD) research and willingness to have a proxy-informed consent.

DESIGN: Cross-sectional.

SETTING: A national survey of community-dwelling adults over the age of 50 and their spouse of any age.

PARTICIPANTS: The 2006 wave of the Health and Retirement Study (N = 1,517).

MEASUREMENTS: Willingness to participate in one of four possible research scenarios and to have a proxy-informed consent for AD research.

RESULTS: Overall, 65.8\% agreed to participate in AD research and 70.7\% agreed to proxy-informed consent. Relative to a minimal benefit and moderate risk scenario, participants were more likely to favor participation in a moderate benefit and minimal risk scenario and less likely to endorse a minimal benefit and severe risk scenario. Those agreeing to participate in the study were more likely to agree to proxy consent and to give leeway to a research proxy to go against their will.

CONCLUSIONS: Most participants view AD research favorably and are agreeable toward participating in such research as well as toward having a research proxy. Participants are able to distinguish between studies of different levels of benefit and risk. Nevertheless, over 50\% agreed to a study of minimal benefit and severe risk. Researchers and clinicians should be aware that those less agreeable toward AD research are less interested in having a research proxy.

}, keywords = {Alzheimer disease, Attitude, Community Participation, Cross-Sectional Studies, Female, Human Experimentation, Humans, Informed Consent, Male, Middle Aged, Public Opinion, Risk Assessment, Third-Party Consent}, issn = {1545-7214}, doi = {10.1097/JGP.0b013e31818cd3d3}, author = {Liat Ayalon} } @article {7399, title = {Work expectations, realizations, and depression in older workers.}, journal = {J Ment Health Policy Econ}, volume = {12}, year = {2009}, note = {Journal Article}, month = {2009 Dec}, pages = {175-86}, publisher = {12}, abstract = {

AIMS OF THE STUDY: In this study, we explore whether ex ante work expectations, conditional on work force status at age 62, affect self-reported depressive symptoms at age 62.

METHODS: Our sample includes 4,387 participants of the Health and Retirement Study, a national longitudinal survey of individuals born between 1931 and 1941, and their spouses. The sample is composed of workers who were less than 62 years of age at the study baseline (1992), and who had reached age 62 by the current study endpoint (2004). This sample enables comparison of realized work status with prior expectations. We estimate the impact of expected work status on self-reported depressive symptoms using negative binomial and logistic regression methods. Sex-stratified regressions are estimated according to full-time work status at age 62. The primary outcome is a summary measure of self-reported depressive symptoms based on a short form of the Center for Epidemiologic Studies-Depression (CES-D) scale. The explanatory variable of interest is the subjective probability of working full-time at the age of 62, reported by participants at the 1992 HRS baseline. We control for baseline socioeconomic and demographic variables as well as life events and changes in macroeconomic conditions that occur within the study timeframe.

RESULTS: Among participants who were not working full time at age 62, we find that men who provided a higher ex ante likelihood of full-time employment at 62 had significantly worse self-reported depressive symptoms than men who provided a lower ex ante likelihood. A similar effect was not found for women. Among participants who were working full time at age 62, we do not find a statistical relationship between ex ante expectations and age-62 self-reported depressive symptoms, for either men or women.

DISCUSSION: The results suggest that an earlier-than-anticipated work exit is detrimental to mental health for men nearing normal retirement age. Previous research has demonstrated that stress is a causal factor in depression, and a premature labor force departure, which is inconsistent with an individual{\textquoteright}s cognitive judgment of a suitably timed exit from work, is a psychologically stressful transition that could realistically induce depression. This may be especially true of men, who in this cohort, have stronger labor force attachment than women and tend to define their roles by their occupation. The advantages of the study include nationally representative data, a baseline depression control that circumscribes the effect of endogeneity, and a reasonably long follow-up. Despite our efforts to infer causality, unmeasured factors may account for part of the observed relationship. IMPLICATIONS FOR HEALTH POLICY AND RESEARCH: Depression is a disease that, if untreated, may have serious consequences for behavioral, medical, and social well-being. Our results suggest that further research should aim to estimate the magnitude of clinically severe and mild depression in populations of those who retire earlier than expected, especially for men. Such information could help health care planners and policy makers to direct resources to the mental health needs of men who retire prematurely.

}, keywords = {Age Factors, depression, Employment, Female, Health Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Psychometrics, Retirement, Sex Factors, Stress, Psychological}, issn = {1091-4358}, url = {URL:http://www.icmpe.org/test1/journal/journal.htm Publisher{\textquoteright}sURL}, author = {Tracy Falba and Jody L Sindelar and William T Gallo} } @article {7222, title = {Actuation of mobility intentions among the young-old: an event-history analysis.}, journal = {Gerontologist}, volume = {48}, year = {2008}, month = {2008 Apr}, pages = {190-202}, publisher = {48}, abstract = {

PURPOSE: Although migration decision making is central to understanding later-life migration, the critical step between migration intentions and mobility outcomes has received only limited empirical attention. We address two questions: How often are intended moves actuated? What factors condition the likelihood that mobility intentions will be actuated?

DESIGN AND METHODS: We employ data from the 1994-2002 Health and Retirement Study, which is a nationally representative panel targeting households containing persons aged 53 to 63 years at baseline. Event-history techniques are used to examine the link between reported mobility intentions at baseline and mobility outcomes across the study period, net of relevant controls. We conduct separate household-level analyses for couple and noncouple households and recognize three types of moves: local, family oriented, and nonlocal.

RESULTS: Findings confirm the utility of mobility expectations as a predictor of future mobility. More importantly, results highlight the complex nature of later-life mobility. The actuation of mobility intentions appears to operate differently in couple than in noncouple households. Moreover, our findings suggest that the role of several key variables depends on the type of move under consideration.

IMPLICATIONS: The ability to identify potential "retirement migrants" may be of practical importance for state and local government officials as well as developers interested in recruiting or retaining young-old residents. Our study offers insight on the interpretation of stated mobility intentions. Moreover, consistent with early theoretical work in the field, our analysis suggests that empirical studies must account for heterogeneity among older movers in order to avoid misleading results.

}, keywords = {Aged, Databases as Topic, Emigration and Immigration, Humans, Intention, Middle Aged, Population Dynamics, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/48.2.190}, author = {Don E Bradley and Charles F Longino and Eleanor P. Stoller and William H Haas} } @article {7209, title = {Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Feb}, pages = {200-8}, publisher = {46}, abstract = {

BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.

DESIGN: Longitudinal (1998-2004) Health and Retirement Study.

SETTING: National probability sample of US community-dwelling adults.

SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.

MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.

RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95\% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.

CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.

}, keywords = {Age Distribution, Aged, Arthritis, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Black or African American, Female, Health Services Accessibility, Healthcare Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, United States, Utilization Review, White People}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e31815cecd8}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Sohn, Min-Woong and Joseph Feinglass and Huan J. Chang and Rowland W Chang} } @article {7242, title = {Antecedents of bridge employment: a longitudinal investigation.}, journal = {J Appl Psychol}, volume = {93}, year = {2008}, month = {2008 Jul}, pages = {818-30}, publisher = {98}, abstract = {

Bridge employment is the labor force participation pattern increasingly observed in older workers between their career jobs and their complete labor force withdrawal. It serves as a transition process from career employment to full retirement. Typical bridge employment decisions include full retirement, career bridge employment, and bridge employment in a different field. In the current study, 3 dominant theories (i.e., role theory, continuity theory, and life course perspective) on retirement processes were reviewed. On the basis of these theories, the authors proposed 4 categories of antecedents (i.e., individual attributes, job-related psychological variables, family-related variables, and a retirement-planning-related variable) of different types of bridge employment decisions. The authors used longitudinal data of a large, nationally representative sample from the Health and Retirement Study (F. Juster \& R. Suzman, 1995) to test the current hypotheses. These data were analyzed with multinomial logistic regression, and most of the hypotheses were supported by the results. The implications of this study are discussed at both theoretical and practical levels.

}, keywords = {Aged, Career Mobility, Employment, Female, Follow-Up Studies, Humans, Job Satisfaction, Male, Middle Aged, Psychological Theory, Retirement, Surveys and Questionnaires}, issn = {0021-9010}, doi = {10.1037/0021-9010.93.4.818}, author = {Wang, Mo and Zhan, Yujie and Liu, Songqi and Kenneth S. Shultz} } @article {7237, title = {The association between low vision and function.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Aug}, pages = {504-25}, publisher = {20}, abstract = {

OBJECTIVE: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability.

METHODS: Guided by the World Health Organization{\textquoteright}s International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study.

RESULTS: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities.

DISCUSSION: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

}, keywords = {Activities of Daily Living, Aged, Aging, Disability Evaluation, Geriatric Assessment, Humans, International Classification of Diseases, Logistic Models, Vision, Low, Visual Acuity}, issn = {0898-2643}, doi = {10.1177/0898264308317534}, author = {Berger, Sue and Frank Porell} } @article {7247, title = {The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey.}, journal = {Eur J Epidemiol}, volume = {23}, year = {2008}, note = {PMID: 18584293}, month = {2008}, pages = {601-7}, publisher = {23}, abstract = {

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95\% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Educational Status, Female, Health Surveys, Humans, Life Expectancy, Life Tables, Male, Middle Aged, Multivariate Analysis, Obesity, Proportional Hazards Models, Smoking, United States, Weight Gain, Weight Loss}, issn = {0393-2990}, doi = {10.1007/s10654-008-9269-8}, author = {Mieke Reuser and Luc G Bonneux and Frans J Willekens} } @article {7253, title = {Changes in weight among U.S. adults aged 70 and over, 1993 to 2002.}, journal = {Prev Med}, volume = {47}, year = {2008}, month = {2008 Nov}, pages = {489-93}, publisher = {47}, abstract = {

OBJECTIVE: To describe the patterns and predictors of weight change among U.S. adults aged 70 and over.

METHOD: The study is a retrospective cohort study of 7441 community-dwelling U.S. adults aged 70 years and over during 1993-2002. We examined changes in weight for men and women, and by race/ethnicity groups. We used multivariate linear regression analysis to determine predictors of weight change while controlling for key covariates at baseline.

RESULTS: The mean body weight decreased in both genders and all ethnic groups. Unadjusted average weight loss was 3.41 kg for men and 3.29 kg for women over nine years. Black women had higher mean body weight at baseline and were more likely to report weight gains of 5 kg or more. Multivariate analysis showed that age and baseline weight were major predictors of weight loss. Physical activity was associated with less weight loss among men.

CONCLUSION: The trends of weight change among U.S. adults aged 70 and over were more prone to weight loss than weight gain, with substantial variations. Public health messages regarding weight control should take into account the heterogeneity of this population and target weight loss as well as weight gain to meet diverse needs of the population.

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Humans, Interviews as Topic, Linear Models, Male, Multivariate Analysis, Population Growth, Retrospective Studies, United States, Weight Gain, Weight Loss}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2008.06.022}, author = {Xiaoxing He and Meng, Hongdao} } @article {7232, title = {Chronic conditions and mortality among the oldest old.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, note = {PMID 18511714}, month = {2008 Jul}, pages = {1209-14}, publisher = {98}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Female, Health Behavior, Health Status, Humans, Male, Middle Aged, Models, Statistical, Predictive Value of Tests, Proportional Hazards Models, Reproducibility of Results, Risk Adjustment, Severity of Illness Index, Socioeconomic factors, Survival Analysis, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.130955}, author = {Sei J. Lee and Alan S Go and Lindquist, Karla and Bertenthal, Daniel and Kenneth E Covinsky} } @article {7273, title = {Cohort differences in wealth and pension participation of near-retirees.}, journal = {Soc Secur Bull}, volume = {68}, year = {2008}, month = {2008}, pages = {45-66}, publisher = {68}, abstract = {

The approaching retirement of the baby-boom generation has attracted both research and public policy attention. Many social and economic changes occurred during the second half of the twentieth century, changes that are likely to affect the retirement economic security of recent cohorts in many ways. In this article, using data from the Health and Retirement Study (HRS), a longitudinal, nationally representative survey of older Americans, we compare potential retirement economic resources-pension participation and nonpension net worth-of two cohorts of near-retirees. Particularly we look at individuals born from 1933 through 1939, often referred to as depression babies, who were ages 55-61 in 1994 and the more recent cohort consisting of individuals of the same ages (55-61) in 2004, who were born from 1943 through 1949. Our findings indicate that the more recent cohort of near-retirees has a significantly higher pension participation rate over their working life, and therefore greater opportunity to establish pension income through their working life, compared with the earlier cohort (82 percent versus 64 percent). The increase in pension participation was more pronounced among the recent cohort of women, an expected outcome given the increase in labor force participation of women over the past half century. As a result, although differences by sex in pension participation remained significant, the gap has narrowed for the recent cohort of near-retirees. In addition, we find that the gap in participation rate between those in the highest and the lowest wealth quintiles has widened over time (from 22 percent in 1994 to 26 percent in 2004). For both cohorts of near-retirees, the evidence indicates that those without a pension have much lower levels of net total worth than those who report having a pension. The pattern that emerges for both cohorts is that about one-fifth of individuals aged 55-61 hold little or no wealth at all, whereas about two-fifths hold a substantial amount of wealth. In addition, housing equity, which rarely is used to finance consumption in retirement, comprises more than one-half of total nonpension net worth for about 60 percent of all households, leaving--on average less than $45,000 jointly in nonhousing wealth and IRA/Keogh assets--a much smaller amount of wealth that is readily accessible if the need arises. The fact that many near-retirees (about 40 percent) in the lowest-two wealth quintiles have no pension to potentially draw income from, coupled with the very low level of total nonpension wealth raises concern about their income security in retirement; they may be likely to rely heavily on Social Security, rely on welfare programs, or continue work in retirement.

}, keywords = {Female, Humans, Income, Longitudinal Studies, Male, Middle Aged, Pensions, Population Growth, Retirement, United States}, issn = {0037-7910}, author = {Irena Dushi and Howard M Iams} } @article {7214, title = {Declines in late-life disability: the role of early- and mid-life factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Apr}, pages = {1588-602}, publisher = {66}, abstract = {

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Disabled Persons, Female, Frail Elderly, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Male, Morbidity, Population Surveillance, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.037}, author = {Vicki A Freedman and Linda G Martin and Robert F. Schoeni and Jennifer C. Cornman} } @article {7198, title = {Degree of disability and patterns of caregiving among older Americans with congestive heart failure.}, journal = {J Gen Intern Med}, volume = {23}, year = {2008}, month = {2008 Jan}, pages = {70-6}, publisher = {23}, abstract = {

OBJECTIVES: Although congestive heart failure (CHF) is a common condition, the extent of disability and caregiving needs for those with CHF are unclear. We sought to determine: (1) prevalence of physical disability and geriatric conditions, (2) whether CHF is independently associated with disability, (3) rates of nursing home admission, and (4) formal and informal in-home care received in the older CHF population.

METHODS: We used cross-sectional data from the 2000 wave of the Health and Retirement Study. We compared outcomes among three categories of older adults: (1) no coronary heart disease (CHD), (2) CHD, without CHF, and (3) CHF. Compared to those without CHF, respondents reporting CHF were more likely to be disabled (P < 0.001) and to have geriatric conditions (P < 0.001). Respondents reporting CHF were more likely to have been admitted to a nursing home (P < 0.05). CHF respondents were more functionally impaired than respondents without CHF.

RESULTS: The adjusted average weekly informal care hours for respondents reporting CHF was higher than for those reporting CHD but without CHF and those reporting no CHD (6.7 vs 4.1 vs 5.1, respectively; P < 0.05). Average weekly formal caregiving hours also differed among the three groups (1.3 CHF vs 0.9 CHD without CHF vs 0.7 no CHD; P > 0.05).

CONCLUSIONS: CHF imposes a significant burden on patients, families, and the long-term care system. Older adults with CHF have higher rates of disability, geriatric conditions, and nursing home admission.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Coronary Disease, Cross-Sectional Studies, Disabled Persons, Female, Health Surveys, Heart Failure, Hospitalization, Humans, Male, Nursing homes, United States}, issn = {1525-1497}, doi = {10.1007/s11606-007-0456-1}, author = {Tanya R Gure and Mohammed U Kabeto and Caroline S Blaum and Kenneth M. Langa} } @article {7225, title = {Depression and retirement in late middle-aged U.S. workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Apr}, pages = {693-713}, publisher = {43}, abstract = {

OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement.

DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992.

STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288).

PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men.

CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.

}, keywords = {Activities of Daily Living, Comorbidity, depression, Employment, Female, Humans, Male, Middle Aged, Retirement, Severity of Illness Index, Sex Factors, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00782.x}, author = {Jalpa A Doshi and Cen, Liyi and Daniel Polsky} } @article {7238, title = {Divergent pathways? Racial/ethnic differences in older women{\textquoteright}s labor force withdrawal.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S122-34}, publisher = {63B}, abstract = {

OBJECTIVES: The purpose of this study was to investigate how women{\textquoteright}s labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences.

METHODS: Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models.

RESULTS: Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital.

DISCUSSION: This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites.

}, keywords = {Aged, Black People, Demography, Disability Evaluation, Disabled Persons, Employment, ethnicity, Hispanic or Latino, Humans, Middle Aged, Retirement, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s122}, author = {Tyson H Brown and David F Warner} } @article {10810, title = {Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments.}, journal = {J Epidemiol Community Health}, volume = {62}, year = {2008}, month = {2008 Jun}, pages = {532-7}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Censuses, Child, Cognition, Education, Educational Status, Female, Health Status, Humans, Least-Squares Analysis, Male, Massachusetts, Memory, Schools, Socioeconomic factors}, issn = {1470-2738}, doi = {10.1136/jech.2006.059469}, author = {M. Maria Glymour and Ichiro Kawachi and Jencks, Christopher and Lisa F Berkman} } @article {7228, title = {Dynamics of work disability and pain.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Mar}, pages = {496-509}, publisher = {27}, abstract = {

This paper investigates the role of pain dynamics in subsequently affecting dynamics in self-reported work disability and the dynamics of employment patterns of older workers in the US. Not only is pain prevalence quite high, there also are many transitions in and out of pain at these ages. We investigate pain and its relationship to health (work disability) and work in a dynamic panel data model, using six biennial waves from the Health and Retirement Study. We find that the dynamics of the presence of pain are central to understanding the dynamics of self-reported work disability and through this pathway, pain dynamics are also a significant factor in the dynamic patterns of employment.

}, keywords = {Aged, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Models, Statistical, pain, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.05.002}, author = {Arie Kapteyn and James P Smith and Arthur H.O. vanSoest} } @article {7264, title = {Early motherhood and mental health in midlife: a study of British and American cohorts.}, journal = {Aging Ment Health}, volume = {12}, year = {2008}, note = {PMID: 18855176}, month = {2008 Sep}, pages = {605-14}, publisher = {12}, abstract = {

OBJECTIVES: Examine the relationship between early age at first birth and mental health among women in their fifties.

METHODS: Analysis of data on women from a British 1946 birth cohort study and the U.S. Health and Retirement Study birth cohort of 1931-1941.

RESULTS: In both samples a first birth before 21 years, compared to a later first birth, is associated with poorer mental health. The association between early first birth and poorer mental health persists in the British study even after controlling for early socioeconomic status, midlife socioeconomic status and midlife health. In the U.S. sample, the association becomes non-significant after controlling for educational attainment.

CONCLUSIONS: Early age at first birth is associated with poorer mental health among women in their fifties in both studies, though the pattern of associations differs.

}, keywords = {Adolescent, Birth Order, Cohort Studies, England, Female, Humans, Interviews as Topic, Maternal Age, Mental Health, Middle Aged, Mothers, Pregnancy, Pregnancy in Adolescence, United States}, issn = {1364-6915}, doi = {10.1080/13607860802343084}, author = {John C Henretta and Emily M D Grundy and Lucy C Okell and Michael E J Wadsworth} } @article {7191, title = {Economic theory and evidence on smoking behavior of adults.}, journal = {Addiction}, volume = {103}, year = {2008}, month = {2008 Nov}, pages = {1777-85}, publisher = {103}, abstract = {

AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework.

METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking.

RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking.

CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

}, keywords = {Adult, Aged, Aged, 80 and over, Choice Behavior, Costs and Cost Analysis, health policy, Humans, Impulsive Behavior, Middle Aged, Risk Factors, Smoking, Smoking cessation, Time Factors}, issn = {1360-0443}, doi = {10.1111/j.1360-0443.2008.02329.x}, url = {http://dx.doi.org/10.1111/j.1360-0443.2008.02329.x}, author = {Frank A Sloan and Wang, Yang} } @article {7283, title = {Educational differentials in life expectancy with cognitive impairment among the elderly in the United States.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {456-77}, publisher = {20}, abstract = {

OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.

METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.

RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.

DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Educational Status, Female, Humans, Life Expectancy, Male, United States}, issn = {0898-2643}, doi = {10.1177/0898264308315857}, author = {Agn{\`e}s Li{\`e}vre and Dawn E Alley and Eileen M. Crimmins} } @article {7205, title = {Effect of arthritis in middle age on older-age functioning.}, journal = {J Am Geriatr Soc}, volume = {56}, year = {2008}, month = {2008 Jan}, pages = {23-8}, publisher = {56}, abstract = {

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.

DESIGN: Prospective longitudinal study.

SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.

PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.

MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.

RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34\% vs 18\%, adjusted hazard ratio (HR)=1.63, 95\% confidence interval (CI)=1.43-1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30\% vs 16\%, adjusted HR=1.55, 95\% CI=1.41-1.71) and persistent difficulty in ADL function (13\% vs 5\%, adjusted HR=1.85, 95\% CI=1.58-2.16).

CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.

}, keywords = {Activities of Daily Living, Arthritis, Chronic disease, Confidence Intervals, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mobility Limitation, Prognosis, Prospective Studies, Risk Factors, Severity of Illness Index, Surveys and Questionnaires, Time Factors, Walking}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2007.01511.x}, author = {Kenneth E Covinsky and Lindquist, Karla and Dorothy D Dunlop and Thomas M Gill and Yelin, Edward} } @article {7307, title = {Effects of social integration on preserving memory function in a nationally representative US elderly population.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, month = {2008 Jul}, pages = {1215-20}, publisher = {98}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Male, Mental Health, Mental Recall, Predictive Value of Tests, Reproducibility of Results, Severity of Illness Index, social isolation, Social Support, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.113654}, author = {Karen A Ertel and M. Maria Glymour and Lisa F Berkman} } @article {7231, title = {Emergency department utilization patterns among older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {63}, year = {2008}, month = {2008 Feb}, pages = {204-9}, publisher = {63A}, abstract = {

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

RESULTS: The majority (56.6\%) of participants had no ED visits during the 4-year period. Just 5.7\% had only low-intensity ED use patterns, whereas 28.9\% used the ED only for high-intensity visits, and 8.7\% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

}, keywords = {Aged, Emergency Service, Hospital, Factor Analysis, Statistical, Female, Humans, Logistic Models, Male, Medicare, Risk Factors, United States}, issn = {1079-5006}, doi = {10.1093/gerona/63.2.204}, author = {Frederic D Wolinsky and Li Liu and Thomas R Miller and An, Hyonggin and John F Geweke and Kaskie, Brian and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and Elizabeth A Cook and Robert L. Ohsfeldt and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @article {7190, title = {End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter?}, journal = {Med Decis Making}, volume = {28}, year = {2008}, month = {2008 Jul-Aug}, pages = {511-23}, publisher = {28}, abstract = {

BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public{\textquoteright}s opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.

OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.

METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.

RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient{\textquoteright}s own savings and when it had 60\% rather than 20\% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.

CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.

}, keywords = {Aged, Choice Behavior, Female, Financing, Personal, Health Care Costs, Humans, Life Expectancy, Male, Medicare, Neoplasms, Socioeconomic factors, Terminal Care, United States}, issn = {0272-989X}, doi = {10.1177/0272989X07312713}, author = {Chao, Li-Wei and Jos{\'e} A Pag{\'a}n and Beth J Soldo} } @article {7221, title = {Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets.}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 May}, pages = {481-8}, publisher = {46}, abstract = {

OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use.

DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.

STUDY DESIGN: The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.

SAMPLE: Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.

RESULTS: Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95\% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95\% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95\% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95\% CI: 1.03-2.26) to have first TKA.

CONCLUSIONS: Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.

}, keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Knee, Comorbidity, ethnicity, Female, Healthcare Disparities, Humans, Income, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Middle Aged, Sex Distribution, Socioeconomic factors, United States}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e3181621e9c}, author = {Amresh D Hanchate and Zhang, Yuqing and David T Felson and Arlene S Ash} } @article {7252, title = {Gender differences in functional status in middle and older age: are there any age variations?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Sep}, pages = {S282-92}, publisher = {63B}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Disabled Persons, Female, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Sex Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s282}, author = {Jersey Liang and Joan M. Bennett and Benjamin A Shaw and Ana R Qui{\~n}ones and Wen Ye and Xiao Xu and Mary Beth Ofstedal} } @article {7244, title = {Health and wealth of elderly couples: causality tests using dynamic panel data models.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Sep}, pages = {1312-25}, publisher = {27}, abstract = {

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

}, keywords = {Aged, Causality, Family Characteristics, Female, Health Status Indicators, Humans, Income, Longitudinal Studies, Male, Middle Aged, Models, Econometric, Retirement, Social Class, Spouses, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2008.04.002}, author = {Pierre-Carl Michaud and Arthur H.O. vanSoest} } @article {7202, title = {Health insurance coverage as people approach and pass age-eligibility for Medicare.}, journal = {J Aging Soc Policy}, volume = {20}, year = {2008}, month = {2008}, pages = {29-44}, publisher = {20}, abstract = {

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

}, keywords = {Aged, Eligibility Determination, Female, Humans, Insurance Coverage, Insurance, Health, Male, Medicare, Middle Aged, United States}, issn = {0895-9420}, doi = {10.1300/j031v20n01_02}, author = {Caffrey, Christine and Christine L Himes} } @article {7234, title = {Health status and health dynamics in an empirical model of expected longevity.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 May}, pages = {564-84}, publisher = {27}, abstract = {

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

}, keywords = {Chronic disease, Delivery of Health Care, Empirical Research, Female, Health Expenditures, Health Status, Humans, Life Expectancy, Longevity, Male, Models, Econometric}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.09.008}, author = {Hugo Ben{\'\i}tez-Silva and Ni, Huan} } @article {7265, title = {[The health status of the elderly population: what do we need to know?].}, journal = {Cien Saude Colet}, volume = {13}, year = {2008}, note = {PMID: 18813630}, month = {2008 Jul-Aug}, pages = {1305-12}, publisher = {13}, abstract = {

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

}, keywords = {Aged, Brazil, Cross-Sectional Studies, Geriatric Assessment, Health Status Indicators, Humans, Middle Aged, United States}, issn = {1678-4561}, doi = {10.1590/s1413-81232008000400027}, author = {Reboucas, Monica and Siulmara Cristina Galera and Pereira, Silvia Regina Mendes and Pereira, Mauricio Gomes} } @article {7207, title = {Identification of dementia: agreement among national survey data, medicare claims, and death certificates.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {313-26}, publisher = {43}, abstract = {

OBJECTIVE: To estimate the proportion of seniors with dementia from three independent data sources and their agreement.

DATA SOURCES: The longitudinal Asset and Health Dynamics among the Oldest Old (AHEAD) study (n=7,974), Medicare claims, and death certificate data.

STUDY DESIGN: Estimates of the proportion of individuals with dementia from: (1) self- or proxy-reported cognitive status measures from surveys, (2) Medicare claims, and (3) death certificates. Agreement using Cohen{\textquoteright}s kappa; multivariate logistic regression.

PRINCIPAL FINDINGS: The proportion varied substantially among the data sources. Agreement was poor (kappa: 0.14-0.46 depending upon comparison assessed); the individuals identified had relatively modest overlap.

CONCLUSIONS: Estimates of dementia occurrence based on cognitive status measures from three independent data sources were not interchangeable. Further validation of these sources is needed. Caution should be used if policy is based on only one data source.

}, keywords = {Aged, Consensus, Data Interpretation, Statistical, Death Certificates, Dementia, Female, Health Surveys, Humans, Incidence, Insurance Claim Review, Male, Mass Screening, Medicare, Research Design, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00748.x}, author = {Truls Ostbye and Donald H. Taylor Jr. and Elizabeth C. Clipp and Lynn Van Scoyoc and Brenda L Plassman} } @article {7217, title = {Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {367-84}, publisher = {20}, abstract = {

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

}, keywords = {Activities of Daily Living, Age Factors, Arthritis, Comorbidity, depression, Depressive Disorder, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Heart Diseases, Humans, Hypertension, Lung Diseases, Male, Mental Disorders, Middle Aged, Neoplasms, Obesity, Risk Factors, Sex Factors, Stroke, United States, Weight Gain}, issn = {0898-2643}, doi = {10.1177/0898264308315851}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7197, title = {Informal care and Medicare expenditures: testing for heterogeneous treatment effects.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Jan}, pages = {134-56}, publisher = {27}, abstract = {

We estimate the effect of informal care on Medicare expenditures not only for care provided by children but also by the source of informal care (sons versus daughters, children versus others) and recipient characteristics (marital status). Our conceptual framework predicts heterogeneous effectiveness by source and recipient of informal care. We estimate two-part expenditure models as a function of informal care, controlling for endogeneity. We find that informal care by children reduces Medicare long-term care and inpatient expenditures of single elderly. We find that children are less effective caregivers among recipients who are married. For single elderly, child caregivers are more effective than other types. Gender of a child caregiver does not matter.

}, keywords = {Adult, Aged, Caregivers, Health Expenditures, Humans, Medicare, Models, Econometric, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.03.002}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {7262, title = {Job loss, retirement and the mental health of older Americans.}, journal = {J Ment Health Policy Econ}, volume = {11}, year = {2008}, month = {2008 Dec}, pages = {167-76}, publisher = {11}, abstract = {

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Heart Diseases, Humans, Life Expectancy, Male, Middle Aged, Myocardial Infarction, Patient Education as Topic, Prejudice, Risk Factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {0895-2841}, doi = {10.1300/j074v20n01_02}, author = {Eileen M. Crimmins and Mark D Hayward and Ueda, Hiroshi and Saito, Yasuhiko and Jung K Kim} } @article {7260, title = {Lifecourse social conditions and racial disparities in incidence of first stroke.}, journal = {Ann Epidemiol}, volume = {18}, year = {2008}, month = {2008 Dec}, pages = {904-12}, publisher = {18}, abstract = {

PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.

METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.

RESULTS: Black subjects had a 48\% greater risk of first stroke incidence than whites (95\% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95\% CI, 1.00-1.28).

CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Cardiovascular Diseases, ethnicity, Female, Health Status Disparities, Humans, Incidence, Interviews as Topic, Life Style, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Risk Factors, Social Environment, Socioeconomic factors, Stroke, United States, White People}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2008.09.010}, author = {M. Maria Glymour and Mauricio Avendano and Steven A Haas and Lisa F Berkman} } @article {7203, title = {Long-term effects of cancer survivorship on the employment of older workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {193-210}, publisher = {43}, abstract = {

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

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

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

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

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

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

}, keywords = {Age Factors, Aged, Data collection, Demography, Disease-Free Survival, Employment, Female, Health Status, Humans, Male, Maryland, Middle Aged, Neoplasms, Pennsylvania, Probability, Prospective Studies, Registries, Retrospective Studies, Sickness Impact Profile, Survivors, Time Factors}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00752.x}, author = {Pamela F. Short and Joseph J. Vasey and John R. Moran} } @article {7263, title = {Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans.}, journal = {Psychosom Med}, volume = {70}, year = {2008}, month = {2008 Nov}, pages = {993-1004}, publisher = {70}, abstract = {

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Culture, depression, Diabetes Mellitus, Educational Status, ethnicity, Factor Analysis, Statistical, Female, Heart Diseases, Humans, Hypertension, Interviews as Topic, Lung Diseases, Male, Self-Assessment, Sex Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e31818ce4fa}, author = {Frances Margaret Yang and Richard N Jones} } @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 {7200, title = {A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Feb}, pages = {862-72}, publisher = {66}, abstract = {

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

}, keywords = {Aged, Female, Health Behavior, Health Status Disparities, Humans, Male, Poverty, Small-Area Analysis, Socioeconomic factors, United States, Urban Population}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.002}, author = {Richard G Wight and Janet R. Cummings and Miller-Martinez, Dana and Arun S Karlamangla and Teresa Seeman and Carol S Aneshensel} } @article {7218, title = {Neighborhoods and disability in later life.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Jun}, pages = {2253-67}, publisher = {66}, abstract = {

This paper uses the US Health and Retirement Study to explore linkages between neighborhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. We consider multiple dimensions of the neighborhood including the built environment as well as social and economic conditions. In doing so, we use factor analysis to reduce indicators into eight neighborhood scales, which we incorporate into two-level logistic regression models along with controls for individual-level factors. We find evidence that economic conditions and the built environment, but not social conditions, matter. Neighborhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. We also find for men that neighborhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55-64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. Our findings highlight the distinctive benefits of neighborhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas.

}, keywords = {Aging, Disabled Persons, Factor Analysis, Statistical, Female, Health Status Disparities, Humans, Male, Middle Aged, Residence Characteristics, Social Conditions, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2008.01.013}, author = {Vicki A Freedman and Irina B Grafova and Robert F. Schoeni and Jeannette Rogowski} } @article {7255, title = {Neighborhoods and obesity in later life.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, month = {2008 Nov}, pages = {2065-71}, publisher = {98}, abstract = {

OBJECTIVES: We examined the influence of neighborhood environment on the weight status of adults 55 years and older.

METHODS: We conducted a 2-level logistic regression analysis of data from the 2002 wave of the Health and Retirement Study. We included 8 neighborhood scales: economic advantage, economic disadvantage, air pollution, crime and segregation, street connectivity, density, immigrant concentration, and residential stability.

RESULTS: When we controlled for individual- and family-level confounders, living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86; 95\% confidence interval [CI] = 0.80, 0.94) and women (OR = 0.83; 95\% CI = 0.77, 0.89). Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Women living in areas of high street connectivity were less likely to be overweight or obese.

CONCLUSIONS: The mechanisms by which neighborhood environment and weight status are linked in later life differ by gender, with economic and social environment aspects being important for men and built environment aspects being salient for women.

}, keywords = {Aged, Air Pollution, Crime, Emigrants and Immigrants, Environment Design, Female, Health Status Indicators, Humans, Income, Logistic Models, Male, Middle Aged, Obesity, Odds Ratio, Overweight, Population Density, Residence Characteristics, Retirement, Social Class, Social Conditions, Social Environment, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.127712}, author = {Irina B Grafova and Vicki A Freedman and Kumar, Rizie and Jeannette Rogowski} } @article {7236, title = {Parent caregiving choices of middle-generation Blacks and Whites in the United States.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Aug}, pages = {560-82}, publisher = {20}, abstract = {

OBJECTIVE: This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents.

METHOD: Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented.

RESULTS: Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks{\textquoteright} IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support.

DISCUSSION: The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

}, keywords = {Activities of Daily Living, Black People, Caregivers, Employment, Family Characteristics, Financial Support, Humans, Intergenerational Relations, Logistic Models, Parent-Child Relations, Parents, Siblings, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/0898264308317576}, author = {Shelley I. White-Means and Rose M. Rubin} } @article {7271, title = {Parental marital disruption, family type, and transfers to disabled elderly parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Nov}, pages = {S349-58}, publisher = {63B}, abstract = {

OBJECTIVE: The objective of this study was to investigate the effect of parental marital status, marital history, and family type on intergenerational living arrangements and adult children{\textquoteright}s time and cash transfers to their unpartnered disabled elderly parents.

METHODS: We used data from the Asset and Health Dynamics Among the Oldest Old survey to estimate the joint probabilities that an adult child provides time and/or cash transfers to a parent and to analyze a five-level categorical variable capturing parent-child living arrangements.

RESULT: The estimates suggest significant detrimental effects of parental divorce and step relationship on time transfers and on the probability of coresidence with the index child. Family type, as captured by the composition of the index child{\textquoteright}s sibling network according to kin relationship to the parent, also affected transfers and living arrangement choices of adult children.

DISCUSSION: The findings that transfers from adult children to their unpartnered disabled elderly parents depend on parental marital status and kin relationship suggest that changing family patterns are altering the traditional role of the family as a support network. These findings raise concerns about the care likely to be available to future cohorts of elderly persons who will have experienced substantially higher rates of divorce, remarriage, and step parenthood than the cohort considered in this study.

}, keywords = {Adult, Aged, Altruism, Divorce, Family Characteristics, Female, Frail Elderly, Gift Giving, Humans, Likelihood Functions, Longitudinal Studies, Male, Multivariate Analysis, Parent-Child Relations, Residence Characteristics, Siblings, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.6.s349}, author = {Liliana E Pezzin and Robert A. Pollak and Barbara Steinberg Schone} } @article {7241, title = {Place of death among older Americans: does state spending on home- and community-based services promote home death?}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Aug}, pages = {829-38}, publisher = {46}, abstract = {

BACKGROUND: The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals{\textquoteright} circumstances largely determine where they die, health policies may affect the range of options available to them.

OBJECTIVE: To examine whether states{\textquoteright} spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals{\textquoteright} family, sociodemographic, and health factors.

METHODS: Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states{\textquoteright} HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community.

RESULTS: Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death.

CONCLUSIONS: States{\textquoteright} generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Death, Humans, Logistic Models, Nursing homes, Residence Characteristics, Terminal Care}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181791a79}, author = {Muramatsu, Naoko and Ruby L Hoyem and yin, Hongjun and Richard T. Campbell} } @article {7229, title = {Predictors of non-local moves among older adults: a prospective study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Jan}, pages = {S7-14}, publisher = {63B}, abstract = {

OBJECTIVES: The goal of this article was to test a series of established predictors of the hazard of moving for persons primarily in their 50s and 60s. We tested demographic covariates, resources, travel experience, and community and person ties using a prospective design.

METHODS: We employed data from the Health and Retirement Study, 1994 to 2002, based on a representative sample of households containing at least one member aged 51 to 61 in 1992. We employed measures available in the Health and Retirement Study to construct a series of Cox proportional hazards models that examined the causes of non-local moves.

RESULTS: Community and person ties emerged as important predictors of non-local moves.

DISCUSSION: Travel experience, when measured by regular vacationing and second homes, may increase community ties to a destination. The life-course model must be modified in its explanation of the importance of community and person ties, and of life transitions, as motivators of migration.

}, keywords = {Aged, Emigration and Immigration, Female, Humans, Interpersonal Relations, Life Change Events, Male, Prospective Studies, Socioeconomic factors, Surveys and Questionnaires, Travel}, issn = {1079-5014}, doi = {10.1093/geronb/63.1.s7}, author = {Charles F Longino and Don E Bradley and Eleanor P. Stoller and William H Haas} } @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 {7248, title = {Preventive health behaviors among grandmothers raising grandchildren.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, note = {ProCite field 6 : The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, month = {2008 Sep}, pages = {S304-11}, publisher = {63B}, abstract = {

OBJECTIVES: We examined differential preventive health behavior among grandmothers who recently began raising a grandchild, grandmothers raising a grandchild for at least 2 years, and grandmothers not raising a grandchild.

METHODS: Data came from the 2000, 2002, and 2004 waves of the Health and Retirement Study. We ran multivariate logistic regression models to assess receipt of influenza vaccination, cholesterol screening, monthly breast self-exam, mammography, and Papanicolaou (Pap) tests among grandmothers aged 50 to 75.

RESULTS: Grandmothers who recently began raising a grandchild were significantly less likely to report influenza vaccination and cholesterol screening than grandmothers not raising grandchildren, even after we controlled for increased emotional and financial strains within the household. We also observed this association for Pap tests, although this finding was only marginally significant. Grandmothers who had been raising a grandchild for at least 2 years were significantly more likely to report influenza vaccination and monthly breast self-exam than grandmothers not raising grandchildren.

DISCUSSION: The enhancement of preventive behavior seen among long-term grandparent caregivers does not fully offset the suppression of preventive behavior during the transition into care; support groups should target a range of interventions toward the promotion of healthy behavior among new grandparent caregivers.

}, keywords = {Aged, Breast Self-Examination, Caregivers, Female, Health Behavior, Humans, Hypercholesterolemia, Influenza, Human, Intergenerational Relations, Logistic Models, Mass Screening, Middle Aged, Papanicolaou Test, Preventive Health Services, United States, Vaccination, Vaginal Smears}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s304}, author = {Lindsey A Baker and Merril Silverstein} } @article {7223, title = {Productive activities and psychological well-being among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Mar}, pages = {S64-72}, publisher = {63B}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, depression, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Models, Psychological, Psychological Theory, Psychomotor Performance, Quality of Life, Social Environment, Volunteers}, issn = {1079-5014}, doi = {10.1093/geronb/63.2.s64}, author = {Hao, Yanni} } @article {7276, title = {Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers.}, journal = {Arch Phys Med Rehabil}, volume = {89}, year = {2008}, month = {2008 Jul}, pages = {1262-6}, publisher = {89}, abstract = {

OBJECTIVE: To compare incident disability patterns across racial and ethnic groups.

DESIGN: Prospective cohort study with 6-year follow-up (1998-2004).

SETTING: National probability sample.

PARTICIPANTS: A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding).

RESULTS: Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31\% vs Hispanic-English [8.57\%], black [7.54\%], white [7.20\%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth.

CONCLUSIONS: Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.

}, keywords = {Acculturation, Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Female, Geriatric Assessment, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged}, issn = {1532-821X}, doi = {10.1016/j.apmr.2007.11.042}, author = {Manasi A. Tirodkar and Song, Jing and Rowland W Chang and Dorothy D Dunlop and Huan J. Chang} } @article {7213, title = {Racial and ethnic disparities in mobility device use in late life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Jan}, pages = {S34-41}, publisher = {63B}, abstract = {

OBJECTIVE: Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference.

METHODS: The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care.

RESULT: Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites.

DISCUSSION: Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.

}, keywords = {Aged, Cross-Sectional Studies, Demography, ethnicity, Female, Health Services Needs and Demand, Humans, Insurance, Health, Male, Self-Help Devices, Socioeconomic factors}, issn = {1079-5014}, doi = {10.1093/geronb/63.1.s34}, author = {Jennifer C. Cornman and Vicki A Freedman} } @article {7243, title = {Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {63}, year = {2008}, month = {2008 Jun}, pages = {629-34}, publisher = {63A}, abstract = {

BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need.

METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery.

RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95\% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age.

CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.

}, keywords = {Aged, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Black or African American, Educational Status, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, United States}, issn = {1079-5006}, doi = {10.1093/gerona/63.6.629}, author = {Steel, Nicholas and Clark, Allan and Iain A Lang and Robert B Wallace and David Melzer} } @article {7256, title = {Racial/ethnic differences in the relationship between the use of health care services and functional disability: the health and retirement study (1992-2004).}, journal = {Gerontologist}, volume = {48}, year = {2008}, month = {2008 Oct}, pages = {659-67}, publisher = {48}, abstract = {

PURPOSE: The purpose of this study was to examine racial/ethnic differences in the relationship between functional disability and the use of health care services in a nationally representative sample of older adults by using the Andersen behavioral model of health services utilization.

DESIGN AND METHODS: The study used 12 years of longitudinal data from the Health and Retirement Study (1992-2004), a nationally representative sample of community-dwelling adults older than 50 in 1992 (N = 8,947). Nonlinear multilevel models used self-reported health care service utilization (physician visits and hospital admissions) to predict racial/ethnic differences in disability (activities of daily living and mobility limitations). The models also evaluated the roles of other predisposing (age and gender), health need (medical conditions and self-rated health), and enabling factors (health insurance, education, income, and wealth).

RESULTS: Blacks and Latinos utilizing physician visits and hospital admissions were associated with significantly more activity of daily living disability than Whites (p <.001). Blacks utilizing physician visits (p <.001) and hospital admissions (p <.05) and Latinos utilizing hospital admissions (p <.05) were associated with more mobility disability than Whites. Other predisposing, health need, and enabling factors did not account for these racial/ethnic differences.

IMPLICATIONS: Nationally, health care use for Blacks and Latinos was associated with more disabilities than for Whites after we accounted for predisposing, health need, and enabling factors. The findings suggest that improving health care quality for all Americans may supersede equal access to health care for reducing ethnic and racial disparities in functional health.

}, keywords = {Activities of Daily Living, Disabled Persons, ethnicity, Female, Health Services, Health Status Disparities, Healthcare Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Racial Groups, Retirement}, issn = {0016-9013}, doi = {10.1093/geront/48.5.659}, author = {Mary E Bowen and Hector M Gonz{\'a}lez} } @article {7239, title = {Retirement and weight changes among men and women in the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S146-53}, publisher = {63B}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Body Mass Index, Body Weight, Demography, depression, Female, Health Behavior, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Obesity, Retirement}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s146}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7261, title = {Risk perceptions, optimism, and natural hazards.}, journal = {Risk Anal}, volume = {28}, year = {2008}, month = {2008 Dec}, pages = {1763-7}, publisher = {28}, abstract = {

This article uses the panel survey developed for the Health and Retirement Study to evaluate whether Hurricane Andrew in 1992 altered longevity expectations of respondents who lived in Dade County, Florida, the location experiencing the majority of about 20 billion dollars of damage. Longevity expectations have been used as a proxy measure for both individual subjective risk assessments and dispositional optimism. The panel structure allows comparison of those respondents{\textquoteright} longevity assessments when the timing of their survey responses bracket Andrew with those of individuals where it does not. After controlling for health effects, the results indicate a significant reduction in longevity expectations due to the information respondents appear to have associated with the storm.

}, keywords = {Aged, Attitude, Cyclonic Storms, Decision making, Disaster Planning, Disasters, Florida, Health Knowledge, Attitudes, Practice, Humans, Longevity, Middle Aged, Perception, Risk, Risk Assessment, Social Behavior}, issn = {1539-6924}, doi = {10.1111/j.1539-6924.2008.00880.x}, author = {V. Kerry Smith} } @article {7254, title = {Robustness in health research: do differences in health measures, techniques, and time frame matter?}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Dec}, pages = {1626-44}, publisher = {27}, abstract = {

Survey-based health research is in a boom phase following an increased amount of health spending in OECD countries and the interest in ageing. A general characteristic of survey-based health research is its diversity. Different studies are based on different health questions in different datasets; they use different statistical techniques; they differ in whether they approach health from an ordinal or cardinal perspective; and they differ in whether they measure short-term or long-term effects. The question in this paper is simple: do these differences matter for the findings? We investigate the effects of life-style choices (drinking, smoking, exercise) and income on six measures of health in the US Health and Retirement Study (HRS) between 1992 and 2002: (1) self-assessed general health status, (2) problems with undertaking daily tasks and chores, (3) mental health indicators, (4) BMI, (5) the presence of serious long-term health conditions, and (6) mortality. We compare ordinal models with cardinal models; we compare models with fixed effects to models without fixed-effects; and we compare short-term effects to long-term effects. We find considerable variation in the impact of different determinants on our chosen health outcome measures; we find that it matters whether ordinality or cardinality is assumed; we find substantial differences between estimates that account for fixed effects versus those that do not; and we find that short-run and long-run effects differ greatly. All this implies that health is an even more complicated notion than hitherto thought, defying generalizations from one measure to the others or one methodology to another.

}, keywords = {Aged, Algorithms, Australia, Data Interpretation, Statistical, Female, Health Behavior, Health Services Research, Health Status Indicators, Humans, Male, Middle Aged, Morbidity, Mortality, Social Class}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2008.06.003}, author = {Frijters, Paul and Ulker, Aydogan} } @article {7280, title = {Screening mammography in older women. Effect of wealth and prognosis.}, journal = {Arch Intern Med}, volume = {168}, year = {2008}, month = {2008 Mar 10}, pages = {514-20}, publisher = {168}, abstract = {

BACKGROUND: Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy.

METHODS: A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years.

RESULTS: Overall, within 2 years, 68\% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis (< or = 10\% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82\% vs 68\%; P < .001) and for women with limited prognoses (> or = 50\% probability of dying in 5 years) (48\% vs 32\%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence.

CONCLUSIONS: Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit.

}, keywords = {Aged, Breast Neoplasms, Chi-Square Distribution, Female, Humans, Longitudinal Studies, Mammography, Mass Screening, Prognosis, Risk Factors, Social Class}, issn = {0003-9926}, doi = {10.1001/archinternmed.2007.103}, author = {Brie A Williams and Lindquist, Karla and Rebecca L. Sudore and Kenneth E Covinsky and Louise C Walter} } @article {7246, title = {Spousal caregiving in late midlife versus older ages: implications of work and family obligations.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Jul}, pages = {S229-S238}, publisher = {63B}, abstract = {

OBJECTIVES: This study examined life-stage differences in the provision of care to spouses with functional impairment.

METHODS: We examined 1,218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses served as primary caregiver and the hours of care provided by spousal primary caregivers by life stage.

RESULTS: We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse.

DISCUSSION: Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Caregivers, Employment, Family Relations, Female, Gender Identity, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Spouses, Time Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.4.s229}, author = {Julie C Lima and Susan M Allen and Goldscheider, Frances and Intrator, Orna} } @article {7204, title = {Spousal concordance in health behavior change.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {96-116}, publisher = {43}, abstract = {

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

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

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

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

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

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

}, keywords = {Attitude to Health, Cross-Sectional Studies, Exercise, Family Characteristics, Female, Health Behavior, Health Care Surveys, Health Promotion, Health Status, Humans, Interpersonal Relations, Life Style, Male, Marriage, Middle Aged, Preventive Health Services, Prospective Studies, Risk-Taking, Smoking, Spouses, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00754.x}, author = {Tracy Falba and Jody L Sindelar} } @article {7259, title = {Spousal smoking and incidence of first stroke: the Health and Retirement Study.}, journal = {Am J Prev Med}, volume = {35}, year = {2008}, month = {2008 Sep}, pages = {245-8}, publisher = {35}, abstract = {

BACKGROUND: Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke.

METHODS: Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged >or=50 years and married at baseline (n=16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1,130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse{\textquoteright}s smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birthstate; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease.

RESULTS: Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio=1.42, 95\% CI=1.05, 1.93) and former smokers (hazard ratio=1.72, 95\% CI=1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked.

CONCLUSIONS: Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.

}, keywords = {Age Factors, Confidence Intervals, Female, Humans, Incidence, Male, Middle Aged, Prospective Studies, Risk Factors, Smoking, Spouses, Stroke, Time Factors, Tobacco Smoke Pollution, United States}, issn = {0749-3797}, doi = {10.1016/j.amepre.2008.05.024}, author = {M. Maria Glymour and Triveni DeFries and Ichiro Kawachi and Mauricio Avendano} } @article {7269, title = {Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education?}, journal = {Stroke}, volume = {39}, year = {2008}, month = {2008 May}, pages = {1533-40}, publisher = {39}, abstract = {

BACKGROUND AND PURPOSE: This study examines the independent effect of wealth, income, and education on stroke and how these disparities evolve throughout middle and old age in a representative cohort of older Americans.

METHODS: Stroke-free participants in the Health and Retirement Study (n=19,565) were followed for an average of 8.5 years. Total wealth, income, and education assessed at baseline were used in Cox proportional hazards models to predict time to stroke. Separate models were estimated for 3 age-strata (50 to 64, 65 to 74, and >or=75), and incorporating risk factor measures (smoking, physical activity, body mass index, hypertension, diabetes, and heart disease).

RESULTS: 1542 subjects developed incident stroke. Higher education predicted reduced stroke risk at ages 50 to 64, but not after adjustment for wealth and income. Wealth and income were independent risk factors for stroke at ages 50 to 64. Adjusted hazard ratios comparing the lowest decile with the 75th-90th percentiles were 2.3 (95\% CI 1.6, 3.4) for wealth and 1.8 (95\% CI 1.3, 2.6) for income. Risk factor adjustment attenuated these effects by 30\% to 50\%, but coefficients for both wealth (HR=1.7, 95\% CI 1.2, 2.5) and income (HR=1.6, 95\% CI 1.2, 2.3) remained significant. Wealth, income, and education did not consistently predict stroke beyond age 65.

CONCLUSIONS: Wealth and income are independent predictors of stroke at ages 50 to 64 but do not predict stroke among the elderly. This age patterning might reflect buffering of the negative effect of low socioeconomic status by improved access to social and health care programs at old ages, but may also be an artifact of selective survival.

}, keywords = {Age Distribution, Age Factors, Aged, Cohort Studies, Educational Status, Female, Humans, Incidence, Income, Life Style, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Socioeconomic factors, Stroke, United States}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.107.490383}, author = {Mauricio Avendano and M. Maria Glymour} } @article {7210, title = {Trajectories of functional health: the {\textquoteright}long arm{\textquoteright} of childhood health and socioeconomic factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Feb}, pages = {849-61}, publisher = {66}, abstract = {

Few studies have specifically examined trajectories of functional health status or estimated the extent to which they are influenced by childhood health and socioeconomic conditions. This study examines how circumstances associated with early life may shape the level and progression of functional limitations among adults at or near retirement. Employing data from the US Health and Retirement Study (HRS), it estimates latent growth curve models (LGM) of functional limitation. The results demonstrate that functional health trajectories in old age continue to be shaped by childhood health and socioeconomic circumstances. Poor childhood health and disadvantaged social origins are associated with both more functional limitations at baseline and higher rates of increase over time. This association is net of baseline adult chronic disease and socioeconomic status. While both childhood and adult factors influence the baseline level of functional limitation, only childhood health and socioeconomic status are associated with the rate of change in limitations over time.

}, keywords = {Aged, Child, Female, Health Behavior, Health Status Disparities, Humans, Male, Middle Aged, Social Class, Socioeconomic factors}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.004}, author = {Steven A Haas} } @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 {7208, title = {Using subjective expectations to forecast longevity: do survey respondents know something we don{\textquoteright}t know?}, journal = {Demography}, volume = {45}, year = {2008}, month = {2008 Feb}, pages = {95-113}, publisher = {45}, abstract = {

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25\% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

}, keywords = {Aged, Aged, 80 and over, Aging, Data collection, Demography, Female, health policy, Humans, Life Expectancy, Life Tables, Longevity, Male, Middle Aged, Mortality, Risk Factors, Sex Factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2008.0010}, author = {Maria Perozek} } @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 {7206, title = {Work disability associated with cancer survivorship and other chronic conditions.}, journal = {Psychooncology}, volume = {17}, year = {2008}, month = {2008 Jan}, pages = {91-7}, publisher = {17}, abstract = {

The long-term effects of cancer and its treatment on employment and productivity are a major concern for the 40\% of cancer survivors in the U.S. who are working age. This study{\textquoteright}s objectives were (1) to quantify the increase in work disability attributable to cancer in a cohort of adult survivors who were an average of 46 months post-diagnosis and (2) to compare disability rates in cancer survivors to individuals with other chronic conditions. Data from the Penn State Cancer Survivor Study (PSCSS) and the Health and Retirement Study (HRS) were compared. The PSCSS sample included 647 survivors age 55-65, diagnosed at four medical centers in Pennsylvania and Maryland. There were 5988 similarly aged subjects without cancer in the HRS. Adjusted odds ratios for work disability were estimated for cancer survivorship, heart disease, stroke, diabetes, lung disease, and arthritis/rheumatism with multivariate logistic regression. Even for cancer-free survivors, the adjusted disability rate was significantly higher in comparison to adults with no chronic conditions (female OR = 1.94; male OR = 1.89). There were few significant differences between disability rates for cancer and other conditions. The elevated disability rate is another argument for viewing cancer survivorship as a chronic condition potentially requiring a broad range of psychosocial services.

}, keywords = {Adult, Aged, Chronic disease, Disability Evaluation, Employment, Female, Humans, Male, Maryland, Middle Aged, Neoplasms, Pennsylvania, Survivors}, issn = {1057-9249}, doi = {10.1002/pon.1194}, author = {Pamela F. Short and Joseph J. Vasey and BeLue, Rhonda} } @article {7151, title = {Age group differences in depressive symptoms among older adults with functional impairments.}, journal = {Health Soc Work}, volume = {32}, year = {2007}, month = {2007 Aug}, pages = {177-88}, publisher = {32}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Adult, Aged, Aged, 80 and over, Economics, Education, Follow-Up Studies, Health Status, Humans, Income, Middle Aged, Mortality, Motor Activity, Pilot Projects, Proportional Hazards Models, Retirement, Risk Factors, Risk-Taking, Smoking, Social Class, Thinness, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.4.s209}, author = {Joseph Feinglass and Lin, Suru and Jason A. Thompson and Joseph J Sudano and Dorothy D Dunlop and Song, Jing and David W. Baker} } @article {7173, title = {Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients{\textquoteright} treatment priorities and self-management?}, journal = {J Gen Intern Med}, volume = {22}, year = {2007}, month = {2007 Dec}, pages = {1635-40}, publisher = {22}, abstract = {

BACKGROUND: The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40\% have at least three.

OBJECTIVE: We sought to understand how the number, type, and severity of comorbidities influence diabetes patients{\textquoteright} self-management and treatment priorities.

DESIGN: Cross-sectional observation study.

PATIENTS: A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS: We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS: 40\% of respondents had at least 1 microvascular comorbidity, 79\% at least 1 macrovascular comorbidity, and 61\% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS: The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients{\textquoteright} self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

}, keywords = {Aged, Attitude to Health, Cohort Studies, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Priorities, Heart Failure, Humans, Male, Middle Aged, Self Care, Severity of Illness Index, United States}, issn = {1525-1497}, doi = {10.1007/s11606-007-0313-2}, author = {Eve A Kerr and Michele M Heisler and Sarah L. Krein and Mohammed U Kabeto and Kenneth M. Langa and David R Weir and John D Piette} } @article {7152, title = {Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults.}, journal = {Gerontologist}, volume = {47}, year = {2007}, month = {2007 Aug}, pages = {423-37}, publisher = {47}, abstract = {

PURPOSE: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults.

DESIGN AND METHODS: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease.

RESULTS: An increasing prevalence of multiple morbidity (58\% compared with 70\% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104\% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41\%, 85\%, and 100\%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations.

IMPLICATIONS: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

}, keywords = {Aged, Arthritis, Chronic disease, Comorbidity, Cost of Illness, Female, Financing, Personal, Health Expenditures, Health Surveys, Heart Diseases, Humans, Hypertension, Interviews as Topic, Male, Middle Aged, United States}, issn = {0016-9013}, doi = {10.1093/geront/47.4.423}, author = {Schoenberg, Nancy E. and Hyungsoo Kim and Edwards, William and Fleming, Steven T.} } @article {7176, title = {Change in depression of spousal caregivers of dementia patients following patient{\textquoteright}s death.}, journal = {Omega (Westport)}, volume = {56}, year = {2007}, month = {2007-2008}, pages = {217-28}, publisher = {56}, abstract = {

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse{\textquoteright}s death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Bereavement, Caregivers, Dementia, depression, Female, Humans, Life Change Events, Long-term Care, Longitudinal Studies, Male, Sex Factors, Spouses, Surveys and Questionnaires, United States}, issn = {0030-2228}, doi = {10.2190/om.56.3.a}, author = {Tweedy, Maureen P. and Charles A Guarnaccia} } @article {7134, title = {Changes in adult child caregiver networks.}, journal = {Gerontologist}, volume = {47}, year = {2007}, month = {2007 Jun}, pages = {280-95}, publisher = {47}, abstract = {

PURPOSE: Caregiving research has typically relied on cross-sectional data that focus on the primary caregiver. This approach neglects the dynamic and systemic character of caregiver networks. Our analyses addressed changes in adult child care networks over a 2-year period.

DESIGN AND METHODS: The study relied on pooled data from Waves 1 through 5 of the Health and Retirement Study. Based on a matrix of specific adult child caregivers across two consecutive time points, we assessed changes in any adult child caregiver as well as in the primary adult child caregiver.

RESULTS: More than half of all adult-child care networks, including more than one fourth of primary adult child caregivers, changed between waves. Gender composition of the caregiver network and availability of other adult child caregivers were particularly important for network change, but socioeconomic context, caregiver abilities and resources, and caregiver burden played a role as well.

IMPLICATIONS: The results underline the need to shift caregiving research toward a dynamic life course and family systems perspective. They also raise concerns about the viability of informal care networks for future smaller birth cohorts and suggest that health care providers need to recognize and address coordination and potential conflicts among care network members.

}, keywords = {Adult, Caregivers, Child, Child Care, Community Networks, Female, Humans, Male, Middle Aged, Socioeconomic factors}, issn = {0016-9013}, doi = {10.1093/geront/47.3.280}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {7165, title = {Childhood social and economic well-being and health in older age.}, journal = {Am J Epidemiol}, volume = {166}, year = {2007}, month = {2007 Nov 01}, pages = {1059-67}, publisher = {166}, abstract = {

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

}, keywords = {Aged, Aged, 80 and over, Black or African American, Child, Confidence Intervals, Educational Status, Female, Frail Elderly, Health Status, Health Status Indicators, Hispanic or Latino, Humans, Male, Middle Aged, Mobility Limitation, Odds Ratio, Poverty, Retrospective Studies, Sampling Studies, San Francisco, Socioeconomic factors, Surveys and Questionnaires, White People}, issn = {0002-9262}, doi = {10.1093/aje/kwm185}, author = {Sandra Y. Moody-Ayers and Lindquist, Karla and Sen, Saunak and Kenneth E Covinsky} } @article {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 {7128, title = {Does money buy better health? Unpacking the income to health association after midlife.}, journal = {Health (London)}, volume = {11}, year = {2007}, month = {2007 Apr}, pages = {199-226}, publisher = {11}, abstract = {

This article estimates the effect of household financial resources on health after midlife using models that minimize health-related selectivity and unobserved heterogeneity bias. I focus on the self-rated health and mobility limitations of adults transitioning into retirement over six panels of the Health and Retirement Study (1992-2002; age 51-61 at wave one; N = 7602). Standard regression models that adjust for health-related selection with prospective and retrospective controls suggest a significant influence of long-term income on health, but an insignificant influence of short-term income. Further adjustment for unobserved fixed effects also suggests that short-term income is insignificant. Sizable recent and long-term health feedbacks to income for a portion of the HRS respondents underscore the need to control for the confounding influence of health over the lifecourse. Together these results suggest that adults after midlife are heterogeneous with respect to the causal and selective processes generating the observed association between income and health.

}, keywords = {Aged, Attitude to Health, Employment, Health Status Indicators, Humans, Income, Middle Aged, Mobility Limitation, Models, Econometric, Retirement, Self Concept, Sociology, Medical, United States}, issn = {1363-4593}, doi = {10.1177/1363459307074694}, author = {Berry, Brent M.} } @article {7177, title = {Does more health care improve health among older adults? A longitudinal analysis.}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Dec}, pages = {888-906}, publisher = {19}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Health Services, Health Services for the Aged, Health Status, Humans, Longitudinal Studies, United States}, issn = {0898-2643}, doi = {10.1177/0898264307308338}, author = {Ezra Golberstein and Jersey Liang and A. R. Quinones and Frederic D Wolinsky} } @article {7178, title = {Does physician communication influence older patients{\textquoteright} diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS).}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {62}, year = {2007}, month = {2007 Dec}, pages = {1435-42}, publisher = {62A}, abstract = {

BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients{\textquoteright} diabetes self-management and glycemic control.

METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81\%). Independent associations were examined between patients{\textquoteright} ratings of their physician{\textquoteright}s PCOM and PDM with patients{\textquoteright} reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.

RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).

CONCLUSION: Among these older adults, both their diabetes providers{\textquoteright} provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.

}, keywords = {Aged, Blood Glucose, Communication, Cross-Sectional Studies, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Male, Multivariate Analysis, Physician-Patient Relations, Self Care}, issn = {1079-5006}, doi = {10.1093/gerona/62.12.1435}, author = {Michele M Heisler and Cole, Ian and David R Weir and Eve A Kerr and Rodney A. Hayward} } @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 {7139, title = {The economic consequences of widowhood for older minority women.}, journal = {Gerontologist}, volume = {47}, year = {2007}, month = {2007 Apr}, pages = {224-34}, publisher = {47}, abstract = {

PURPOSE: We compare the economic consequences of widowhood for pre-retirement age and early-retirement age Black, Hispanic, and non-Hispanic White women.

METHODS: We use the 1992 and 2000 waves of the Health and Retirement Study to assess the effects of widowhood on the household incomes and assets of non-Hispanic White, Black, and Hispanic women who were 51 years of age or older at baseline (N = 4,544).

RESULTS: For women of all racial and ethnic groups, marital disruption, including widowhood, results in a substantial decline in household income and assets. Net of demographic controls, the relative loss is far greater for Black and Hispanic widows than for non-Hispanic White widows.

IMPLICATIONS: The data reveal a substantial widowhood penalty for total household income and net worth for women in each racial and ethnic group. However, the findings suggest that minority widows are at a particularly high risk of poverty in late life, given that they have lower incomes and fewer assets to begin with. Implications of the results for the financial security of women approaching retirement are discussed.

}, keywords = {Aged, Black or African American, Female, Hispanic or Latino, Humans, Longitudinal Studies, Middle Aged, United States, White People, Widowhood}, issn = {0016-9013}, doi = {10.1093/geront/47.2.224}, author = {Jacqueline L. Angel and Maren A. Jimenez and Ronald J. Angel} } @article {7143, title = {Educational disparities in the prevalence and consequence of physical vulnerability.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S193-7}, publisher = {62B}, abstract = {

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States.

METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index.

RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53\%) of these adults had less than 12 years of education.

DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Cross-Sectional Studies, Educational Status, Female, Geriatric Assessment, Health Surveys, Humans, Male, Mobility Limitation, Risk Factors, Socioeconomic factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s193}, author = {Daniel O. Clark and Timothy E. Stump and Douglas K Miller and Long, J. Scott} } @article {8741, title = {Evidence on early-life income and late-life health from America{\textquoteright}s Dust Bowl era.}, journal = {Proceedings of the National Academy of Sciences }, volume = {104}, year = {2007}, month = {2007 Aug 14}, pages = {13244-9}, abstract = {

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

}, keywords = {Aged, Data collection, Female, Health Status, History, 20th Century, Humans, Income, Male, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {0027-8424}, doi = {10.1073/pnas.0700035104}, author = {David M Cutler and Grant Miller and Douglas M Norton} } @article {7188, title = {Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services.}, journal = {BMC Health Serv Res}, volume = {7}, year = {2007}, month = {2007 May 09}, pages = {70}, publisher = {7}, abstract = {

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality.

METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used.

RESULTS: 897 (59\%) of the men were veterans, of whom 134 (15\%) were dual users. Among dual users, 60 (45\%) met the criterion based on inpatient services, 54 (40\%) based on outpatient services, and 20 (15\%) based on both. 766 men (50\%) died. Adjusting for covariates, the independent effect of any dual use was a 38\% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45\% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98\% (AHR = 1.98; p = .02).

CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Care, Cluster Analysis, Continuity of Patient Care, Emergency Service, Hospital, Episode of Care, Hospital Mortality, Hospitals, Veterans, Humans, Male, Medicare, Proportional Hazards Models, United States, Veterans}, issn = {1472-6963}, doi = {10.1186/1472-6963-7-70}, author = {Frederic D Wolinsky and An, Hyonggin and Li Liu and Thomas R Miller and Gary E Rosenthal} } @article {7137, title = {Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {137-58}, publisher = {44}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Cardiovascular Diseases, depression, Diabetes Mellitus, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Medically Uninsured, Medicare, Middle Aged, Outcome Assessment, Health Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.298.24.2886}, author = {J. Michael McWilliams and Meara, Ellen and Alan M. Zaslavsky and John Z. Ayanian} } @article {7187, title = {Hospital episodes and physician visits: the concordance between self-reports and medicare claims.}, journal = {Med Care}, volume = {45}, year = {2007}, month = {2007 Apr}, pages = {300-7}, publisher = {45}, abstract = {

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

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

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

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

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

}, keywords = {Aged, Centers for Medicare and Medicaid Services, U.S., Episode of Care, Female, Hospitalization, Humans, Insurance Claim Review, Interviews as Topic, Male, Physicians, Quality Assurance, Health Care, Self Disclosure, United States}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000254576.26353.09}, author = {Frederic D Wolinsky and Thomas R Miller and An, Hyonggin and John F Geweke and Robert B Wallace and Kara B Wright and Elizabeth A Chrischilles and Li Liu and Claire E Pavlik and Elizabeth A Cook and Robert L. Ohsfeldt and Kelly K Richardson and Gary E Rosenthal} } @article {7140, title = {Informal caregiving and Body Mass Index among older adults.}, journal = {J Gerontol Nurs}, volume = {33}, year = {2007}, month = {2007 Apr}, pages = {42-51}, publisher = {33}, abstract = {

The authors sought to obtain nationally representative estimates of the time of informal caregiving provided to older adults classified into the four standard Body Mass Index (BMI) classifications. They estimated multivariate regression models using data from the 2000 Health and Retirement Study to determine the weekly hours of informal caregiving for older adults classified into the four standard BMI classifications. In the fully adjusted models, being underweight was associated with receiving significantly more informal care, however, obesity was not associated with more informal care. The implications of these findings are discussed in terms of nursing practice and research to prevent weight loss and frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Mass Index, Body Weight, Caregivers, Female, Geriatric Assessment, Humans, Male, Social Class}, issn = {0098-9134}, doi = {10.3928/00989134-20070401-06}, author = {Kristi Rahrig Jenkins and Mohammed U Kabeto and Fultz, Nancy H. and Kenneth M. Langa} } @article {7161, title = {An interpersonal continuity of care measure for Medicare Part B claims analyses.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S160-8}, publisher = {62B}, abstract = {

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3\%, and interpersonal continuity of care with any physician was 26.1\%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Disability Evaluation, Female, Health Services Accessibility, Health Surveys, Humans, Insurance Claim Review, Male, Medicare Part B, Mobility Limitation, Physician-Patient Relations, Primary Health Care, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s160}, author = {Frederic D Wolinsky and Thomas R Miller and John F Geweke and Elizabeth A Chrischilles and An, Hyonggin and Robert B Wallace and Claire E Pavlik and Kara B Wright and Robert L. Ohsfeldt and Gary E Rosenthal} } @article {7153, title = {Latent variable analyses of age trends of cognition in the Health and Retirement Study, 1992-2004.}, journal = {Psychol Aging}, volume = {22}, year = {2007}, month = {2007 Sep}, pages = {525-545}, publisher = {22}, abstract = {

The present study was conducted to better describe age trends in cognition among older adults in the longitudinal Health and Retirement Study (HRS) from 1992 to 2004 (N = 17,000). The authors used contemporary latent variable models to organize this information in terms of both cross-sectional and longitudinal inferences about age and cognition. Common factor analysis results yielded evidence for at least 2 common factors, labeled Episodic Memory and Mental Status, largely separable from vocabulary. Latent path models with these common factors were based on demographic characteristics. Multilevel models of factorial invariance over age indicated that at least 2 common factors were needed. Latent curve models of episodic memory were based on age at testing and showed substantial age differences and age changes, including impacts due to retesting as well as several time-invariant and time-varying predictors.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Health Surveys, Humans, Individuality, Longitudinal Studies, Male, Mental Recall, Mental Status Schedule, Middle Aged, Models, Statistical, Neuropsychological tests, Psychometrics, Retention, Psychology, Sex Factors, United States}, issn = {0882-7974}, doi = {10.1037/0882-7974.22.3.525}, author = {John J McArdle and Gwenith G Fisher and Kelly M Kadlec} } @article {7126, title = {Longitudinal variable selection by cross-validation in the case of many covariates.}, journal = {Stat Med}, volume = {26}, year = {2007}, month = {2007 Feb 20}, pages = {919-30}, publisher = {26}, abstract = {

Longitudinal models are commonly used for studying data collected on individuals repeatedly through time. While there are now a variety of such models available (marginal models, mixed effects models, etc.), far fewer options exist for the closely related issue of variable selection. In addition, longitudinal data typically derive from medical or other large-scale studies where often large numbers of potential explanatory variables and hence even larger numbers of candidate models must be considered. Cross-validation is a popular method for variable selection based on the predictive ability of the model. Here, we propose a cross-validation Markov chain Monte Carlo procedure as a general variable selection tool which avoids the need to visit all candidate models. Inclusion of a {\textquoteright}one-standard error{\textquoteright} rule provides users with a collection of good models as is often desired. We demonstrate the effectiveness of our procedure both in a simulation setting and in a real application.

}, keywords = {Cohort Studies, Computer Simulation, Female, Humans, Linear Models, Longitudinal Studies, Male, Markov chains, Monte Carlo Method, Smoking, Socioeconomic factors}, issn = {0277-6715}, doi = {10.1002/sim.2572}, author = {Cantoni, E. and Field, C. and Mills Fleming, J. and Ronchetti, E.} } @article {7123, title = {The long-term effects of poor childhood health: an assessment and application of retrospective reports.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {113-35}, publisher = {44}, abstract = {

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

}, keywords = {Adolescent, Adult, Age Factors, Aged, Child, Child Welfare, Child, Preschool, Chronic disease, Disabled Persons, Female, Health Status, Humans, Infant, Infant, Newborn, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Time, United States}, issn = {0070-3370}, doi = {10.1353/dem.2007.0003}, author = {Steven A Haas} } @article {7168, title = {Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study.}, journal = {Arch Intern Med}, volume = {167}, year = {2007}, month = {2007 Sep 24}, pages = {1853-60}, publisher = {167}, abstract = {

BACKGROUND: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.

METHODS: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

RESULTS: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihyperglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07\% in black respondents and 8.14\% in Latino respondents compared with 7.22\% in white respondents (P < .001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < .001). Adjusting for hypothesized mechanisms accounted for 14.0\% of the higher HbA(1c) levels in black respondents and 19.0\% in Latinos, with the full model explaining 22.0\% of the variance. Besides black and Latino ethnicity, only insulin use (P < .001), age younger than 65 years (P = .007), longer diabetes duration (P = .004), and lower self-reported medication adherence (P = .04) were independently associated with higher HbA(1c) levels.

CONCLUSIONS: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities--medication adherence--was among the most significant independent predictors of glycemic control.

}, keywords = {Aged, Aged, 80 and over, Black People, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Accessibility, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Patient Compliance, Socioeconomic factors, Treatment Refusal, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.167.17.1853}, author = {Michele M Heisler and Jessica Faul and Rodney A. Hayward and Kenneth M. Langa and Caroline S Blaum and David R Weir} } @article {7144, title = {New evidence of racial differences in access and their effects on the use of nursing homes among older adults.}, journal = {Med Care}, volume = {45}, year = {2007}, month = {2007 Jul}, pages = {672-9}, publisher = {45}, abstract = {

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

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

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

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

}, keywords = {Aged, Assisted Living Facilities, Attitude to Health, Black or African American, Female, Health Services Accessibility, Health Status, Homes for the Aged, Humans, Male, Nursing homes, Socioeconomic factors, Time Factors, White People}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e3180455677}, author = {Adaeze B Akamigbo and Frederic D Wolinsky} } @article {7122, title = {Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics.}, journal = {J Pain}, volume = {8}, year = {2007}, month = {2007 Jan}, pages = {75-84}, publisher = {8}, abstract = {

UNLABELLED: Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28\%, and 17\% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99\% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99\% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99\% CI, 1.09-2.17), psychological distress (OR, 1.99; 99\% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99\% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99\% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.

PERSPECTIVE: This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Black People, Chronic disease, Data collection, ethnicity, Female, Hispanic or Latino, Humans, Insurance, Health, Logistic Models, Male, Middle Aged, pain, Pain Measurement, Population, Socioeconomic factors, United States, White People}, issn = {1526-5900}, doi = {10.1016/j.jpain.2006.06.002}, author = {Reyes-Gibby, Cielito C. and Aday, Lu Ann and Todd, Knox H. and Cleeland, Charles S. and Anderson, Karen O.} } @article {7127, title = {Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders.}, journal = {J Nutr}, volume = {137}, year = {2007}, month = {2007 Apr}, pages = {1005-10}, publisher = {137}, abstract = {

The relation of food insecurity in elders with outcomes such as overweight and depression, and the influence of participation in food assistance programs on these relations, has not been established. The aim of this study was to examine the relation between food insecurity and weight and depression in elders, and determine whether participation in food assistance programs modifies the effect of food insecurity on weight and depression. Two longitudinal data sets were used: the Health and Retirement Study (1996-2002) and the Asset and Health Dynamics Among the Oldest Old (1995-2002). The relation of food insecurity and participation in food assistance programs was assessed by multilevel linear regression analysis. Food insecurity was positively related to weight and depression among elders. Some analyses supported that food-insecure elders who participated in food assistance programs were less likely to be overweight and depressed than those who did not participate in food assistance programs. This finding implies that food assistance programs can have both nutritional and non-nutritional impacts. The positive impact of participation in food assistance programs of reducing or preventing poor outcomes resulting from food insecurity will improve elders{\textquoteright} quality of life, save on their healthcare expenses, and help to meet their nutritional needs.

}, keywords = {Aged, depression, Female, Food Services, Food Supply, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Models, Theoretical, Overweight, Public Assistance, United States}, issn = {0022-3166}, doi = {10.1093/jn/137.4.1005}, author = {Kim, Kirang and Edward A Frongillo} } @article {7130, title = {Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute?}, journal = {J Aging Health}, volume = {19}, year = {2007}, month = {2007 Feb}, pages = {152-77}, publisher = {19}, abstract = {

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

}, keywords = {Aged, Caregivers, depression, Employment, Female, Forecasting, Health Behavior, Health Status, Humans, Male, Marital Status, Middle Aged, Netherlands, Regression Analysis, Sweden, United States, Volunteers}, issn = {0898-2643}, doi = {10.1177/0898264306297602}, author = {Namkee G Choi and Bohman, Thomas M.} } @article {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 {8850, title = {Profiling retirees in the retirement transition and adjustment process: examining the longitudinal change patterns of retirees{\textquoteright} psychological well-being.}, journal = {Journal of Applied Psychology}, volume = {92}, year = {2007}, month = {2007 Mar}, pages = {455-74}, abstract = {

The author used role theory, continuity theory, and the life course perspective to form hypotheses regarding the different retirement transition and adjustment patterns and how different individual and contextual variables related to those patterns. The longitudinal data of 2 samples (n(1) = 994; n(2) = 1,066) from the Health and Retirement Survey were used. Three latent growth curve patterns of retirees{\textquoteright} psychological well-being were identified as coexisting in the retiree samples through growth mixture modeling (GMM) analysis. On the basis of the latent class membership derived from GMM, retiree subgroups directly linked to different growth curve patterns were profiled with individual (e.g., bridge job status) and contextual variables (e.g., spouse working status). By recognizing the existence of multiple retiree subgroups corresponding to different psychological well-being change patterns, this study suggests that retirees do not follow a uniform adjustment pattern during the retirement process, which reconciles inconsistent previous findings. A resource perspective is further introduced to provide a more integrated theory for the current findings. The practical implications of this study are also discussed at both individual level and policy level.

}, keywords = {Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Retirement, Social Adjustment}, issn = {0021-9010}, doi = {10.1037/0021-9010.92.2.455}, author = {Wang, Mo} } @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 {7184, title = {The relationship between self-rated health and mortality in older black and white Americans.}, journal = {J Am Geriatr Soc}, volume = {55}, year = {2007}, month = {2007 Oct}, pages = {1624-9}, publisher = {55}, abstract = {

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

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

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

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

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

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

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Black People, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Mortality, Population Surveillance, Prognosis, Self Disclosure, Sex Distribution, United States, White People}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2007.01360.x}, author = {Sei J. Lee and Sandra Y. Moody-Ayers and C. Seth Landefeld and Louise C Walter and Lindquist, Karla and Mark Segal and Kenneth E Covinsky} } @article {7138, title = {Risk of nursing home admission among older americans: does states{\textquoteright} spending on home- and community-based services matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S169-78}, publisher = {62B}, abstract = {

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states{\textquoteright} generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35\%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost Savings, Cost-Benefit Analysis, Female, Financing, Government, Health Expenditures, Home Care Services, Homes for the Aged, Humans, Insurance Coverage, Long-term Care, Male, Medicaid, Medicare, Nursing homes, Patient Admission, Patient Readmission, Risk Assessment, Risk Factors, State Health Plans, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s169}, author = {Muramatsu, Naoko and yin, Hongjun and Richard T. Campbell and Ruby L Hoyem and Martha A. Jacob and Christopher Ross} } @article {7132, title = {Self-rated health trajectories and mortality among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S22-7}, publisher = {62}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Aged, Aged, 80 and over, Attitude to Health, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, Health Status, Health Status Indicators, Humans, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Mortality, Multivariate Analysis, Risk Factors, Sex Factors, Smoking, Socioeconomic factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s22}, author = {Thomas R Miller and Frederic D Wolinsky} } @article {7154, title = {Should health studies measure wealth? A systematic review.}, journal = {Am J Prev Med}, volume = {33}, year = {2007}, month = {2007 Sep}, pages = {250-64}, publisher = {33}, abstract = {

BACKGROUND: Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health.

METHODS: Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable.

RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health.

CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies.

}, keywords = {Bias, Biomedical Research, Female, Financing, Personal, Health Services Research, Health Status Indicators, Humans, Male, Research Design, Socioeconomic factors}, issn = {0749-3797}, doi = {10.1016/j.amepre.2007.04.033}, author = {Craig E Pollack and Chideya, Sekai and Cubbin, Catherine and Brie A Williams and Dekker, Mercedes and Paula Braveman} } @article {7155, title = {Is the {\textquoteright}stroke belt{\textquoteright} worn from childhood?: risk of first stroke and state of residence in childhood and adulthood.}, journal = {Stroke}, volume = {38}, year = {2007}, month = {2007 Sep}, pages = {2415-21}, publisher = {38}, abstract = {

BACKGROUND AND PURPOSE: Most Stroke Belt studies define exposure based on residence at stroke onset. We assessed whether residence in the Stroke Belt during childhood confers extra stroke risk in adulthood, even among people who left the region.

METHODS: Stroke-free Health and Retirement Study participants (n=18 070) followed up (average, 8.4 years) for first stroke (1452 events) were classified as living in 1 of 7 Stroke Belt states in childhood or at study enrollment (average age, 63 years). We used Cox proportional-hazards models to compare stroke risk for people who had never lived in the Stroke Belt with those who had lived there at both ages, in childhood only, or in adulthood only.

RESULTS: Compared with never having lived in the Stroke Belt, the hazard ratio for Stroke Belt residence in both childhood and adulthood was 1.23 (95\% CI, 1.06, 1.43) and for Stroke Belt residence in childhood only was 1.25 (95\% CI, 1.02, 1.55). Stroke Belt residence at enrollment but not during childhood was not significantly related to stroke risk (hazard ratio=1.01; 95\% CI, 0.70, 1.46), but the small sample in this group resulted in wide CIs. Results changed little after risk factor adjustment, including comprehensive adult socioeconomic measures. Subgroup analyses found similar patterns by sex and birth cohort. In contrast, blacks who had lived in the Stroke Belt in childhood only did not appear to have significantly elevated stroke risk compared with blacks who had never lived in the Stroke Belt.

CONCLUSIONS: The excess stroke risk for people who had lived in Stroke Belt states during childhood implicates early life exposures in the etiology of the Stroke Belt.

}, keywords = {Adult, Child, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Southeastern United States, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.107.482059}, author = {M. Maria Glymour and Mauricio Avendano and Lisa F Berkman} } @article {7133, title = {Urban neighborhoods and depressive symptoms among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S52-9}, publisher = {62}, abstract = {

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older.

METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models.

RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population.

DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status Indicators, Health Surveys, Humans, Incidence, Male, Minority Groups, Peer Group, Population Dynamics, Risk Factors, Social Environment, United States, Urban Population}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s52}, author = {Carol S Aneshensel and Richard G Wight and Miller-Martinez, Dana and Amanda L. Botticello and Arun S Karlamangla and Teresa Seeman} } @article {7160, title = {Use of health services by previously uninsured Medicare beneficiaries.}, journal = {N Engl J Med}, volume = {357}, year = {2007}, month = {2007 Jul 12}, pages = {143-53}, publisher = {357}, abstract = {

BACKGROUND: Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study to assess self-reported health care use and expenditures from 1992 through 2004 among 5158 adults who were privately insured or uninsured before Medicare coverage began at the age of 65 years. We used propensity-score methods to compare health care use and expenditures for previously insured and uninsured beneficiaries who were similar across numerous characteristics at 59 to 60 years of age and adjusted for differences in supplemental and prescription-drug coverage after 65 years of age.

RESULTS: Among 2951 adults with hypertension, diabetes, heart disease, or stroke diagnosed before 65 years of age, previously uninsured adults who acquired Medicare coverage at the age of 65 reported significantly greater increases in the numbers of doctor visits (P<0.001) and hospitalizations (P=0.001) and in total medical expenditures (P=0.02) than did previously insured adults. Significant differential increases were not evident among the 2207 adults without these conditions (P>0.12 for all comparisons). In analyses adjusted for supplemental and prescription-drug coverage, previously uninsured adults with these conditions reported more doctor visits (13\% relative difference, P=0.04), more hospitalizations (20\% relative difference, P=0.04), and higher total medical expenditures (51\% relative difference, P=0.09) from ages 65 to 72 years than did previously insured adults.

CONCLUSIONS: The costs of expanding health insurance coverage for uninsured adults before they reach the age of 65 years may be partially offset by subsequent reductions in health care use and spending for these adults after the age of 65, particularly if they have cardiovascular disease or diabetes before the age of 65 years.

}, keywords = {Aged, Cardiovascular Diseases, Diabetes Mellitus, Female, Health Expenditures, Health Services, Hospitalization, Humans, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Medicare, Middle Aged, Socioeconomic factors, United States}, issn = {1533-4406}, doi = {10.1056/NEJMsa067712}, author = {J. Michael McWilliams and Meara, Ellen and Alan M. Zaslavsky and John Z. Ayanian} } @article {7129, title = {Use of preventive care by the working poor in the United States.}, journal = {Prev Med}, volume = {44}, year = {2007}, month = {2007 Mar}, pages = {254-9}, publisher = {44}, abstract = {

OBJECTIVE: Examine the association between poverty and preventive care use among older working adults.

METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200\% of the federal poverty level were defined as poor.

RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38\% (influenza vaccination) to 76\% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95\% CI, 0.86-0.96), prostate cancer (RR 0.89, 95\% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95\% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95\% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95\% CI, 0.84-1.01).

CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.

}, keywords = {Cost of Illness, Cross-Sectional Studies, Employment, Female, Health Promotion, Health Services Accessibility, Health Services Needs and Demand, Humans, Male, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Poverty, Preventive Health Services, Risk Assessment, Socioeconomic factors, United States, Vulnerable Populations}, issn = {0091-7435}, doi = {10.1016/j.ypmed.2006.11.006}, author = {Joseph S. Ross and Bernheim, Susannah M. and Elizabeth H Bradley and Teng, Hsun-Mei and William T Gallo} } @article {7131, title = {Weight and depressive symptoms in older adults: direction of influence?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S43-51}, publisher = {62}, abstract = {

OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95\% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95\% CI = 1.00-1.54; women: OR = 1.12, 95\% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Depressive Disorder, Female, Health Status Indicators, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Odds Ratio, Prospective Studies, Sex Factors, Statistics as Topic, United States, Weight Gain, Weight Loss}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s43}, author = {Valerie L Forman-Hoffman and Jon W. Yankey and Stephen L Hillis and Robert B Wallace} } @article {7189, title = {What a drop can do: dried blood spots as a minimally invasive method for integrating biomarkers into population-based research.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Nov}, pages = {899-925}, publisher = {44}, abstract = {

Logistical constraints associated with the collection and analysis of biological samples in community-based settings have been a significant impediment to integrative, multilevel bio-demographic and biobehavioral research. However recent methodological developments have overcome many of these constraints and have also expanded the options for incorporating biomarkers into population-based health research in international as well as domestic contexts. In particular using dried blood spot (DBS) samples-drops of whole blood collected on filter paper from a simple finger prick-provides a minimally invasive method for collecting blood samples in nonclinical settings. After a brief discussion of biomarkers more generally, we review procedures for collecting, handling, and analyzing DBS samples. Advantages of using DBS samples-compared with venipuncture include the relative ease and low cost of sample collection, transport, and storage. Disadvantages include requirements for assay development and validation as well as the relatively small volumes of sample. We present the results of a comprehensive literature review of published protocols for analysis of DBS samples, and we provide more detailed analysis of protocols for 45 analytes likely to be of particular relevance to population-level health research. Our objective is to provide investigators with the information they need to make informed decisions regarding the appropriateness of blood spot methods for their research interests.

}, keywords = {Biomarkers, Blood Specimen Collection, Humans, Phlebotomy, Preservation, Biological}, issn = {0070-3370}, doi = {10.1353/dem.2007.0038}, author = {Thomas W McDade and Sharon Williams and J Josh Snodgrass} } @article {7098, title = {Changes in health for the uninsured after reaching age-eligibility for Medicare.}, journal = {J Gen Intern Med}, volume = {21}, year = {2006}, month = {2006 Nov}, pages = {1144-9}, publisher = {21}, abstract = {

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

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

DESIGN: Prospective cohort study.

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Demography, Female, Health Status, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Residence Characteristics, Sexual Partners, Surveys and Questionnaires, United States}, issn = {1079-5014}, doi = {10.1093/geronb/61.2.s71}, author = {Susan L. Brown and Lee, Gary R. and Jennifer R. Bulanda} } @article {7064, title = {Crediting care or marriage? Reforming Social Security family benefits.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Jan}, pages = {S24-34}, publisher = {61}, abstract = {

OBJECTIVE: For more than 20 years policy advocates and policymakers have argued that Social Security should reward women for raising children. Current family benefits, which only benefit women who marry, are thought to be outdated and unable to protect the neediest women. Thus, would Black and poor women fare better if family benefits were linked to parenthood, as opposed to marriage? I examined three care credit proposals that reflect the most common proposals put forth in the United States and the most common designs in other countries.

METHODS: I used the 1992 Health and Retirement Study and the Current Population Survey to create a policy simulation that estimates how women reaching age 62 from 2020 to 2030 would be affected by care credits.

RESULT: Black and poor women fared best with benefits linked to parenthood. The specific proposal allowed parents, from the 35 earnings years used to calculate their benefit, to substitute $15,000 for up to 9 earnings{\textquoteright} years that fell below this level.

DISCUSSION: The poorest women fare better with family benefits linked to parenthood instead of marital status. Moreover, they fare best when working women can benefit from care credits, but the care credit{\textquoteright}s value is not linked to earnings.

}, keywords = {Family, Female, Humans, Insurance Benefits, Marital Status, Mothers, Social Security, United States}, issn = {1079-5014}, doi = {10.1093/geronb/61.1.s24}, author = {Herd, Pamela} } @article {7105, title = {Driving cessation and consumption expenses in the later years.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Nov}, pages = {S347-53}, publisher = {61B}, abstract = {

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

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

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

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

}, keywords = {Aged, Automobile Driving, Economics, Female, Health Status, Humans, Male, Sex Factors, Surveys and Questionnaires, Transportation}, issn = {1079-5014}, doi = {10.1093/geronb/61.6.s347}, author = {Hyungsoo Kim and Virginia E. Richardson} } @article {7116, title = {Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?}, journal = {BMC Health Serv Res}, volume = {6}, year = {2006}, month = {2006 Oct 09}, pages = {131}, publisher = {6}, abstract = {

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11\%) of the veterans were classified as dual users. 766 men (50.3\%) had died by December 31, 2002, including 64.9\% of the dual users and 49.3\% of all others, for an attributable mortality risk of 15.6\% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1\% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans{\textquoteright} dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

}, keywords = {Aged, Aged, 80 and over, Deductibles and Coinsurance, Episode of Care, Health Services Research, Hospitals, Veterans, Humans, Male, Medicare, Mortality, Outcome Assessment, Health Care, Proportional Hazards Models, Quality Indicators, Health Care, Risk Assessment, Selection Bias, Surveys and Questionnaires, United States, United States Department of Veterans Affairs, Veterans}, issn = {1472-6963}, doi = {10.1186/1472-6963-6-131}, author = {Frederic D Wolinsky and Thomas R Miller and An, Hyonggin and Paul R Brezinski and Thomas E Vaughn and Gary E Rosenthal} } @article {7095, title = {The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study.}, journal = {Health Serv Res}, volume = {41}, year = {2006}, month = {2006 Jun}, pages = {759-87}, publisher = {41}, abstract = {

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

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

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

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

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

}, keywords = {Chronic disease, Data collection, Female, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Private Sector, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2006.00513.x}, author = {Avi Dor and Joseph J Sudano and David W. Baker} } @article {7115, title = {The effect of recurrent involuntary job loss on the depressive symptoms of older US workers.}, journal = {Int Arch Occup Environ Health}, volume = {80}, year = {2006}, month = {2006 Nov}, pages = {109-16}, publisher = {80}, abstract = {

OBJECTIVES: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses.

METHODS: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51-61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff.

RESULTS: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms.

CONCLUSIONS: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.

}, keywords = {Adaptation, Physiological, depression, Employment, Female, Humans, Life Change Events, Longitudinal Studies, Male, Middle Aged, Retirement, Stress, Psychological, United States}, issn = {0340-0131}, doi = {10.1007/s00420-006-0108-5}, author = {William T Gallo and Elizabeth H Bradley and Teng, Hsun-Mei and Stanislav V Kasl} } @article {7070, title = {Effects of retirement and grandchild care on depressive symptoms.}, journal = {Int J Aging Hum Dev}, volume = {62}, year = {2006}, month = {2006}, pages = {1-20}, publisher = {62}, abstract = {

This study explores how grandchild care in conjunction with grandparents{\textquoteright} retirement affects depressive symptoms, using data from the Health and Retirement Survey. The findings demonstrate that retirement moderates the influence of grandchild care obligations on well-being, measured by depressive symptoms. For retired men, freedom from grandchild care obligations is associated with heightened well-being. Among women, continued employment seems to protect against potential negative effects of extensive grandchild care obligations on well-being. The results for men seem most in line with the argument that family care obligations spoil retirement, whereas the results for women suggest a scenario that is most compatible with the role enhancement thesis.

}, keywords = {Aged, Aging, Child, Child Rearing, depression, Family Characteristics, Female, Holistic health, Humans, Intergenerational Relations, Leisure activities, Longitudinal Studies, Male, Middle Aged, Retirement, Sex Factors, Social Responsibility, Surveys and Questionnaires, United States}, issn = {0091-4150}, doi = {10.2190/8Q46-GJX4-M2VM-W60V}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {7003, title = {Expansion of elderly couples{\textquoteright} IADL caregiver networks beyond the marital dyad.}, journal = {Int J Aging Hum Dev}, volume = {63}, year = {2006}, month = {2006}, pages = {95-113}, publisher = {37}, abstract = {

Factors influencing expansion of instrumental activities of daily living (IADL) caregiver networks beyond the spouse/partner were studied, using data from the Asset and Health Dynamics among the Oldest Old (AHEAD) nationally representative sample of American elders (ages 70 and older). Analyses were based on 427 Black and White couples in which one partner regularly received IADL assistance; nearly 20\% had expanded networks. Logistic regression showed expanded networks were significantly more likely when spouses had IADL or basic personal activity of everyday living (ADL) limitations and help recipients were wives or had numerous IADL or ADL limitations; they also tended to be more common (p <.10) for couples with numerous nearby daughters and help recipients with proxies and those without serious cognitive problems. Network expansion was unrelated to recipients{\textquoteright} number of health conditions and Medicaid coverage or couples{\textquoteright} ages, marital duration, income, and number of proximate sons. Implications for service programs and caregiving theories of the circumstances linked to IADL assistance from outside the marital dyad are discussed.

}, keywords = {Activities of Daily Living, Aged, Caregivers, Female, Humans, Logistic Models, Male, Marriage, Multivariate Analysis, Self-Help Groups}, issn = {0091-4150}, doi = {10.2190/CW8G-PB6B-NCGH-HT1M}, author = {Sheila Feld and Ruth E Dunkle and Tracy Schroepfer} } @article {7072, title = {Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance.}, journal = {Soc Sci Med}, volume = {62}, year = {2006}, month = {2006 Feb}, pages = {909-22}, publisher = {62}, abstract = {

Pervasive health disparities continue to exist among racial/ethnic minority groups, but the factors related to these disparities have not been fully elucidated. We undertook this prospective cohort study to determine the independent contributions of socioeconomic status (SES), health behaviors, and health insurance in explaining racial/ethnic disparities in mortality and health declines. Our study period was 1992-1998, and our study population consists of a US nationally representative sample of 6286 non-Hispanic whites (W), 1391 non-Hispanic blacks (B), 405 Hispanics interviewed in English (H/E), and 318 Hispanics interviewed in Spanish (H/S), ages 51-61 in 1992 in the Health and Retirement Study. The main outcome measures were death; major decline in self-reported overall health (SROH); and combined outcome of death or major decline in SROH. Crude mortality rates over the 6-year study period for W, B, H/E and H/S were 5.8\%, 10.6\%, 5.8\%, and 4.4\%, respectively. Rates of major decline in SROH were 14.6\%, 23.2\%, 22.1\% and 39.4\%, for W, B, H/E and H/S, respectively. Higher mortality rates for B versus W were mostly explained by worse baseline health. For major decline in SROH, education, income, and net worth independently explained more of the disparities for all three minority groups as compared to health behaviors and insurance, reducing the effect for B and H/E to non-significance, while leaving a significant elevated odds ratio for H/S. Without addressing the as-yet undetermined and pernicious effects of lower SES, public health initiatives that promote changing individual health behaviors and increasing rates of insurance coverage among blacks and Hispanics will not eliminate racial/ethnic health disparities.

}, keywords = {Black or African American, Cohort Studies, Female, Health Behavior, Health Status Disparities, Hispanic or Latino, Humans, Insurance, Health, Logistic Models, Male, Medically Uninsured, Middle Aged, Mortality, Poverty, Risk Assessment, Social Class, Sociology, Medical, United States, White People}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2005.06.041}, author = {Joseph J Sudano and David W. Baker} } @article {7114, title = {Functional impairment, race, and family expectations of death.}, journal = {J Am Geriatr Soc}, volume = {54}, year = {2006}, month = {2006 Nov}, pages = {1682-7}, publisher = {54}, abstract = {

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant{\textquoteright}s death. The primary outcome was whether death was expected. The primary predictors were the decedent{\textquoteright}s functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent{\textquoteright}s race.

RESULTS: Overall, 58\% of families reported that their family member{\textquoteright}s death was expected. Expecting death was strongly associated with functional impairment; 71\% of families of decedents with ADL disability expected death, compared with 24\% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60\%) than African Americans (49\%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95\% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95\% CI = 0.46-0.86).

CONCLUSION: Family members of older adults expected death only 58\% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.

}, keywords = {Activities of Daily Living, Aged, Attitude to Death, Black or African American, Cross-Sectional Studies, Disabled Persons, Family, Female, Hispanic or Latino, Humans, Male, White People}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2006.00941.x}, author = {Brie A Williams and Lindquist, Karla and Sandra Y. Moody-Ayers and Louise C Walter and Kenneth E Covinsky} } @article {7092, title = {Increased wealth and income as correlates of self-assessed retirement.}, journal = {J Gerontol Soc Work}, volume = {47}, year = {2006}, month = {2006}, pages = {175-201}, publisher = {47}, abstract = {

This study examined whether retirement implies complete withdrawal from the labor force and the role that increased wealth and income play in regard to the nature of retirement. Data came from the Health \& Retirement Study, Waves 1-5. Findings indicated that most study sample pre-retirees remained in the labor force as they moved into what are considered the normal retirement years. As they moved on average from 50+ years of age to 60+ years of age, increasing percentages of study sample pre-retirees reported themselves as completely retired. Those who viewed themselves as completely retired were far less likely to work than those who did not view themselves as completely retired. Of particular importance was the finding that increased income in 2000 decreased the likelihood of self-reported complete retirement. Equally important was the finding that increased assets had no effect on retirement status with the exception of survey year 1998 when increased assets decreased the likelihood of viewing oneself as completely retired. Findings suggested that pro-work retirement policies aimed at increasing labor force participation among pre-retirees and increasing the normal retirement age can be effective. Five pro-work policies were discussed.

}, keywords = {Aged, Data collection, Employment, Female, Financing, Personal, Humans, Income, Interviews as Topic, Male, Middle Aged, Motivation, Organizational Policy, Pensions, Retirement, Self-Assessment, Social Security, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v47n01_11}, author = {Caputo, Richard K.} } @article {7089, title = {Insurance coverage and health care use among near-elderly women.}, journal = {Womens Health Issues}, volume = {16}, year = {2006}, note = {Official publication of the Jacobs Institute of Women{\textquoteright}s Health}, month = {2006 May-Jun}, pages = {139-48}, publisher = {16}, abstract = {

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

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

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

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

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

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

}, keywords = {Aged, Cross-Sectional Studies, depression, Female, Follow-Up Studies, Health Status, Hostility, Humans, Loneliness, Male, Middle Aged, Risk Factors, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires}, issn = {0882-7974}, doi = {10.1037/0882-7974.21.1.140}, author = {John T. Cacioppo and Mary Elizabeth Hughes and Linda J. Waite and Louise C Hawkley and Ronald A. Thisted} } @article {7096, title = {A longitudinal study of the relationship between health behavior risk factors and dependence in activities of daily living.}, journal = {J Prev Med Public Health}, volume = {39}, year = {2006}, month = {2006 May}, pages = {221-8}, publisher = {39}, abstract = {

OBJECTIVES: The purpose of this study was to shed further light on the effect of modifiable health behavior risk factors on dependence in activities of daily living, defined in a multidimensional fashion.

METHODS: The study participants were 10,278 middle aged Americans in a longitudinal health study, the Health and Retirement Survey (HRS). A multi-stage probability sampling design incorporating the effect of population sizes (Metropolitan and non-metropolitan), ethnicity (the non-Hispanic White, the Hispanic, and the Black), and age (age 51-61) was utilized. Basic Activities of Daily Living (ADL) were measured using five activities necessary for survival (impairment in dressing, eating, bathing, sleeping, and moving across indoor spaces). Explanatory variables were four health behavior risk factors included smoking, exercise, Body Mass Index (BMI), and alcohol consumption.

RESULTS: Most participants at baseline were ADL independent (1992). 97.8\% of participants were independent in all ADL{\textquoteright}s at baseline and 78.2\% were married. Approximately 27.5\% were current smokers at baseline, and the subjects reported moderate or heavy exercise were 74.8\%. All demographic characteristics and behavioral risk factors were significantly associated with the ADL status at Wave 4 except alcohol consumption. Risk behaviors such as current smoking, sedentary life style and high BMI at Wave 1 were associated with ADL status deterioration; however, moderate alcohol consumption tended to be more related to better ADL status than abstaining at Wave 4. ADL status at Wave 1 was the strongest factor and the next was exercise and smoking affecting ADL status at Wave 4. People who were in ADL dependent at Wave 1 were 15.17 times more likely to be ADL dependent at Wave 4 than people who were in ADL independent at Wave 1. Concerning smoking cigarettes, people who kept only light exercise or sedentary life style at Wave 1 were 1.70 times more likely to be died at Wave 4 than the people who did not smoke at Wave 1.

CONCLUSIONS: All demographics and health behaviors at wave 1 had consistently similar OR trends for ADL status to each other except alcohol consumption. Smoking and exercise in health behaviors, and age and gender in demographics at Wave 1 were significant factors associated with ADL group separation at Wave 4.

}, keywords = {Activities of Daily Living, Alcohol Drinking, Body Mass Index, ethnicity, Exercise, Female, Health Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Smoking, United States}, issn = {1975-8375}, author = {Sang-Hyuk Jung and Truls Ostbye and Kyoung-Ok Park} } @article {7447, title = {Postretirement earnings relative to preretirement earnings: gender and racial differences.}, journal = {J Gerontol Soc Work}, volume = {47}, year = {2006}, note = {Using Smart Source Parsing pp. May Sage Publications, Thousand Oaks CA}, month = {2006}, pages = {63-82}, publisher = {32}, abstract = {

As the social security program comes under increasing financial pressure in the coming decades, the federal government will encourage elderly people to continue to work. Data from the Social Security Administration indicate that earnings are already a sizable component of retirement income. But there is public concern about how women and minorities will fare economically in this changing policy environment. To what extent can women and minorities keep earning money after they reach retirement age? This article presents the results of a study that investigated the postretirement earnings, relative to the preretirement earnings, of women and minorities, and compared the results with those for men and whites. The major finding, based on regression analyses, was that women{\textquoteright}s postretirement earnings, relative to their preretirement earnings, were greater than those of men. Furthermore, the regression results indicate that nonwhites{\textquoteright} postretirement earnings could not be predicted by their preretirement earnings or by any of the independent variables used in the study, including age, gender, education, marital status, number of children, occupation, and preretirement earnings.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Data collection, Employment, Female, Humans, Income, Male, Men, Minority Groups, Pensions, Retirement, Salaries and Fringe Benefits, Sex Factors, Social Security, Time Factors, United States, White People, women}, issn = {0163-4372}, doi = {10.1300/J083v47n03_05}, author = {Martha N. Ozawa and Hong, Baeg-Eui} } @article {7065, title = {Religious influences on preventive health care use in a nationally representative sample of middle-age women.}, journal = {J Behav Med}, volume = {29}, year = {2006}, month = {2006 Feb}, pages = {1-16}, publisher = {29}, abstract = {

Despite the many benefits of preventive services, they are often underutilized. Social factors, such as religion, can figure prominently in these discrepancies by either creating barriers or facilitating use. Using data from the Health and Retirement Survey (HRS, 1992-1996), the current study examines the relationship between religious attendance, religious salience, and denomination and three types of female preventive services in a sample of middle-age women (N = 4253). Findings indicate that women who attend religious services more frequently use more mammograms, Pap smears, and self-breast exams. In addition, women belonging to Mainline Protestant or Jewish denominations use certain preventive services more than Evangelical Protestants. Finally, women with higher levels of religious salience are more likely to conduct self-breast exams. These findings add important information to the public health literature concerning factors that influence preventive service use. They also add to the growing field of religion and health research where preventive health care use is emerging as a possible mechanism linking religion to a wide variety of physical health outcomes.

}, keywords = {Aged, Breast Self-Examination, Female, Health Behavior, Health Status Indicators, Health Surveys, Humans, Mammography, Mass Screening, Middle Aged, Papanicolaou Test, Preventive Health Services, Religion and Medicine, Religion and Psychology, Social Support, Socioeconomic factors, United States, Utilization Review, Vaginal Smears}, issn = {0160-7715}, doi = {10.1007/s10865-005-9035-2}, author = {Benjamins, Maureen Reindl} } @article {7110, title = {Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions.}, journal = {Gerontologist}, volume = {46}, year = {2006}, month = {2006 Aug}, pages = {464-73}, publisher = {46}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Caribbean Region, Child, Diabetes Mellitus, Forecasting, Health Status, Heart Diseases, Humans, Latin America, Malnutrition, Middle Aged, Mortality, Nutritional Status, United States}, issn = {0898-2643}, doi = {10.1177/0898264305285664}, author = {Alberto Palloni and Mary McEniry and Rebeca Wong and Pelaez, M.} } @article {7087, title = {Urban neighborhood context, educational attainment, and cognitive function among older adults.}, journal = {Am J Epidemiol}, volume = {163}, year = {2006}, month = {2006 Jun 15}, pages = {1071-8}, publisher = {163}, abstract = {

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.

}, keywords = {Aged, Aged, 80 and over, Chi-Square Distribution, Cognition Disorders, Educational Status, Female, Humans, Linear Models, Male, Residence Characteristics, Risk Factors, Socioeconomic factors, United States, Urban Population}, issn = {0002-9262}, doi = {10.1093/aje/kwj176}, author = {Richard G Wight and Carol S Aneshensel and Miller-Martinez, Dana and Amanda L. Botticello and Janet R. Cummings and Arun S Karlamangla and Teresa Seeman} } @article {13121, title = {The validation of the Texas revised inventory of grief on an older Latino sample.}, journal = {J Soc Work End Life Palliat Care}, volume = {2}, year = {2006}, month = {2006}, pages = {33-60}, abstract = {

PURPOSE: Bereavement is considered to be one of the most profound experiences in older adulthood. However, assessments of emotional reactions to grief and loss have often been based on measures tested on primarily Anglo samples. This study examined the validity and factor structure of a commonly used bereavement measure on an older Latino sample.

DESIGN AND METHODS: Using convergent and discriminant validation procedures, this instrument was tested using a purposive sample of 134 older, recently bereaved Latinos.

RESULTS: While the instrument was originally designed to measure two domains of grief: Past Behaviors and Present Feelings, confirmatory and exploratory factor analysis revealed a three-factor solution for this sample which included also Disbelief of the loss. Items within this domain included anger, rejection, and a sense of injustice.

IMPLICATIONS: This study underscores the need for improved measures in research on grief and bereavement to capture the intensity and severity of grief in a cross-cultural context.

}, keywords = {Aged, Aged, 80 and over, Bereavement, Culture, Factor Analysis, Statistical, Female, Grief, Hispanic or Latino, Humans, Male, Middle Aged, Psychometrics, Reproducibility of Results, Socioeconomic factors, Surveys and Questionnaires, Texas}, issn = {1552-4256}, doi = {10.1300/j457v02n04_03}, author = {Wilson, Steve} } @article {7088, title = {Why don{\textquoteright}t people buy long-term-care insurance?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Jul}, pages = {S185-93}, publisher = {61B}, abstract = {

OBJECTIVES: The objective of this article was to assess the determinants of an individual{\textquoteright}s decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser{\textquoteright}s education, and the purchaser{\textquoteright}s income.

METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy.

RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important.

DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.

}, keywords = {Aged, Choice Behavior, Commerce, Decision making, Demography, Female, Humans, Insurance, Health, Long-term Care, Male, Middle Aged, United States}, issn = {1079-5014}, doi = {10.1093/geronb/61.4.s185}, author = {Cramer, Anne Theisen and Gail A Jensen} } @article {7008, title = {Disparities among older adults in measures of cognitive function by race or ethnicity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Sep}, pages = {P242-50}, publisher = {60B}, abstract = {

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Black or African American, Case-Control Studies, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Hispanic or Latino, Humans, Linear Models, Longitudinal Studies, Male, Racial Groups, United States}, issn = {1079-5014}, doi = {10.1093/geronb/60.5.p242}, author = {Frank A Sloan and Wang, Jingshu} } @article {7050, title = {Functional impairment as a risk factor for urinary incontinence among older Americans.}, journal = {Neurourol Urodyn}, volume = {24}, year = {2005}, month = {2005}, pages = {51-5}, publisher = {24}, abstract = {

AIMS: Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms.

METHODS: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms.

RESULTS: A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain.

CONCLUSIONS: Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Disability Evaluation, Female, Humans, Longitudinal Studies, Male, Motor Activity, Risk Factors, Socioeconomic factors, Urinary incontinence}, issn = {0733-2467}, doi = {10.1002/nau.20089}, author = {Kristi Rahrig Jenkins and Fultz, Nancy H.} } @article {7021, title = {Health and living arrangements among older Americans: does marriage matter?}, journal = {J Aging Health}, volume = {17}, year = {2005}, month = {2005 Jun}, pages = {305-35}, publisher = {17}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Health Surveys, Humans, Life Expectancy, Life Tables, Logistic Models, Male, Markov chains, Obesity, Risk Factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.4.438}, author = {Sandra L Reynolds and Saito, Yasuhiko and Eileen M. Crimmins} } @article {7019, title = {The impact of own and spouse{\textquoteright}s urinary incontinence on depressive symptoms.}, journal = {Soc Sci Med}, volume = {60}, year = {2005}, month = {2005 Jun}, pages = {2537-48}, publisher = {60}, abstract = {

This study investigated the impact of own and spouse{\textquoteright}s urinary incontinence on depressive symptoms. Attention was paid to the possibility that gender and caregiving might be important factors in understanding significant effects. We used negative binomial regression to analyze survey data for 9974 middle-aged and older respondents to the Health and Retirement Study in the USA. Results supported the hypothesis that the respondents{\textquoteright} own urinary incontinence was associated with depressive symptoms (unadj. IRR = 1.73, 95\% CIs = 1.53, 1.95 for men; unadj. IRR = 1.50, 95\% CIs = 1.38, 1.63 for women). Controlling sociodemographic and health variables reduced this relationship, but it remained statistically significant for both men and women. Having an incontinent wife put men at greater risk for depressive symptoms (unadj. IRR = 1.13, 95\% CIs = 1.02, 1.25), although this relation became nonsignificant with the addition of control variables. No relation between women{\textquoteright}s depressive symptoms and husbands{\textquoteright} (in)continence status was found. Caregiving was not a significant variable in the adjusted analyses, but spouses{\textquoteright} depressive symptoms emerged as a significant predictor of the respondents{\textquoteright} own depressive symptoms. Health care providers must be sensitive to the emotional impact of urinary incontinence. Our findings also suggest the importance of considering the patient{\textquoteright}s mental health within a wider context, particularly including the physical and mental health of the patient{\textquoteright}s spouse.

}, keywords = {Aged, Caregivers, Cohort Studies, depression, Female, Humans, Male, Middle Aged, United States, Urinary incontinence}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2004.11.019}, author = {Fultz, Nancy H. and Kristi Rahrig Jenkins and Truls Ostbye and Donald H. Taylor Jr. and Mohammed U Kabeto and Kenneth M. Langa} } @article {7035, title = {Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain.}, journal = {J Ment Health Policy Econ}, volume = {8}, year = {2005}, month = {2005 Dec}, pages = {219-28}, publisher = {8}, abstract = {

BACKGROUND: The economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure{\textquoteright}{\textquoteright} depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression?

AIMS OF STUDY: We analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65.

METHODS: Cross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression.

RESULTS: Compared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered.

IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.

}, keywords = {Aged, Cost of Illness, Cross-Sectional Studies, depression, Employment, Female, Humans, Male, Middle Aged, pain, United States}, issn = {1091-4358}, author = {Tian, Haijun and Robinson, Rebecca L. and Sturm, Roland} } @article {7058, title = {Life course pathways to adult-onset diabetes.}, journal = {Soc Biol}, volume = {52}, year = {2005}, month = {2005 Fall-Winter}, pages = {94-111}, publisher = {52}, abstract = {

Early life conditions, such as socioeconomic status (SES) and health, have the potential to set in motion multiple and reinforcing pathways that shape both the prevalence and onset of diabetes among older adults. Using data from the Health and Retirement Study (1998-2002) for persons age 51 years and older, we investigated the core mediating mechanisms linking early life conditions with diabetes prevalence in 1998 and onset over a 4-year follow-up period, focusing on adult achievement processes and obesity as key mechanisms. We found that father{\textquoteright}s education is negatively associated with diabetes prevalence for older men and women. However, no markers of early life SES are directly associated with older men{\textquoteright}s and women{\textquoteright}s onset of diabetes, and the negative effects of adult SES on diabetes onset pertain only to women. Early life health affects the onset of diabetes among women--but not the prevalence--and no evidence of this association was found for men. We found no evidence that obesity is an important mechanism connecting either early life or adult SES with diabetes development in men or women. We speculate that early life SES may accelerate the development of diabetes at younger ages, and that the pathways linking life course SES, early life health, and diabetes are partly gender-specific and biological in nature.

}, keywords = {Aged, Child, Diabetes Mellitus, Type 2, Family Health, Female, Follow-Up Studies, Humans, Life Style, Likelihood Functions, Logistic Models, Male, Middle Aged, Obesity, Poverty, Risk Factors, Social Class, United States}, issn = {0037-766X}, doi = {https://doi.org/10.1080/19485565.2005.9989104}, author = {Best, Latrica E. and Mark D Hayward and Mira M Hidajat} } @article {6994, title = {Lifetime earnings, social security benefits, and the adequacy of retirement wealth accumulation.}, journal = {Soc Secur Bull}, volume = {66}, year = {2005}, note = {Revision of CRR Working Paper 2004-10}, month = {2005}, pages = {38-57}, publisher = {66}, keywords = {Adult, Humans, Income, Middle Aged, Models, Econometric, Pensions, Retirement, Social Security, United States}, issn = {0037-7910}, url = {https://www.ssa.gov/policy/docs/ssb/v66n1/v66n1p38.html}, author = {Engen, Eric M. and William G. Gale and Cori E. Uccello} } @article {7043, title = {Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Nov}, pages = {P296-P303}, publisher = {60}, abstract = {

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

}, keywords = {Aged, Analysis of Variance, Attitude to Health, Chronic disease, depression, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Personality Inventory, Psychometrics, Reproducibility of Results, Self-Assessment, Statistics as Topic}, issn = {1079-5014}, doi = {10.1093/geronb/60.6.p296}, author = {Karl Kosloski and Stull, Donald E. and Kercher, Kyle and VanDussen, Daniel J.} } @article {7023, title = {Long-term risk for depressive symptoms after a medical diagnosis.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Jun 13}, pages = {1260-6}, publisher = {165}, abstract = {

BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke.

METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions.

RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95\% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95\% CI, 1.64-2.79) and heart disease (HR, 1.45; 95\% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95\% CI, 1.11-1.92).

CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.

}, keywords = {Chronic disease, Comorbidity, Depressive Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Risk, Time Factors}, issn = {0003-9926}, doi = {10.1001/archinte.165.11.1260}, author = {Daniel Polsky and Jalpa A Doshi and Marcus, Steven and Oslin, David and Rothbard, Aileen and Thomas, Niku and Thompson, Christy L.} } @article {7051, title = {Men who work at age 70 or older.}, journal = {J Gerontol Soc Work}, volume = {45}, year = {2005}, month = {2005}, pages = {41-63}, publisher = {45}, abstract = {

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

}, keywords = {Aged, Employment, Health Status, Humans, Logistic Models, Male, Multivariate Analysis, Public Policy, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v45n04_04}, author = {Martha N. Ozawa and Terry Y S Lum} } @article {7010, title = {Net worth predicts symptom burden at the end of life.}, journal = {J Palliat Med}, volume = {8}, year = {2005}, month = {2005 Aug}, pages = {827-37}, publisher = {8}, abstract = {

OBJECTIVES: To explore the predictors of symptom burden at the end of life.

DESIGN: Observational, secondary analysis of Health and Retirement Study (HRS) data.

SETTING: USA.

PARTICIPANTS: Two thousand six hundred four deceased, older adults.

METHODS: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms.

RESULTS: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58\% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85-0.96) and less pain (odds ratio [OR] 0.66, CI 0.51-0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62-2.53) and depression (OR 1.31, CI 1.07-1.61). Patients experienced more depression (OR 2.37, CI 1.85-3.03) and dyspnea (OR 1.40, CI 1.09-1.78).

LIMITATION: Use of proxy reports for primary data.

CONCLUSION: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.

}, keywords = {Aged, Aged, 80 and over, Data collection, Female, Humans, Logistic Models, Male, Severity of Illness Index, Social Class, Terminally Ill, United States}, issn = {1096-6218}, doi = {10.1089/jpm.2005.8.827}, author = {Maria J Silveira and Mohammed U Kabeto and Kenneth M. Langa} } @article {7044, title = {Physical and mental health status of older long-term cancer survivors.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2145-52}, publisher = {53}, abstract = {

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

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

SETTING: General community population in the United States.

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

MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy.

RESULTS: Cancer survivors reported higher rates of lung disease (13.9\% vs 9.6\%; P=.001), heart condition (29.3\% vs 22.9\%; P<.001), arthritis (69.4\% vs 59.4\%; P<.001), incontinence (26.6\% vs 19.7\%; P=.001), frequent pain (36.4\% vs 29.4\%; P=.005), and obesity (27.0\% vs 24.2\%; P=.001) than individuals without cancer but lower rates of smoking (12.0\% vs 14.8\%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2\% vs 44.6\%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004).

CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Chronic disease, Cohort Studies, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Mental Health, Middle Aged, Neoplasms, Survivors, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00507.x}, author = {Nancy L. Keating and Norredam, Marie and Landrum, Mary Beth and Haiden A. Huskamp and Meara, Ellen} } @article {6993, title = {Predictors of perceptions of involuntary retirement.}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Feb}, pages = {36-47}, publisher = {45}, abstract = {

PURPOSE: Retirement is often treated as a voluntary transition, yet selected circumstances can restrict choice in retirement decision processes. We investigated conditions under which retirees perceive their retirement as "forced" rather than "wanted."

METHODS: Analyses relied on Waves 1-4 of the Health and Retirement Survey (N=1,160; 572 men and 588 women). Logistic regression models estimated the effects of background factors, choice and restricted choice conditions, and retirement contexts on perceptions of forced retirement.

RESULTS: Nearly one third of older workers perceived their retirement as forced. Such forced retirement reflects restricted choice through health limitations, job displacement, and care obligations. Other predictors include marital status, race, assets, benefits, job tenure, and off-time retirement.

IMPLICATIONS: Future research should establish personal and policy implications of forced retirement. Programs are needed to help older workers forced into retirement find alternative employment opportunities and to reduce the conditions leading to forced retirement.

}, keywords = {Activities of Daily Living, Choice Behavior, Demography, Humans, Retirement, Social Perception, Socioeconomic factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.1.36}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {7041, title = {Processes of cumulative adversity: childhood disadvantage and increased risk of heart attack across the life course.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60 Spec No 2}, year = {2005}, month = {2005 Oct}, pages = {117-24}, publisher = {60B}, abstract = {

OBJECTIVES: This article examines how processes of cumulative adversity shape heart attack risk trajectories across the life course.

METHODS: Our sample includes 9,760 Health and Retirement Study respondents born between 1931 and 1941. Using self-reported retrospective measures of respondents{\textquoteright} early background, we first identify three latent classes with differential exposure to childhood disadvantage. Intervening covariates associated with educational attainment, employment status, income attainment, marital history, and health behaviors are added to capture sequential processes of adversity. Final latent-class cluster models estimate the cumulative impact of these covariates on three different heart attack risk trajectories between 1992 and 2002: high, increasing, and low.

RESULTS: Early disadvantage and childhood illness have severe enduring effects and increase the risk for heart attack. Adult pathways, however, differentially influence trajectories of heart attack risk and mediate the effects of early disadvantage.

DISCUSSION: Findings suggest that future research should consider how processes of cumulative adversity initiated in childhood influence health outcomes in older ages.

}, keywords = {Child, Cluster Analysis, Family Characteristics, Female, Human Development, Humans, Likelihood Functions, Male, Middle Aged, Myocardial Infarction, Psychosocial Deprivation, Regression Analysis, Risk Factors, Social Environment, Socioeconomic factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/60.special_issue_2.s117}, author = {Angela M O{\textquoteright}Rand and Jenifer Hamil-Luker} } @article {7024, title = {Profiles of self-rated health in midlife adults with chronic illnesses.}, journal = {Nurs Res}, volume = {54}, year = {2005}, month = {2005 May-Jun}, pages = {167-77}, publisher = {54}, abstract = {

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time.

OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time.

METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time.

RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes.

DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

}, keywords = {Chronic disease, Comorbidity, Data collection, Educational Status, Exercise, Female, Health Behavior, Health Status, Humans, Male, Marital Status, Middle Aged, Nursing Research, Smoking}, issn = {0029-6562}, doi = {10.1097/00006199-200505000-00004}, author = {Finnegan, Lorna and Marion, Lucy and Cox, Cheryl} } @article {7031, title = {Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study.}, journal = {Arch Phys Med Rehabil}, volume = {86}, year = {2005}, month = {2005 Aug}, pages = {1521-6}, publisher = {86}, abstract = {

OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans.

DESIGN: Longitudinal cohort study.

SETTING: National probability sample.

PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up.

RESULTS: Onset is most frequent among African Americans (24.4\%), followed by Hispanics (22.2\%), and whites (16.9\%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans.

CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis.

}, keywords = {Activities of Daily Living, Aged, Arthritis, Black or African American, Female, Geriatric Assessment, Health Behavior, Health Services Needs and Demand, Hispanic or Latino, Humans, Longitudinal Studies, Male, Predictive Value of Tests, Prospective Studies, Risk Factors, United States, White People}, issn = {0003-9993}, doi = {10.1016/j.apmr.2005.02.009}, author = {Shih, Vivian C. and Song, Jing and Rowland W Chang and Dorothy D Dunlop} } @article {6991, title = {Setting eligibility criteria for a care-coordination benefit.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2051-9}, publisher = {53}, abstract = {

OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served.

DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older.

SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries).

MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency.

RESULTS: A small portion of Medicare beneficiaries (1.3-5.8\%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population.

CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case Management, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Disease Management, Eligibility Determination, Female, Geriatric Assessment, Health Surveys, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Retirement, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00496.x}, author = {Christine T Cigolle and Kenneth M. Langa and Mohammed U Kabeto and Caroline S Blaum} } @article {6996, title = {The significance of nonmarital cohabitation: marital status and mental health benefits among middle-aged and older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Jan}, pages = {S21-9}, publisher = {60B}, abstract = {

OBJECTIVES: According to the 2000 Census, about 1.2 million persons over age 50 are currently cohabiting. Do these unmarried cohabiting partnerships provide adults with mental health benefits that are similar to those enjoyed by marrieds? We extended prior work on marital status and depression by including cohabitation in our conceptualization of marital status.

METHODS: We used data from the 1998 Health and Retirement Study (N = 18,598) to examine the relationship between marital status and depressive symptoms among adults over age 50. We also examined gender differences in this association.

RESULTS: We found that cohabitors report more depressive symptoms, on average, than do marrieds, net of economic resources, social support, and physical health. Additional analyses revealed that only among men do cohabitors report significantly higher depression scores. Cohabiting and married women as well as cohabiting men experience similar levels of depression, and all of these groups report levels that are significantly higher than married men{\textquoteright}s.

DISCUSSION: Our findings demonstrate the importance of accounting for nontraditional living arrangements among persons aged 50 and older. Cohabitation appears to be more consequential for men{\textquoteright}s than women{\textquoteright}s depressive symptoms.

}, keywords = {Aged, depression, Female, Humans, Insurance Benefits, Male, Marital Status, Mental Health Services, Middle Aged, Sexual Partners, Social Support, United States}, issn = {1079-5014}, doi = {10.1093/geronb/60.1.s21}, author = {Susan L. Brown and Jennifer R. Bulanda and Lee, Gary R.} } @article {7042, title = {Social status and risky health behaviors: results from the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60 Spec No 2}, year = {2005}, month = {2005 Oct}, pages = {85-92}, publisher = {60B}, abstract = {

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks.

METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age.

RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age.

DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

}, keywords = {Aged, Aging, Alcohol Drinking, Body Weight, Exercise, Female, Health Behavior, Humans, Life Style, Likelihood Functions, Logistic Models, Longitudinal Studies, Male, Middle Aged, Smoking, Social Class, United States}, issn = {1079-5014}, doi = {10.1093/geronb/60.special_issue_2.s85}, author = {Linda A. Wray and Duane F. Alwin and Ryan J McCammon} } @article {7057, title = {A socioeconomic profile of older adults with HIV.}, journal = {J Health Care Poor Underserved}, volume = {16}, year = {2005}, month = {2005 Feb}, pages = {19-28}, publisher = {16}, abstract = {

The objective of this study was to assess the socioeconomic circumstances of older patients with HIV and acquired immunodeficiency syndrome (AIDS). The investigators compared subjects from a national probability sample of 2,864 respondents from the HIV Cost and Services Utilization Study (HCSUS, 1996) with 9,810 subjects from Wave 1 (1992) of the Health and Retirement Survey (HRS). Bivariate analyses compare demographic characteristics, financial resources, and health insurance status between older and younger adults and between older adults with HIV and the general population. It was found that nearly 10\% of the HIV-positive population is between the ages of 50 and 61 years. Older whites with HIV are mostly homosexual men who are more well educated, more often privately insured, and more financially stable than the HIV population as a whole. In contrast, older minorities with HIV possess few economic resources in either absolute or relative terms. The success of new drug therapies and the changing demographics of the HIV population necessitate innovative policies that promote labor force participation and continuous access to antiretroviral therapies.

}, keywords = {Female, HIV Infections, Humans, Insurance, Health, Male, Middle Aged, Social Class}, issn = {1049-2089}, doi = {10.1353/hpu.2005.0013}, author = {Joyce, Geoffrey F. and Dana P Goldman and Leibowitz, Arleen A. and Abby Alpert and Bao, Yuhua} } @article {7053, title = {Supplemental private health insurance and depressive symptoms in older married couples.}, journal = {Int J Aging Hum Dev}, volume = {61}, year = {2005}, month = {2005}, pages = {293-312}, publisher = {61}, abstract = {

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Analysis of Variance, Black People, Chi-Square Distribution, depression, Female, Humans, Insurance Coverage, Insurance, Health, Linear Models, Male, Risk Factors, Spouses, United States, White People}, issn = {0091-4150}, doi = {10.2190/21LA-XQCE-BKJF-MC17}, author = {Min, Meeyoung O. and Aloen L. Townsend and Baila Miller and Rovine, Michael J.} } @article {7013, title = {Survival expectations of the obese: Is excess mortality reflected in perceptions?}, journal = {Obes Res}, volume = {13}, year = {2005}, month = {2005 Apr}, pages = {754-61}, publisher = {13}, abstract = {

OBJECTIVE: This study compared self-reported subjective life expectancy (i.e., probability of living to age 75) for normal-weight, overweight, and obese weight groups to examine whether individuals are internalizing information about the health risks due to excessive weight.

RESEARCH METHODS AND PROCEDURES: Using data from the Health and Retirement Study, a total of 9035 individuals 51 to 61 years old were analyzed by BMI category. The primary outcome measure was individuals{\textquoteright} reports about their own expectations of survival to age 75. Absolute and relative risks of survival were compared with published estimates of survival to age 75.

RESULTS: Consistently, higher levels of BMI were associated with lower self-estimated survival probabilities. Differences relative to normal weight ranged from 4.9\% (p < 0.01) for male nonsmokers to 8.8\% (p < 0.001) for female nonsmokers. However, these differences were substantially less than those obtained from published survival curve estimates, suggesting that obese individuals tended to underestimate mortality risks.

DISCUSSION: Individuals appeared to underestimate the mortality risks of excessive weight; thus, knowledge campaigns about the risks of obesity should remain a top priority.

}, keywords = {Aged, Body Mass Index, Body Weight, Diabetes Mellitus, Female, Health Surveys, Humans, Hypertension, Male, Obesity, Perception, Retirement, Smoking, Surveys and Questionnaires, Survival Rate}, issn = {1071-7323}, doi = {10.1038/oby.2005.85}, author = {Tracy Falba and Susan H. Busch} } @article {7052, title = {Understanding the racial and ethnic differences in caregiving arrangements.}, journal = {J Gerontol Soc Work}, volume = {45}, year = {2005}, month = {2005}, pages = {3-21}, publisher = {45}, abstract = {

In this study, the relative importance of family/household structure, socioeconomic status, and culture is examined, and their connection to racial and ethnic variations in caregiving networks is explored. Each of these three domains is seen as contributing to the race/ethnic variations in caregiving arrangements.

}, keywords = {Aged, Caregivers, ethnicity, Family Characteristics, Female, Frail Elderly, Humans, Logistic Models, Male, Multivariate Analysis, Social work, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v45n04_02}, author = {Terry Y S Lum} } @article {7027, title = {Use of complementary medicine in older Americans: results from the Health and Retirement Study.}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Aug}, pages = {516-24}, publisher = {45}, abstract = {

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy.

DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices).

RESULTS: Of respondents over 65 years of age, 88\% used CAM, with dietary supplements and chiropractic most commonly reported (65\% and 46\%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases.

IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.

}, keywords = {Activities of Daily Living, Aged, Chi-Square Distribution, Complementary Therapies, Female, Humans, Male, Middle Aged, Regression Analysis, Surveys and Questionnaires, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.4.516}, author = {Ness, Jose and Dominic J Cirillo and David R Weir and Nisly, Nicole L. and Robert B Wallace} } @article {6995, title = {A variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes.}, journal = {J Allied Health}, volume = {34}, year = {2005}, month = {2005 Spring}, pages = {3-10}, publisher = {34}, abstract = {

Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10\% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Disability Evaluation, Female, Health Services Accessibility, Humans, Male, Occupational therapy, Physical Therapy Modalities, Risk Factors, Socioeconomic factors, Stroke Rehabilitation, United States}, issn = {0090-7421}, author = {Chad Cook and Stickley, Lois and Ramey, Kevin and Knotts, Valerie J.} } @article {7039, title = {What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings.}, journal = {Med Care}, volume = {43}, year = {2005}, month = {2005 Oct}, pages = {1054-7}, publisher = {43}, abstract = {

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age.

METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration.

RESULTS: A total of 1015 subjects responded to the rating task (98\% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P{\textquoteright}s<0.075), whereas responses to the your-age scale did not (P=0.8).

CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Attitude to Health, Calibration, Female, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Male, Prospective Studies, Psychometrics, Self Concept}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000178193.38413.70}, author = {Peter A. Ubel and Jankovic, Aleksandra and Dylan M Smith and Kenneth M. Langa and Angela Fagerlin} } @article {7055, title = {When is baseline adjustment useful in analyses of change? An example with education and cognitive change.}, journal = {Am J Epidemiol}, volume = {162}, year = {2005}, month = {2005 Aug 01}, pages = {267-78}, publisher = {162}, abstract = {

In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased.

}, keywords = {Age Factors, Aged, Bias, Cognition Disorders, Educational Status, Epidemiologic Methods, Female, Health Status, Humans, Longitudinal Studies, Male, Models, Statistical, Neuropsychological tests, Regression Analysis, United States}, issn = {0002-9262}, doi = {10.1093/aje/kwi187}, author = {M. Maria Glymour and Weuve, Jennifer and Lisa F Berkman and Ichiro Kawachi and Robins, James M.} } @article {7020, title = {Who foregoes survivor protection in employer-sponsored pension annuities?}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Feb}, pages = {26-35}, publisher = {45}, abstract = {

PURPOSE: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the share of married retirees with pension annuities who forego survivor protection.

DESIGN AND METHODS: The analysis consists of a probit model of the pension payout decision, based on data from the 1992-2000 waves of the Health and Retirement Study.

RESULTS: More than one quarter (28\%) of married men and two thirds of married women receiving employer-sponsored retirement annuities declined survivor protection. Men with small pensions and limited household wealth, men in better health than their spouses, and men whose spouses have pension coverage from their own employers are more likely than other men to reject survivor protection.

IMPLICATIONS: Most workers appear to make payout decisions by rationally balancing the costs and benefits of each type of annuity, suggesting that existing measures to encourage joint and survivor annuities are adequate. However, the growth in 401(k) plans, which are generally not covered by existing laws protecting spousal pension rights, may leave widows vulnerable.

}, keywords = {Female, Humans, Male, Multivariate Analysis, Pensions, Socioeconomic factors, Spouses, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.1.26}, author = {Richard W. Johnson and Cori E. Uccello and Joshua H. Goldwyn} } @article {6963, title = {Body mass index, physical activity, and the risk of decline in overall health and physical functioning in late middle age.}, journal = {Am J Public Health}, volume = {94}, year = {2004}, month = {2004 Sep}, pages = {1567-73}, publisher = {94}, abstract = {

OBJECTIVES: We examined the relation between body mass index, exercise, overall health, and physical functioning.

METHODS: We studied 7867 adults aged 51 to 61 years in 1992 to 1996. Adjusted relative risks for health decline and new physical difficulties were determined with logistic regression.

RESULTS: Overweight and obesity were independently associated with health decline (adjusted relative risk [ARR] = 1.29 and 1.36) and development of a new physical difficulty (ARR = 1.27 and 1.45). Regular exercise significantly reduced the risk of health decline and development of a new physical difficulty, even among obese individuals.

CONCLUSIONS: Maintaining ideal body weight is important in preventing decline in overall health and physical functioning. However, regular exercise can reduce the risk of health decline even among individuals who cannot achieve ideal weight.

}, keywords = {Attitude to Health, Body Mass Index, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Obesity, Quality of Life, Risk Assessment, Risk Factors, Risk Reduction Behavior, Self Care, United States}, issn = {0090-0036}, doi = {10.2105/ajph.94.9.1567}, author = {Xiaoxing He and David W. Baker} } @article {6940, title = {Body-weight change and physical functioning among young old adults.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004}, pages = {248-66}, publisher = {16}, abstract = {

OBJECTIVES: The main purpose of this study is to examine if body weight change is a potential risk factor for the onset of functional impairment across time among various functional domains.

METHODS: Using longitudinal data from the Health and Retirement Study, logistic regression models on the onset of functional impairment over three time points are estimated for young old adults.

RESULTS: Results indicate that weight gain is associated with greater risk of lower body mobility impairment. An increase in body mass index of greater than 5\% increases the likelihood of the onset of lower body mobility functional impairment.

DISCUSSION: Study findings support the promotion of healthy weight management. Future studies in this area may want to investigate effective interventions that contribute to healthy weight maintenance among this cohort.

}, keywords = {Activities of Daily Living, Aged, Body Weight, Demography, Exercise, Health Behavior, Humans, Movement Disorders, Socioeconomic factors}, issn = {0898-2643}, doi = {10.1177/0898264303262626}, author = {Kristi Rahrig Jenkins} } @article {6936, title = {Born to retire: the foreshortened life course.}, journal = {Gerontologist}, volume = {44}, year = {2004}, month = {2004 Feb}, pages = {3-9}, publisher = {44}, abstract = {

Retirement is no longer a concern solely for the second half of life. Rather, the idea that we will someday retire is increasingly present to all adults and it is even urged on adolescents. The earliest reaches of adulthood are being colonized by frequent reminders that it takes individual effort to achieve retirement. The changing nature of pensions, the identification of retirement saving with financial markets, the politics of Social Security, the aging baby boom generation, and the interests of a powerful industry and of government are daily compelling people{\textquoteright}s attention to retirement as a lifelong goal. With retirement as adulthood{\textquoteright}s great project of deferred gratification, the result could be greater personal readiness to retire but also some ironic outcomes, such as a stronger retirement norm, reluctance to spend on children, and outsized expectations for later life.

}, keywords = {Adolescent, Adult, Aged, Child, Female, Humans, Investments, Life Style, Male, Middle Aged, Pensions, Retirement, Social Security}, issn = {0016-9013}, doi = {10.1093/geront/44.1.3}, author = {David J Ekerdt} } @article {6984, title = {Brief communication: the relationship between having a living will and dying in place.}, journal = {Ann Intern Med}, volume = {141}, year = {2004}, month = {2004 Jul 20}, pages = {113-7}, publisher = {141}, abstract = {

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95\% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients{\textquoteright} preferences for location of death.

}, keywords = {Aged, Death, Health Status, Homes for the Aged, Hospices, Hospital Mortality, Housing, Humans, Living Wills, Nursing homes, Retrospective Studies}, issn = {1539-3704}, doi = {10.7326/0003-4819-141-2-200407200-00009}, author = {Howard B Degenholtz and Rhee, YongJoo and Robert M. Arnold} } @article {6962, title = {Changes in weight among a nationally representative cohort of adults aged 51 to 61, 1992 to 2000.}, journal = {Am J Prev Med}, volume = {27}, year = {2004}, month = {2004 Jul}, pages = {8-15}, publisher = {27}, abstract = {

BACKGROUND: Few studies have examined patterns and predictors of changes in body weight among adults in late middle age.

METHODS: Prospective cohort study of 7391 community-dwelling U.S. adults aged 51 to 61 years at baseline (1992), using publicly available data files from the 1992, 1994, 1996, 1998, and 2000 Health and Retirement Survey interviews. Changes in weight and body mass index (BMI) were examined for different racial/ethnic groups of men and women. The predictors of changes in body weight and BMI were determined using gender-specific linear regression.

RESULTS: Mean body weight and BMI increased in both genders and all ethnic groups. The mean weight gain was higher for women (1.67 kg, 95\% confidence interval [CI]=1.34-1.99) than for men (1.43 kg, 95\% CI=1.17-1.68). White men and women had the lowest baseline BMI but tended to gain more weight than other racial/ethnic groups. In multivariate analyses, individuals who were older or had higher baseline weight showed less weight gain. Men were less likely to gain weight if their self-reported overall health at baseline was poor compared to those in excellent health. Regular light or vigorous recreational activities and work-related activities were not associated with less weight gain. Race, education, and income were not associated with weight gain in multivariate analyses.

CONCLUSIONS: All population subgroups are at risk for weight gain. Public health messages should target diverse populations. The current levels of physical activity attained by this population do not appear to protect against weight gain.

}, keywords = {Body Mass Index, Body Weight, Female, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Motor Activity, Multivariate Analysis, Prospective Studies, Racial Groups, Sex Factors, United States}, issn = {0749-3797}, doi = {10.1016/j.amepre.2004.03.016}, author = {Xiaoxing He and David W. Baker} } @article {6978, title = {Cognitive deficits and the course of major depression in a cohort of middle-aged and older community-dwelling adults.}, journal = {J Am Geriatr Soc}, volume = {52}, year = {2004}, month = {2004 Jul}, pages = {1060-9}, publisher = {52}, abstract = {

OBJECTIVES: To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2- and 4-year follow-ups in a sample of community-dwelling middle-aged and older adults.

DESIGN: Prospective cohort study.

SETTING: A U.S. national prospective cohort study of middle-aged and older adults, the Health and Retirement Study.

PARTICIPANTS: A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12-month Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised major depression (MD).

MEASUREMENTS: MD was assessed using the World Health Organization Composite International Diagnostic Interview-Short Form. Persistent significant depressive symptoms were assessed using an eight-item version of the Center for Epidemiological Studies Depression scale.

RESULTS: Cognitive deficits were associated with persistent significant depressive symptoms at follow-up. In a latent state-trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points.

CONCLUSION: Trait-like cognitive deficits commonly complicate the course of MD in community-dwelling middle-aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.

}, keywords = {Aged, Chi-Square Distribution, Cognition Disorders, Depressive Disorder, Major, Female, Geriatric Assessment, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Residence Characteristics, Risk Factors, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2004.52302.x}, author = {Ramin Mojtabai and Mark Olfson} } @article {6948, title = {Does urinary incontinence affect middle-aged and older women{\textquoteright}s time use and activity patterns?}, journal = {Obstet Gynecol}, volume = {104}, year = {2004}, month = {2004 Dec}, pages = {1327-34}, publisher = {104}, abstract = {

OBJECTIVE: To investigate the relationship between urinary incontinence and women{\textquoteright}s levels and hours of participation in 31 activities.

METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation.

RESULTS: The hypothesis that urinary incontinence affects women{\textquoteright}s time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene.

CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options.

LEVEL OF EVIDENCE: II-2.

}, keywords = {Aged, Female, Humans, Interpersonal Relations, Leisure activities, Logistic Models, Middle Aged, Quality of Life, Urinary incontinence}, issn = {0029-7844}, doi = {10.1097/01.AOG.0000143829.21758.3c}, author = {Fultz, Nancy H. and Gwenith G Fisher and Kristi Rahrig Jenkins} } @article {6958, title = {Economic status in later life among women who raised children outside of marriage.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {59}, year = {2004}, month = {2004 Nov}, pages = {S315-23}, publisher = {59B}, abstract = {

OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life.

METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999.

RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55\% more likely to live in poverty at ages 65-75 than women who were always married when their children were young.

DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.

}, keywords = {Adolescent, Adult, Aged, Aging, Child, Child Rearing, Demography, Female, Humans, Illegitimacy, Middle Aged, Single-Parent Family, Social Support, Socioeconomic factors}, issn = {1079-5014}, doi = {10.1093/geronb/59.6.s315}, author = {Richard W. Johnson and Melissa Favreault} } @article {6941, title = {The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement.}, journal = {J Am Geriatr Soc}, volume = {52}, year = {2004}, month = {2004 Jan}, pages = {72-9}, publisher = {52}, abstract = {

OBJECTIVES: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance.

DESIGN: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2.

SETTING: A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview.

PARTICIPANTS: Respondents to the AHEAD survey, N=8,222 at Wave 1.

MEASUREMENTS: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home.

RESULTS: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95\% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2.

CONCLUSION: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient{\textquoteright}s difficulty and that follow-up assessment is crucial after equipment is prescribed.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Bed Rest, Cross-Sectional Studies, Disability Evaluation, Female, Homemaker Services, Humans, Least-Squares Analysis, Logistic Models, Longitudinal Studies, Male, Nursing homes, Risk Factors, Self-Help Devices}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2004.52013.x}, author = {Donald H. Taylor Jr. and Hoenig, H.} } @article {6925, title = {The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits.}, journal = {Milbank Q}, volume = {82}, year = {2004}, note = {RDA 1996-024}, month = {2004}, pages = {507-46, table of contents}, publisher = {82}, abstract = {

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort{\textquoteright}s lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs{\textquoteright} outlays and worsen their financial condition.

}, keywords = {Accidents, Traffic, Adolescent, Adult, Aged, Aged, 80 and over, Alcoholism, Cost Sharing, Female, Health Behavior, Humans, Insurance Coverage, Life Expectancy, Male, Middle Aged, Old Age Assistance, Social Security, United States}, issn = {0887-378X}, doi = {10.1111/j.0887-378X.2004.00320.x}, author = {Ostermann, Jan and Frank A Sloan} } @article {6927, title = {The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans.}, journal = {Health Serv Res}, volume = {39}, year = {2004}, month = {2004 Jun}, pages = {531-52}, publisher = {39}, abstract = {

OBJECTIVE: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

DATA SOURCES/STUDY SETTING: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

STUDY DESIGN: Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.

PRINCIPAL FINDINGS: Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.

CONCLUSIONS: Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Quality of Life, Quality-Adjusted Life Years, Regression Analysis, Sex Distribution, Smoking, Smoking cessation, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2004.00243.x}, author = {Truls Ostbye and Donald H. Taylor Jr.} } @article {6924, title = {The effect of spousal mental and physical health on husbands{\textquoteright} and wives{\textquoteright} depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Jun}, pages = {398-425}, publisher = {16}, abstract = {

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms in a national sample of older married couples.

METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents{\textquoteright} depressive symptoms.

RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses{\textquoteright} physical health was associated with a significant reduction in respondent depressive symptoms (p < .05).

DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

}, keywords = {Aged, Caregivers, depression, Female, Health Status, Humans, Male, Mental Health, Models, Theoretical, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264304264208}, author = {Michele J. Siegel and Elizabeth H Bradley and William T Gallo and Stanislav V Kasl} } @article {6971, title = {The effect of the tobacco settlement and smoking bans on alcohol consumption.}, journal = {Health Econ}, volume = {13}, year = {2004}, month = {2004 Oct}, pages = {1063-80}, publisher = {13}, abstract = {

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

}, keywords = {Aged, Alcohol Drinking, Behavior, Addictive, Data collection, Female, Humans, Male, Middle Aged, Models, Econometric, Smoking, United States}, issn = {1057-9230}, doi = {10.1002/hec.930}, author = {Gabriel A. Picone and Frank A Sloan and Justin G Trogdon} } @article {6983, title = {Elders who delay medication because of cost: health insurance, demographic, health, and financial correlates.}, journal = {Gerontologist}, volume = {44}, year = {2004}, month = {2004 Dec}, pages = {779-87}, publisher = {44}, abstract = {

PURPOSE: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost.

DESIGN AND METHODS: This was a cross-sectional study of a nationwide sample of 6,535 elders participating in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Participants reported if they had taken less medication than prescribed or if they had not filled prescriptions because of cost in the past 2 years. This response was then compared with the self-report of multiple variables, including demographic, health status, health insurance coverage, and financial variables.

RESULTS: Elders who were most vulnerable to medication delay as a result of cost included those with Medicare coverage only, low income, high out-of-pocket prescription costs, and poor health as well as African American elders and those aged 65-80 years.

IMPLICATIONS: This study provides important information about community-dwelling elders that reported a delay in medication use because of cost. As a Medicare prescription benefit has been passed, it will be important to monitor how these changes affect the elders identified at risk for medication delay.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Drug Therapy, Fees, Pharmaceutical, Female, Health Status, Humans, Insurance, Pharmaceutical Services, Logistic Models, Male, Medicare, Multivariate Analysis, Patient Compliance, Self Administration, Socioeconomic factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/44.6.779}, author = {Klein, Dawn and Carolyn L. Turvey and Robert B Wallace} } @article {6933, title = {Elevated depressive symptoms among caregiving grandparents.}, journal = {Health Serv Res}, volume = {39}, year = {2004}, month = {2004 Dec}, pages = {1671-89}, publisher = {39}, abstract = {

OBJECTIVE: To determine whether caregiving grandparents are at an increased risk for depressive symptoms.

DATA SOURCE: National sample (n=10,293) of grandparents aged 53-63 years in 1994, and their spouse/partners, who took part in the Health and Retirement Study (HRS).

STUDY DESIGN: Grandparents were surveyed in 1994 and resurveyed every two years thereafter, through 2000. Over that period, 977 had a grandchild move in or out of their home. These grandparents served as their own controls to assess the impact of having a grandchild in the home. Data Extraction. Depressive symptoms were measured using an abbreviated form of the Center for Epidemiologic Studies-Depression (CES-D) scale, scored 1-8, with a score > or =4 associated with depression "caseness".

PRINCIPAL FINDINGS: At the time of the 1994 interview, 8.2 percent of grandparents had a grandchild in their home. However, there was substantial variation across demographic groups (e.g., 29.4 percent of single nonwhite grandmothers, but only 2.0 percent of single white grandfathers had a grandchild in residence). The impact of having a grandchild in the home varied by grandparent demographic group, with single grandparents and those without coresident adult children experiencing the greatest probability of elevation in depressive symptoms when a grandchild was in residence. For example, single nonwhite grandmothers experienced an 8 percentage point increase in the probability of having a CES-D score > or =4 when a grandchild was in their home, compared to when a grandchild was not in their home, controlling for changes in health care, income, and household composition over time (95 percent CI=0.1 to 15.0 percentage points).

CONCLUSIONS: Grandparents have a greater probability of elevated depressive symptoms when a grandchild is in their home, versus when a grandchild is not in their home. Single women of color bear a disproportionate burden of the depression associated with caring for grandchildren. Since an increasing number of grandparents function as a de facto safety net keeping their grandchildren out of formal foster care, identifying strategies to support the health and well-being of caregiving grandparents is an emerging priority.

}, keywords = {Child, Data collection, depression, Family, Humans, Intergenerational Relations, Interviews as Topic, Middle Aged, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2004.00312.x}, author = {Blustein, J. and Sewin Chan and Guanais, F.C.} } @article {6918, title = {Extent and cost of informal caregiving for older Americans with symptoms of depression.}, journal = {Am J Psychiatry}, volume = {161}, year = {2004}, month = {2004 May}, pages = {857-63}, publisher = {161}, abstract = {

OBJECTIVE: The purpose of this study was to obtain nationally representative estimates of the additional time and cost associated with informal caregiving for older Americans with depressive symptoms.

METHOD: Data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people age 70 years or older (N=6,649), were used to determine the weekly hours and imputed costs of informal caregiving for elderly people with no depressive symptoms in the last week, one to three depressive symptoms in the last week, and four to eight depressive symptoms in the last week.

RESULTS: Forty-four percent of survey respondents reported one to three depressive symptoms, and 18\% reported four to eight depressive symptoms. In multivariate regression analyses that adjusted for sociodemographics, caregiver network, and coexisting chronic health conditions, respondents with no depressive symptoms received an average of 2.9 hours per week of informal care, compared with 4.3 hours per week for those with one to three symptoms and 6.0 hours per week for those with four to eight symptoms. Caregiving associated with depressive symptoms in elderly Americans represented a yearly cost of about $9 billion.

CONCLUSIONS: Depressive symptoms in elderly persons are independently associated with significantly higher levels of informal caregiving, even after the effects of major coexisting chronic conditions are adjusted. The additional hours of care attributable to depressive symptoms represent a significant time commitment for family members and, therefore, a significant societal economic cost. Further research should evaluate the causal pathways by which depressive symptoms lead to high levels of caregiving and should examine whether successful treatment of depression reduces the need for informal care.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Comorbidity, Costs and Cost Analysis, Depressive Disorder, Fees and Charges, Female, Health Care Costs, Home Nursing, Humans, Longitudinal Studies, Male, Personality Inventory, Workload}, issn = {0002-953X}, doi = {10.1176/appi.ajp.161.5.857}, author = {Kenneth M. Langa and Marcia A. Valenstein and A. Mark Fendrick and Mohammed U Kabeto and Sandeep Vijan} } @article {6920, title = {The health effects of restricting prescription medication use because of cost.}, journal = {Med Care}, volume = {42}, year = {2004}, note = {Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485}, month = {2004 Jul}, pages = {626-34}, publisher = {42}, abstract = {

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

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

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

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

}, keywords = {Aged, Chronic disease, Female, Financing, Personal, Health Services Accessibility, Health Status, Humans, Male, Middle Aged, Multivariate Analysis, Patient Compliance, Prospective Studies, Risk, United States}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000129352.36733.cc}, author = {Michele M Heisler and Kenneth M. Langa and Eby, Elizabeth L. and A. Mark Fendrick and Mohammed U Kabeto and John D Piette} } @article {6935, title = {Health insurance coverage and mortality among the near-elderly.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Jul-Aug}, pages = {223-33}, publisher = {23}, abstract = {

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

}, keywords = {Cohort Studies, Female, health policy, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Mortality, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.4.223}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Meara, Ellen and John Z. Ayanian} } @article {6985, title = {Heart disease, comorbidity, and activity limitation in community-dwelling elderly.}, journal = {Eur J Cardiovasc Prev Rehabil}, volume = {11}, year = {2004}, month = {2004 Oct}, pages = {427-34}, publisher = {11}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Female, Health Status, Heart Diseases, Humans, Male, Middle Aged, Motor Activity, Residence Characteristics, Self Concept, Socioeconomic factors}, issn = {1741-8267}, doi = {10.1097/01.hjr.0000140716.25015.b8}, author = {Oldrige, Neil B. and Timothy E. Stump} } @article {6928, title = {Honeymoons and joint lunches: effects of retirement and spouse{\textquoteright}s employment on depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {59}, year = {2004}, month = {2004 Sep}, pages = {P233-45}, publisher = {59B}, abstract = {

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

}, keywords = {Adaptation, Psychological, Aged, Aging, Data collection, depression, Employment, Female, Humans, Life Change Events, Longitudinal Studies, Male, Mental Health, Middle Aged, Retirement, Sex Factors, Spouses}, issn = {1079-5014}, doi = {10.1093/geronb/59.5.p233}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {6912, title = {The impact of diabetes on workforce participation: results from a national household sample.}, journal = {Health Serv Res}, volume = {39}, year = {2004}, note = {Social Security Administration/Michigan Retirement Research Center Grant UM01-11}, month = {2004 Dec}, pages = {1653-69}, publisher = {39}, abstract = {

OBJECTIVE: Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation.

DATA SOURCE: We used the Health and Retirement Study (HRS), a national household sample of adults aged 51-61 in 1992, as a data source.

STUDY DESIGN: We conducted cross-sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow-up. We used two-part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes-related losses in productivity.

PRINCIPAL FINDINGS: Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was 60.0 billion US dollars over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for 4.4 billion US dollars in lost income due to early retirement, 0.5 billion US dollars due to increased sick days, 31.7 billion US dollars due to disability, and 22.0 US dollars billion in lost income due to premature mortality, for a total of 58.6 billion dollars in lost productivity, or 7.3 billion US dollars per year.

CONCLUSIONS: In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.

}, keywords = {Chronic disease, Cohort Studies, Cost of Illness, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Efficiency, Employment, Female, Health Services Research, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2004.00311.x}, author = {Sandeep Vijan and Rodney A. Hayward and Kenneth M. Langa} } @article {6917, title = {Increasing obesity rates and disability trends.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Mar-Apr}, pages = {199-205}, publisher = {23}, abstract = {

Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain.

}, keywords = {Aged, Disabled Persons, Female, Humans, Male, Middle Aged, Obesity, Population Surveillance, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.2.199}, author = {Sturm, Roland and Ringel, Jeanne S. and Andreyeva, Tatiana} } @article {6976, title = {Informal care and health care use of older adults.}, journal = {J Health Econ}, volume = {23}, year = {2004}, month = {2004 Nov}, pages = {1159-80}, publisher = {23}, abstract = {

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.

}, keywords = {Aged, Female, Health Care Surveys, health policy, Health Services for the Aged, Home Care Services, Home Nursing, Homes for the Aged, Humans, Male, Nursing homes, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2004.04.008}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {6951, title = {Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the Health and Retirement Survey.}, journal = {Am J Ind Med}, volume = {45}, year = {2004}, month = {2004 May}, pages = {408-16}, publisher = {45}, abstract = {

BACKGROUND: The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States.

METHODS: We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals.

RESULTS: The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR = 1.89; 95\% CI = 0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR = 2.64; 95\% CI = 1.01, 6.94).

CONCLUSIONS: Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers.

}, keywords = {Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Retirement, Risk Factors, Stress, Psychological, Stroke, Unemployment, United States}, issn = {0271-3586}, doi = {10.1002/ajim.20004}, author = {William T Gallo and Elizabeth H Bradley and Tracy Falba and J. A. Dubin and Cramer, L. and Stanislav V Kasl} } @article {6934, title = {Life course transitions and depressive symptoms among women in midlife.}, journal = {Int J Aging Hum Dev}, volume = {58}, year = {2004}, month = {2004}, pages = {241-65}, publisher = {58}, abstract = {

This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature.

}, keywords = {Caregivers, depression, Female, Health Status, Humans, Interviews as Topic, Life Change Events, Longitudinal Studies, Marital Status, Middle Aged, Quality of Life}, issn = {0091-4150}, doi = {10.2190/4CUU-KDKC-2XAD-HY0W}, author = {M Jean Turner and Timothy S Killian and Rebekah Cain} } @article {6969, title = {Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms.}, journal = {Psychol Med}, volume = {34}, year = {2004}, month = {2004 May}, pages = {623-34}, publisher = {34}, abstract = {

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults.

METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6\%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline.

CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.

}, keywords = {Age Factors, Aged, Depressive Disorder, Major, Female, Follow-Up Studies, Health Status, Humans, Logistic Models, Male, Middle Aged, Prevalence, Residence Characteristics, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {0033-2917}, doi = {10.1017/S0033291703001764}, author = {Ramin Mojtabai and Mark Olfson} } @article {6977, title = {Moderate and severe obesity have large differences in health care costs.}, journal = {Obes Res}, volume = {12}, year = {2004}, month = {2004 Dec}, pages = {1936-43}, publisher = {12}, abstract = {

OBJECTIVE: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old.

RESEARCH METHODS AND PROCEDURES: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days.

RESULTS: The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50\% increase) than a BMI of 30 to 35 (about a 25\% increase); a BMI of over 40 doubled health care costs (approximately 100\% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services.

DISCUSSION: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.

}, keywords = {Aged, Ambulatory Care, Body Mass Index, Body Weight, Female, Health Care Costs, Hospitalization, Humans, Male, Middle Aged, Obesity, Sex Characteristics}, issn = {1071-7323}, doi = {10.1038/oby.2004.243}, author = {Andreyeva, Tatiana and Sturm, Roland and Ringel, Jeanne S.} } @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 {6943, title = {Nonmetro residence, hearing loss, and its accommodation among elderly people.}, journal = {J Rural Health}, volume = {20}, year = {2004}, month = {2004 Spring}, pages = {136-41}, publisher = {20}, abstract = {

BACKGROUND: No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid.

PURPOSE: This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993-1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey.

METHODS: Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing.

FINDINGS: Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor.

CONCLUSION: Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.

}, keywords = {Aged, Aged, 80 and over, Comorbidity, Female, Health Surveys, Hearing aids, Hearing loss, Humans, Male, Memory Disorders, Odds Ratio, Rural Health, United States, Urban Population}, issn = {0890-765X}, doi = {10.1111/j.1748-0361.2004.tb00020.x}, author = {Nan E. Johnson} } @article {6972, title = {Number of children associated with obesity in middle-aged women and men: results from the health and retirement study.}, journal = {J Womens Health (Larchmt)}, volume = {13}, year = {2004}, month = {2004 Jan-Feb}, pages = {85-91}, publisher = {12}, abstract = {

OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men.

METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples).

RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7\% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4\% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different.

CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.

}, keywords = {Adult, Aged, Body Mass Index, Family Characteristics, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Obesity, Parity, Risk Assessment, United States}, issn = {1540-9996}, doi = {10.1089/154099904322836492}, author = {Weng, Haoling H. and Bastian, Lori A. and Donald H. Taylor Jr. and Truls Ostbye} } @article {6915, title = {Obesity{\textquoteright}s effects on the onset of functional impairment among older adults.}, journal = {Gerontologist}, volume = {44}, year = {2004}, month = {2004 Apr}, pages = {206-16}, publisher = {44}, abstract = {

PURPOSE: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health behaviors and health conditions may explain the relationship between body weight and the onset of functional impairment.

DESIGN AND METHODS: With the use of longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, logistic regression models on the onset of functional impairment over two time points are estimated for older adults.

RESULTS: Results indicate that body weight (more specifically being overweight or obese) makes one more likely to experience the onset of functional impairment across various domains of impairment. Outside of health behaviors and health conditions, obesity has an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living.

IMPLICATIONS: Study findings support the active treatment of weight problems in older adults. Future directions for research in this area should address effective weight management interventions targeting issues related to older individuals.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Weight, Chronic disease, Disabled Persons, Exercise, Female, Humans, Longitudinal Studies, Male, Motor Activity, Movement, Obesity, Risk-Taking, United States}, issn = {0016-9013}, doi = {10.1093/geront/44.2.206}, author = {Kristi Rahrig Jenkins} } @article {6921, title = {Out-of-pocket health care expenditures among older Americans with dementia.}, journal = {Alzheimer Dis Assoc Disord}, volume = {18}, year = {2004}, month = {2004 Apr-Jun}, pages = {90-8}, publisher = {18}, abstract = {

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Costs and Cost Analysis, Data Interpretation, Statistical, Female, Financing, Personal, Health Care Costs, Health Expenditures, Health Surveys, Humans, Insurance Coverage, Longitudinal Studies, Male}, issn = {0893-0341}, doi = {10.1097/01.wad.0000126620.73791.3e}, author = {Kenneth M. Langa and Eric B Larson and Robert B Wallace and A. Mark Fendrick and Norman L Foster and Mohammed U Kabeto and David R Weir and Robert J. Willis and A. Regula Herzog} } @article {6914, title = {Out-of-pocket health-care expenditures among older Americans with cancer.}, journal = {Value Health}, volume = {7}, year = {2004}, month = {2004 Mar-Apr}, pages = {186-94}, publisher = {7}, abstract = {

OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).

METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.

RESULTS: Of the 6370 respondents, 5382 (84\%) reported No CA, 812 (13\%) reported CA/No Tx, and 176 (3\%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27\% of their yearly income on OOPE compared to only 5\% of yearly income for high-income individuals with no cancer history (P < .01).

CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

}, keywords = {Aged, Aged, 80 and over, Cost of Illness, Family Characteristics, Female, Financing, Personal, Health Expenditures, Health Services Research, Humans, Insurance, Health, Longitudinal Studies, Male, Medicaid, Medicare, Michigan, Neoplasms}, issn = {1098-3015}, doi = {10.1111/j.1524-4733.2004.72334.x}, author = {Kenneth M. Langa and A. Mark Fendrick and M.E. Chernew and Mohammed U Kabeto and Paisley, Kerry L. and Hayman, James A.} } @article {6938, title = {Physical activity and mortality across cardiovascular disease risk groups.}, journal = {Med Sci Sports Exerc}, volume = {36}, year = {2004}, month = {2004 Nov}, pages = {1923-9}, abstract = {

PURPOSE: Several cohort studies suggest that sedentary individuals have an increased risk of death compared with individuals who are physically active. Most of these studies have been conducted in highly selected patient populations who tend to be healthier and are from higher socioeconomic status (SES) groups. We examined the impact of a sedentary lifestyle on mortality by cardiovascular disease (CVD) risk group in a national sample of U.S. adults who represent a wide range of activity levels, health conditions, and SES groups.

METHODS: Using data from the HRS, a nationally representative, observational study of 9824 U.S. adults aged 51-61 yr in 1992, we estimated the relative risk of death comparing sedentary individuals with those who are physically active by CVD risk group in a multivariate logistic regression model.

RESULTS: Even after adjusting for confounders, regular moderate to vigorous physical activity was associated with substantially lower overall mortality (odds ratio (OR) = 0.62 (95\% CI 0.44-0.86)) compared with sedentary individuals. High CVD risk individuals (21\% of the population) accounted for 64\% of deaths attributable to a sedentary lifestyle. Those with high CVD risk had the most significant benefit from being active (regular moderate to vigorous exercisers OR = 0.55 (95\% CI 0.31-0.97) and occasional or light exercisers OR 0.55 (95\% CI 0.41-0.74)) compared with high CVD risk individuals who were sedentary.

CONCLUSION: A sedentary lifestyle is associated with a higher risk of death in preretirement-aged U.S. adults. Individuals with high CVD risk appear to get the largest benefit from being physically active. Physical activity interventions targeting high CVD risk individuals should be a medical and public health priority.

}, keywords = {Cardiovascular Diseases, Cohort Studies, Female, Follow-Up Studies, Humans, Life Style, Logistic Models, Male, Middle Aged, Motor Activity, Multivariate Analysis, Odds Ratio, Prospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Survival Analysis, United States}, issn = {0195-9131}, doi = {10.1249/01.mss.0000145443.02568.7a}, author = {Richardson, Caroline R. and Kriska, Andrea M. and Lantz, Paula M. and Rodney A. Hayward} } @article {6922, title = {Quality of preventive clinical services among caregivers in the health and retirement study.}, journal = {J Gen Intern Med}, volume = {19}, year = {2004}, month = {2004 Aug}, pages = {875-8}, publisher = {19}, abstract = {

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

}, keywords = {Aged, Caregivers, Cohort Studies, Cross-Sectional Studies, Female, Health Care Surveys, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Preventive Health Services, Quality of Health Care, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2004.30411.x}, author = {Kim, Catherine and Mohammed U Kabeto and Robert B Wallace and Kenneth M. Langa} } @article {6970, title = {Race, gender, and the retirement decisions of people ages 60 to 80: prospects for age integration in employment.}, journal = {Int J Aging Hum Dev}, volume = {59}, year = {2004}, month = {2004}, pages = {255-86}, publisher = {59}, abstract = {

UNLABELLED: Demographic projections have prompted concerns about the potential economic burden of an aging population. This article, drawing on the 1998 Health and Retirement Study, explores ways in which race, gender, and age moderate the effects of various factors on labor force participation among people ages 60 to 80. Key findings center on health, education, and non-wage income. First, the effect of low non-wage income is weaker at older ages due to higher levels of functional disability. Second, the effect of low education is stronger for women, who perceive their chances of finding employment as low. Third, the effect of health is weaker for blacks, as they are less likely to find steady employment regardless of health.

POLICY IMPLICATIONS: Employer flexibility in number of hours worked might make sense for workers close to retirement age, while job search and training programs might be preferable for workers past the typical retirement age.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Black People, Educational Status, Employment, Female, Health Status, Humans, Income, Logistic Models, Male, Middle Aged, Retirement, Sex Distribution, White People}, issn = {0091-4150}, doi = {10.2190/GE24-03MX-U34P-AMNH}, author = {Tay K. McNamara and Williamson, John B.} } @article {6955, title = {Religion and functional health among the elderly: is there a relationship and is it constant?}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Jun}, pages = {355-74}, publisher = {16}, abstract = {

OBJECTIVES: Religion significantly influences a variety of health outcomes, especially among the elderly. Few studies have examined how the relationship may differ by age within this age group. It is possible that increasing levels of religiosity within the elderly, or other age-related differences, may strengthen the influence of religion on functional limitations.

METHOD: This study used the Assets and Health Dynamics Among the Oldest Old Survey, a nationally representative, longitudinal data set, to estimate the effects of religious attendance and salience on functional ability.

RESULTS: More frequent attendance is associated with fewer functional limitations, whereas higher levels of salience are associated with more limitations. No significant age interactions were found.

DISCUSSION: Attendance and salience predict the number of functional limitations in the elderly but in different directions. These effects tend to be stable within the elderly population, indicating that further age divisions may not be necessary when examining this relationship in future studies.

}, keywords = {Activities of Daily Living, Age Factors, Aging, Demography, Health Behavior, Health Status, Humans, Mental Health, Religion and Psychology, Socioeconomic factors, United States}, issn = {0898-2643}, doi = {10.1177/0898264304264204}, author = {Benjamins, Maureen Reindl} } @article {6945, title = {Religion and preventative health care utilization among the elderly.}, journal = {Soc Sci Med}, volume = {58}, year = {2004}, month = {2004 Jan}, pages = {109-18}, publisher = {58}, abstract = {

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Catholicism, Diagnostic Tests, Routine, Female, Health Services for the Aged, Health Status, Humans, Interviews as Topic, Jews, Logistic Models, Longitudinal Studies, Male, Patient Acceptance of Health Care, Preventive Health Services, Primary Health Care, Protestantism, Religion and Psychology, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/s0277-9536(03)00152-7}, author = {Benjamins, Maureen Reindl and Brown, Carolyn} } @article {6944, title = {Resolving inconsistencies in trends in old-age disability: report from a technical working group.}, journal = {Demography}, volume = {41}, year = {2004}, month = {2004 Aug}, pages = {417-41}, publisher = {41}, abstract = {

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1\%-2.5\% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Homemaker Services, Humans, Male, Models, Statistical, Self-Help Devices, United States}, issn = {0070-3370}, doi = {10.1353/dem.2004.0022}, author = {Vicki A Freedman and Eileen M. Crimmins and Robert F. Schoeni and Brenda C Spillman and Aykan, Hakan and Kramarow, Ellen and Land, Kenneth and Lubitz, James and Kenneth G. Manton and Linda G Martin and Shinberg, Diane and Timothy A Waidmann} } @article {6926, title = {Retirement transitions and spouse disability: effects on depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {59}, year = {2004}, month = {2004 Nov}, pages = {S333-42}, publisher = {59B}, abstract = {

OBJECTIVES: The purpose of this study was to investigate the effects of type of retirement (forced, early, abrupt) and spouse{\textquoteright}s disability on longitudinal change in depressive symptoms.

METHODS: The analyses rely on Waves 1-4 of the Health and Retirement Survey (N = 2,649). Generalized estimating equations models with bootstrapped standard errors and adjustment for survey design and non-independence of dyad members estimate effects of retirement, type of retirement, and spouse{\textquoteright}s disability on depressive symptoms, controlling for relevant covariates.

RESULTS: The results suggest that depressive symptoms increase when retirement is abrupt and perceived as too early or forced. Women retirees who stopped employment and were either forced into retirement or perceived their retirement as too early report significantly more depressive symptoms with increasing spouse activities of daily living (ADLs) limitations. There is no similar effect for men. In contrast, for working retirees who retired on time, depressive symptoms decrease with increasing spouse ADLs.

DISCUSSION: These results highlight the importance of retirement context on postretirement well-being. They suggest that both type of retirement transition and marital contexts such as spouse{\textquoteright}s disability influence postretirement well-being, and these effects differ by gender.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Caregivers, Demography, depression, Disabled Persons, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retirement, Spouses, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/59.6.s333}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {6929, title = {Urinary incontinence and its association with death, nursing home admission, and functional decline.}, journal = {J Am Geriatr Soc}, volume = {52}, year = {2004}, month = {2004 May}, pages = {712-8}, publisher = {52}, abstract = {

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).

DESIGN: A population-based prospective cohort study from 1993 to 1995.

SETTING: Community-dwelling within the United States.

PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.

MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.

RESULTS: The prevalence of UI was 14.8\% (18.5\% in women; 8.5\% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9\% vs 8.7\%; unadjusted odds ratio (OR)=1.29, 95\% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4\% vs 2.6\%, OR=1.77; 95\% CI=1.18-2.63), and to have declined in ADL function (13.6\% vs 8.1\%; OR=1.78, 95\% CI=1.36-2.33) and IADL function (21.2\% vs 13.8\%; OR 1.69, 95\% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95\% CI=0.67-1.21), nursing home admission (AOR=1.33, 95\% CI=0.86-2.04), or ADL decline (AOR=1.24, 95\% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95\% CI=1.05-1.63), although adjustment markedly reduced the strength of this association.

CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Mass Index, Female, Follow-Up Studies, Frail Elderly, Health Status, Humans, Male, Nursing homes, Outcome Assessment, Health Care, Risk Factors, Smoking, Socioeconomic factors, Time Factors, Urinary incontinence}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2004.52207.x}, author = {Holroyd-Leduc, Jayna M. and Kala M. Mehta and Kenneth E Covinsky} } @article {6946, title = {Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study.}, journal = {Soc Psychiatry Psychiatr Epidemiol}, volume = {39}, year = {2004}, month = {2004 Oct}, pages = {828-35}, publisher = {39}, abstract = {

BACKGROUND: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS).

METHOD: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734). Depressive symptoms were assessed with the CES-D. Symptom coverage and response categories varied across study wave. The first wave (1992) used a four-category response, whereas subsequent waves (1994 and 1996) used a two-category response. A structural equations model (SEM) based in Item Response Theory (IRT) was used to calibrate symptoms and generate linked depressive symptom burden scores.

RESULTS: Linked depressive symptom burden scores, derived from calibrated symptoms, were distributed similarly across HRS wave.

CONCLUSION: Our results demonstrate the applicability of an IRT-based SEM to address a common challenge in prospective studies: changes in the content and context of symptom assessment. Future investigations may make use of our linked syndrome scores to further explore other aspects of depression from a longitudinal perspective.

}, keywords = {Adult, Aged, Aging, Calibration, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Psychological, Psychological Tests, Psychometrics, United States}, issn = {0933-7954}, doi = {10.1007/s00127-004-0815-8}, author = {Richard N Jones and Stephanie J. Fonda} } @article {6989, title = {Workplace characteristics and work disability onset for men and women.}, journal = {Soz Praventivmed}, volume = {49}, year = {2004}, month = {2004}, pages = {122-31}, publisher = {49}, abstract = {

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits.

METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview.

RESULTS: Women{\textquoteright}s disability onset and health problems appear less related to job characteristics than men{\textquoteright}s. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions.

CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

}, keywords = {Disabled Persons, Female, Humans, Logistic Models, Male, Middle Aged, Occupational Diseases, Proportional Hazards Models, Retirement, Risk, Sex Factors, Sick Leave, Stress, Psychological, United States, Workers{\textquoteright} compensation, Workload, Workplace}, issn = {0303-8408}, doi = {10.1007/s00038-004-3105-z}, author = {Eileen M. Crimmins and Mark D Hayward} } @article {6863, title = {Additive and interactive effects of comorbid physical and mental conditions on functional health.}, journal = {J Aging Health}, volume = {15}, year = {2003}, month = {2003 Aug}, pages = {465-81}, publisher = {15}, abstract = {

OBJECTIVE: To understand the role of cognitive impairment and depressive symptoms on functional outcomes of stroke and diabetes. Evaluation approaches to functional outcomes have rarely focused on the presence of specific comorbidities, particularly those involving mental health disorders.

METHODS: Data are from the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons 70+ years of age in 1993. Analyses are limited to 5,646 self-respondents for whom functional outcome data are available in 1995. Additive and interactive multiple regression models are compared for each outcome and focal condition combination.

RESULTS: The additive model is sufficient for the majority of outcome and focal condition combinations. The interaction term is significant in 4 of 12 comparisons.

DISCUSSION: Stroke, diabetes, cognitive impairment, and depressive symptoms exhibit strong independent effects on physical functioning. Support for the hypothesis that cognitive impairment and depression exacerbate the impact of stroke and diabetes is more limited.

}, keywords = {Activities of Daily Living, Aged, Aging, Black or African American, Cognition Disorders, depression, Diabetes Complications, Educational Status, Health Surveys, Hispanic or Latino, Humans, Stroke, United States, White People}, issn = {0898-2643}, doi = {10.1177/0898264303253502}, author = {Fultz, Nancy H. and Mary Beth Ofstedal and A. Regula Herzog and Robert B Wallace} } @article {6848, title = {Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {58}, year = {2003}, month = {2003 May}, pages = {M461-7}, publisher = {58A}, abstract = {

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults.

METHODS: We studied 6301 elderly adults (mean age, 77 years; 62\% women; 81\% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment.

RESULTS: During 2 years of follow-up, 9\% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3\% in those with the best function on both measures to 16\% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3\%, 5\%, and 9\% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6\%, 7\%, and 12\% in participants with the middle level of cognitive function (p <.001 for trend), and 10\%, 13\%, and 16\% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95\% confidence interval, 2.0-4.7).

CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.

}, keywords = {Aged, Cognition, depression, Female, Humans, Male, Mortality, Proportional Hazards Models, Risk Factors}, issn = {1079-5006}, doi = {10.1093/gerona/58.5.m461}, author = {Kala M. Mehta and Kristine Yaffe and Kenneth M. Langa and Laura Sands and Whooley, Mary and Kenneth E Covinsky} } @article {6889, title = {Asking neutral versus leading questions: implications for functional limitation measurement.}, journal = {J Aging Health}, volume = {15}, year = {2003}, month = {2003 Nov}, pages = {661-87}, publisher = {15}, abstract = {

UNLABELLED: National surveys of older Americans routinely have included functional limitation items using either a leading approach ("how much difficulty do you have...") or a neutral approach ("do you have any difficulty..."). This article evaluates the performance of scales based on these two approaches.

METHODS: Using responses from 595 randomly selected participants to the 1994 Health and Retirement Study, the authors compared prevalences and evaluated scales based on each approach with respect to the extent of missing data, face validity, reliability, predictive validity, convergent validity, and robustness of odds ratios in predictive models.

RESULTS: The authors found that leading questions provided higher estimates of functional limitations than neutral questions, but both approaches yielded scales with similar validity and reliability. However, for both approaches, scales incorporating degree of difficulty had better validity and reliability than those based on counts of tasks. All four approaches yielded substantially similar coefficients in a model predicting disability onset.

DISCUSSION: The authors conclude that, because they minimize survey time without compromising validity and reliability, items that explicitly capture degree of difficulty by asking "How much difficulty do you have..." may be the optimal approach for survey designers.

}, keywords = {Activities of Daily Living, Aged, Factor Analysis, Statistical, Health Surveys, Humans, Research Design, Surveys and Questionnaires, United States}, issn = {0898-2643}, doi = {10.1177/0898264303256250}, author = {Vicki A Freedman and Aykan, Hakan and Kleban, Morton H.} } @article {6878, title = {Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity.}, journal = {Gerontologist}, volume = {43}, year = {2003}, month = {2003 Dec}, pages = {817-27}, publisher = {43}, abstract = {

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

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

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

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

}, keywords = {Caregivers, depression, Female, Humans, Male, Middle Aged, Regression Analysis, Risk Factors, Stress, Psychological}, issn = {0016-9013}, doi = {10.1093/geront/43.6.817}, author = {Amirkhanyan, Anna A. and Douglas A. Wolf} } @article {6898, title = {Cognitive function and acute care utilization.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 Jan}, pages = {S38-49}, publisher = {58B}, abstract = {

OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS: Sixteen percent, 64\%, and 20\% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

}, keywords = {Aged, Cognition Disorders, Female, Geriatric Assessment, Health Behavior, Health Status, Hospitalization, Hospitals, Humans, Length of Stay, Male, Neuropsychological tests, Outpatient Clinics, Hospital, Severity of Illness Index, United States}, issn = {1079-5014}, doi = {10.1093/geronb/58.1.s38}, author = {Walsh, Edith G. and Bei Wu and Mitchell, Janet B. and Lisa F Berkman} } @article {6877, title = {County-level income inequality and depression among older Americans.}, journal = {Health Serv Res}, volume = {38}, year = {2003}, month = {2003 Dec}, pages = {1863-83}, publisher = {38}, abstract = {

OBJECTIVES: To examine (1) whether county-level income inequality is associated with depression among Americans aged 70 and older, taking into consideration county-level mean household income and individual-level socioeconomic status (SES), demographic characteristics, and physical health, and (2) whether income inequality effects are stronger among people with lower SES and physical health.

DATA SOURCES: The individual-level data from the first wave of the Assets and Health Dynamics among the Oldest Old survey (1993-1994) were linked with the county-level income inequality and mean household income data from the 1990 Census.

STUDY DESIGN: Multilevel analysis was conducted to examine the association between income inequality (the Gini coefficient) and depression.

PRINCIPAL FINDINGS: Income inequality was significantly associated with depression among older Americans. Those living in counties with higher income inequality were more depressed, independent of their demographic characteristics, SES, and physical health. The association was stronger among those with more illnesses.

CONCLUSIONS: While previous empirical research on income inequality and physical health is equivocal, evidence for income inequality effects on mental health seems to be strong.

}, keywords = {Age Factors, Aged, Aged, 80 and over, depression, Female, Health Status Indicators, Humans, Income, Male, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2003.00206.x}, author = {Muramatsu, Naoko} } @article {6891, title = {Determinants of self-perceived changes in health status among pre- and early-retirement populations.}, journal = {Int J Aging Hum Dev}, volume = {56}, year = {2003}, month = {2003}, pages = {197-222}, publisher = {56}, abstract = {

Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects{\textquoteright} selective optimization and resiliency.

}, keywords = {Activities of Daily Living, Age Factors, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Retirement, Self Concept, United States}, issn = {0091-4150}, doi = {10.2190/T8JD-1P30-6MFT-8WHA}, author = {Namkee G Choi} } @article {6890, title = {Determinants of stability and changes in self-reported work disability among older working-age populations.}, journal = {J Aging Soc Policy}, volume = {15}, year = {2003}, month = {2003}, pages = {11-31}, publisher = {15}, abstract = {

Data from the Health and Retirement Study, 1992-1994, were used to analyze (1) the prevalence and incidence of self-reported work disability among older working-age populations over a two-year period, and (2) the effect of the stability/changes in physical and functional health conditions, controlling for socioeconomic and occupational characteristics, on the stability/changes in self-reported work ability/disability. Findings show a high rate of transitions into and out of work-disabled status over the two-year period. Findings also show that, although objective physical and functional health problems and low self-ratings of health at wave 1 were significant determinants of self-reported work disability at wave 1, most subsequent changes in objective physical and functional health conditions over the two-year period were not significantly associated with the changes in self-report of work disability between wave 1 and wave 2. Especially, improved health conditions were not significantly associated with regained work ability between the two waves. Of the demographic variables, female gender significantly increased the likelihood of reporting work disability at wave 2, and being Black or Hispanic significantly decreased the likelihood of reporting regained work ability at wave 2. Research and policy implications of the findings are discussed.

}, keywords = {Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Self Disclosure, Surveys and Questionnaires}, issn = {0895-9420}, doi = {10.1300/J031v15n01_02}, author = {Namkee G Choi} } @article {6881, title = {Health care utilization among older adults with arthritis.}, journal = {Arthritis Rheum}, volume = {49}, year = {2003}, month = {2003 Apr 15}, pages = {164-71}, publisher = {49}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Arthritis, Comorbidity, Cost of Illness, Female, Health Services, Home Care Services, Hospitals, Humans, Insurance, Health, Longitudinal Studies, Male, Nursing homes, Physicians{\textquoteright} Offices, Social Class}, issn = {0004-3591}, doi = {10.1002/art.11003}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6860, title = {High out-of-pocket health care spending by the elderly.}, journal = {Health Aff (Millwood)}, volume = {22}, year = {2003}, month = {2003 May-Jun}, pages = {194-202}, publisher = {22}, abstract = {

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

}, keywords = {Aged, Drug Costs, Drug Prescriptions, Financing, Personal, Health Care Surveys, Health Expenditures, Health Maintenance Organizations, Health Services for the Aged, Humans, Insurance, Health, Medicare, Poverty, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.22.3.194}, author = {Dana P Goldman and Julie M Zissimopoulos} } @article {6897, title = {Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 Sep}, pages = {S305-13}, publisher = {58B}, abstract = {

OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants.

METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status.

RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants.

DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations.

}, keywords = {Acculturation, Aged, Cross-Sectional Studies, depression, Emigration and Immigration, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Residence Characteristics}, issn = {1079-5014}, doi = {10.1093/geronb/58.5.s305}, author = {Janet M Wilmoth and Pei-Chun Chen} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6865, title = {The labor market consequences of race differences in health.}, journal = {Milbank Q}, volume = {81}, year = {2003}, month = {2003}, pages = {441-73}, publisher = {81}, keywords = {Adult, Age Distribution, Age Factors, Attitude to Health, Black or African American, Cross-Cultural Comparison, Data Interpretation, Statistical, Employment, Female, Health Services Needs and Demand, Health Status Indicators, Humans, Indians, North American, Male, Middle Aged, Sex Distribution, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0887-378X}, doi = {10.1111/1468-0009.t01-1-00063}, author = {John Bound and Timothy A Waidmann and Michael Schoenbaum and Bingenheimer,Jeffrey B.} } @article {6845, title = {Life expectancy with cognitive impairment in the older population of the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 May}, pages = {S179-86}, publisher = {58B}, abstract = {

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan{\textquoteright}s method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5\%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Humans, Life Expectancy, Male, Neuropsychological tests, Probability, Psychometrics, Sex Factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/58.3.s179}, author = {Suthers, Kristen and Jung K Kim and Eileen M. Crimmins} } @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 {6850, title = {Racial disparities in joint replacement use among older adults.}, journal = {Med Care}, volume = {41}, year = {2003}, month = {2003 Feb}, pages = {288-98}, publisher = {41}, abstract = {

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98\%; Hispanic: 0.97\%, annually) less frequently compared with white persons (1.48\% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95\% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95\% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95\% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

}, keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Black or African American, Cohort Studies, Data Interpretation, Statistical, Health Services Accessibility, Health Services Needs and Demand, Health Status, Health Surveys, Hispanic or Latino, Humans, Interviews as Topic, Osteoarthritis, Sampling Studies, United States, White People}, issn = {0025-7079}, doi = {10.1097/01.MLR.0000044908.25275.E1}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6882, title = {Racial/ethnic differences in rates of depression among preretirement adults.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Nov}, pages = {1945-52}, publisher = {93}, abstract = {

OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

RESULTS: African Americans (odds ratio [OR] = 1.16, 95\% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95\% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites.

CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.

}, keywords = {Aged, Black or African American, Cohort Studies, Comorbidity, Demography, Depressive Disorder, Major, Diagnostic and Statistical Manual of Mental Disorders, Female, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Probability, Risk Factors, Socioeconomic factors, United States, White People}, issn = {0090-0036}, doi = {10.2105/ajph.93.11.1945}, author = {Dorothy D Dunlop and Song, Jing and Lyons, J.S. and Larry M Manheim and Rowland W Chang} } @article {6876, title = {Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).}, journal = {Ann Fam Med}, volume = {1}, year = {2003}, month = {2003 Nov-Dec}, pages = {209-17}, publisher = {1}, abstract = {

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70\% to 80\% among women aged 50 to 64 years, then declines to around 40\% among those aged 85 to 90 years. For Pap tests there is a decline from 75\% among women aged 50 to 54 years to 25\% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Breast Neoplasms, Cost-Benefit Analysis, Female, Health Services for the Aged, Humans, Longitudinal Studies, Mammography, Middle Aged, Multivariate Analysis, Papanicolaou Test, Patient Acceptance of Health Care, Risk, United States, Uterine Cervical Neoplasms, Vaginal Smears}, issn = {1544-1709}, doi = {10.1370/afm.54}, author = {Truls Ostbye and Gary N. Greenberg and Donald H. Taylor Jr. and Lee, Ann Marie M.} } @article {6873, title = {Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys.}, journal = {Gerontology}, volume = {49}, year = {2003}, month = {2003 Jul-Aug}, pages = {265-71}, publisher = {49}, abstract = {

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality.

OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics.

METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9\% (n = 185) of the men died and 5\% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2\% (n = 99) of the women died in the 3 years of follow-up.

RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model.

CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

}, keywords = {Aged, Female, Health Status, Health Surveys, Humans, Life Expectancy, Male, Mortality, Prognosis, Proportional Hazards Models, Self Concept, Sex Distribution, Survival Analysis}, issn = {0304-324X}, doi = {10.1159/000070409}, author = {Michele J. Siegel and Elizabeth H Bradley and Stanislav V Kasl} } @article {6855, title = {Sickness and preventive medical behavior.}, journal = {J Health Econ}, volume = {22}, year = {2003}, month = {2003 Jul}, pages = {675-89}, publisher = {22}, abstract = {

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

}, keywords = {Aged, Anxiety, Breast Self-Examination, Cholesterol, Female, Health Behavior, Health Expenditures, Health Status, Humans, Influenza Vaccines, Male, Mammography, Mass Screening, Middle Aged, Papanicolaou Test, Patient Acceptance of Health Care, Preventive Health Services, Primary Prevention, Prostatic Neoplasms, Retirement, Risk Factors, Vaginal Smears}, issn = {0167-6296}, doi = {10.1016/S0167-6296(03)00042-0}, author = {Stephen Wu} } @article {6903, title = {Urinary incontinence and depression in middle-aged United States women.}, journal = {Obstet Gynecol}, volume = {101}, year = {2003}, month = {2003 Jan}, pages = {149-56}, publisher = {101}, abstract = {

OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression.

METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders.

RESULTS: Approximately 16\% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80\% (odds ratio [OR] 1.82; 95\% confidence interval [CI] 1.26, 2.63) and 40\% (OR 1.41; 95\% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates.

CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Cross-Sectional Studies, depression, Female, Humans, Logistic Models, Middle Aged, United States, Urinary incontinence}, issn = {0029-7844}, doi = {10.1016/s0029-7844(02)02519-x}, author = {Ingrid E Nygaard and Carolyn L. Turvey and Burns, Trudy L. and Elizabeth A Chrischilles and Robert B Wallace} } @article {6827, title = {Body-mass index and 4-year change in health-related quality of life.}, journal = {J Aging Health}, volume = {14}, year = {2002}, month = {2002 May}, pages = {195-210}, publisher = {14}, abstract = {

OBJECTIVE: To determine the effect of body-mass index (BMI) categories (a proxy for adiposity) on 4-year changes in health-related quality of life (HRQL) independent of baseline disease severity.

DESIGN: Secondary analyses of a prospective, longitudinal study.

PARTICIPANTS: Data on 7,895 adults ages 51 to 61 years who responded to the Health and Retirement Surveys in 1992, 1994, and 1996 were included.

RESULTS: Estimates of the effect of BMI on changes in HRQL were adjusted by disease severity. Each BMI category was associated with an increasing risk of decline in perceived health, with the highest risk in the higher categories. A BMI of between 30 and 35 was associated with a risk of decline in mobility.

CONCLUSIONS: The findings suggest a significant impact of BMI on changes in HRQL that is independent of disease severity and baseline HRQL.

}, keywords = {Body Mass Index, Disabled Persons, Female, Health Status, Humans, Male, Middle Aged, Obesity, Quality of Life, United States}, issn = {0898-2643}, doi = {10.1177/089826430201400202}, url = {http://reviews.bmn.com/medline/search/record?uid=MDLN.21990701andrefer=scirus}, author = {Damush, T.M. and Timothy E. Stump and Daniel O. Clark} } @article {6832, title = {Breast cancer and women{\textquoteright}s labor supply.}, journal = {Health Serv Res}, volume = {37}, year = {2002}, month = {2002 Oct}, pages = {1309-28}, publisher = {37}, abstract = {

OBJECTIVE: To investigate the effect of breast cancer on women{\textquoteright}s labor supply. DATE SOURCE/STUDY SETTING: Using the 1992 Health and Retirement Study, we estimate the probability of working using probit regression and then, for women who are employed, we estimate regressions for average weekly hours worked using ordinary least squares (OLS). We control for health status by using responses to perceived health status and comorbidities. For a sample of married women, we control for spouses{\textquoteright} employer-based health insurance. We also perform additional analyses to detect selection bias in our sample.

PRINCIPAL FINDINGS: We find that the probability of breast cancer survivors working is 10 percentage points less than that for women without breast cancer. Among women who work, breast cancer survivors work approximately three more hours per week than women who do not have cancer. Results of similar magnitude persist after health status is controlled in the analysis, and although we could not definitively rule out selection bias, we could not find evidence that our results are attributable to selection bias.

CONCLUSIONS: For some women, breast cancer may impose an economic hardship because it causes them to leave theirjobs. However, for women who survive and remain working, this study failed to show a negative effect on hours worked associated with breast cancer. Perhaps the morbidity associated with certain types and stages of breast cancer and its treatment does not interfere with work.

}, keywords = {Breast Neoplasms, Comorbidity, Cost of Illness, Decision making, Employment, Family Characteristics, Female, Health Benefit Plans, Employee, Health Status, Humans, Marital Status, Middle Aged, Probability, Selection Bias, Survivors, United States, Women, Working}, issn = {0017-9124}, doi = {10.1111/1475-6773.01041}, author = {Cathy J. Bradley and Bednarek, Heather and David Neumark} } @article {6789, title = {Breast cancer survival, work, and earnings.}, journal = {J Health Econ}, volume = {21}, year = {2002}, month = {2002 Sep}, pages = {757-79}, publisher = {21}, abstract = {

Relying on data from the Health and Retirement Study (HRS) linked to longitudinal social security earnings data, we examine differences between breast cancer survivors and a non-cancer control group in employment, hours worked, wages, and earnings. Overall, breast cancer has a negative impact on employment. However, among survivors who work, hours of work, wages, and earnings are higher compared to women in the control group. We explore possible biases underlying these estimates, focusing on selection, but cannot rule out a causal interpretation. Our research points to heterogeneous labor market responses to breast cancer, and shows that breast cancer does not appear to be debilitating for women who remain in the work force.

}, keywords = {Breast Neoplasms, Cohort Studies, Diagnostic Tests, Routine, Efficiency, Employment, Female, Humans, Longitudinal Studies, Mammography, Middle Aged, Models, Econometric, Probability, Research Design, Retirement, Salaries and Fringe Benefits, Social Security, Survivors, United States, Women, Working}, issn = {0167-6296}, doi = {10.1016/s0167-6296(02)00059-0}, author = {Cathy J. Bradley and Bednarek, Heather and David Neumark} } @article {6814, title = {Can patient self-management help explain the SES health gradient?}, journal = {Proc Natl Acad Sci U S A}, volume = {99}, year = {2002}, month = {2002 Aug 06}, pages = {10929-34}, publisher = {99}, abstract = {

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation-better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys-one cohort study and one randomized clinical trial-that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

}, keywords = {Adolescent, Adult, Antiretroviral Therapy, Highly Active, Diabetes Mellitus, Type 1, Educational Status, Female, Health Knowledge, Attitudes, Practice, HIV Infections, Humans, Insulin, Longitudinal Studies, Male, Patient Compliance, Population Surveillance, Prospective Studies, Randomized Controlled Trials as Topic, Self Care, Social Class}, issn = {0027-8424}, doi = {10.1073/pnas.162086599}, author = {Dana P Goldman and James P Smith} } @article {6839, title = {Driving life expectancy of persons aged 70 years and older in the United States.}, journal = {Am J Public Health}, volume = {92}, year = {2002}, month = {2002 Aug}, pages = {1284-9}, publisher = {92}, abstract = {

OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

RESULTS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

CONCLUSIONS: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.

}, keywords = {Accidents, Traffic, Activities of Daily Living, Aged, Aged, 80 and over, Automobile Driving, Decision making, Family Characteristics, Female, Frail Elderly, Humans, Interviews as Topic, Licensure, Life Expectancy, Logistic Models, Male, Risk Factors, Transportation, United States}, issn = {0090-0036}, doi = {10.2105/ajph.92.8.1284}, author = {Foley, Daniel J. and Heimovitz, Harley K. and Jack M. Guralnik and Brock, Dwight B.} } @article {6829, title = {The health capital of families: an investigation of the inter-spousal correlation in health status.}, journal = {Soc Sci Med}, volume = {55}, year = {2002}, month = {2002 Oct}, pages = {1157-72}, publisher = {55}, abstract = {

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

}, keywords = {Activities of Daily Living, Chronic disease, Decision making, Female, Health Behavior, Health Status Indicators, Humans, Interviews as Topic, Life Style, Male, Marital Status, Middle Aged, Regression Analysis, Risk Factors, Risk-Taking, Self Efficacy, Sociology, Medical, Spouses, United States}, issn = {0277-9536}, doi = {10.1016/s0277-9536(01)00253-2}, author = {Sven E. Wilson} } @article {6788, title = {Health in household context: living arrangements and health in late middle age.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, month = {2002 Mar}, pages = {1-21}, publisher = {43}, abstract = {

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

}, keywords = {Activities of Daily Living, Depressive Disorder, Family Characteristics, Family Health, Female, Health Status Indicators, Humans, Longitudinal Studies, Male, Marital Status, Middle Aged, Self Efficacy, United States}, issn = {0022-1465}, doi = {10.2307/3090242}, author = {Mary Elizabeth Hughes and Linda J. Waite} } @article {6803, title = {Individual consequences of volunteer and paid work in old age: health and mortality.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, month = {2002 Dec}, pages = {490-509}, publisher = {43}, abstract = {

The impacts of the productive social activities of volunteer and paid work on health have rarely been investigated among the oldest Americans despite a recent claim for their beneficial effect (Rowe and Kahn 1998). This paper used data from Waves 3 and 4 of the Asset and Health Dynamics among the Oldest Old (AHEAD) Study to (1) investigate the impact of these activities on health measured as self-reported health and activities of daily living (ADL) functioning limitations and to (2) explore possible causal mechanisms. Using multinomial logistic regression analysis, amounts of volunteer and paid work over a minimum of 100 annual hours self-reported at Wave 3 were related to poor health and death as competing risks measured at Wave 4, controlling for health measured at Wave 2 and for other predictors of poor health and death. Findings suggest that performing more than 100 annual hours of volunteer work and of paid work have independent and significant protective effects against subsequent poor health and death. Additional analyses suggest that the quantity of volunteer and paid work beyond 100 annual hours is not related to health outcomes and that physical exercise and mental health measured as cognitive functioning and depressive symptoms explain not entirely overlapping parts of the relationship between productive activities and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Employment, Female, Health Status, Humans, Male, Mortality, Multivariate Analysis, Prospective Studies, United States, Volunteers}, issn = {0022-1465}, doi = {10.2307/3090239}, author = {Luoh, M. and A. Regula Herzog} } @article {6790, title = {Informal caregiving for diabetes and diabetic complications among elderly americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {57}, year = {2002}, month = {2002 May}, pages = {S177-86}, publisher = {57B}, abstract = {

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Costs and Cost Analysis, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Humans, Hypoglycemic Agents, Insulin, Male, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/57.3.s177}, author = {Kenneth M. Langa and Sandeep Vijan and Rodney A. Hayward and M.E. Chernew and Caroline S Blaum and Mohammed U Kabeto and David R Weir and Steven J. Katz and Robert J. Willis and A. Mark Fendrick} } @article {6791, title = {Informal caregiving time and costs for urinary incontinence in older individuals in the United States.}, journal = {J Am Geriatr Soc}, volume = {50}, year = {2002}, month = {2002 Apr}, pages = {733-7}, publisher = {50}, abstract = {

OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals.

DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443).

SETTING: Community-dwelling older people.

PARTICIPANTS: National population-based sample of community-dwelling older people.

MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads.

RESULTS: Thirteen percent of men and 24\% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P <.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P <.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care.

CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.

}, keywords = {Aged, Caregivers, Comorbidity, Confounding Factors, Epidemiologic, Female, Humans, Incontinence Pads, Male, Regression Analysis, Time Factors, United States, Urinary incontinence}, issn = {0002-8614}, doi = {10.1046/j.1532-5415.2002.50170.x}, author = {Kenneth M. Langa and Fultz, Nancy H. and Sanjay Saint and Mohammed U Kabeto and A. Regula Herzog} } @article {6822, title = {It takes two: marriage and smoking cessation in the middle years.}, journal = {J Aging Health}, volume = {14}, year = {2002}, month = {2002 Aug}, pages = {336-54}, publisher = {14}, abstract = {

OBJECTIVES: In this prospective study of smoking cessation among married individuals in midlife we examine correspondence in the change of each partner{\textquoteright}s smoking status with that of the other, independent of established psychosocial correlates of smoking cessation.

METHODS: Using longitudinal data from the first two waves of the Health and Retirement Study, 1992-1994, hierarchical logistic regression models were estimated for married male and female smokers separately.

RESULTS: Findings support our hypothesis of correspondence in the smoking cessation of married male and female smokers net of other sociodemographic, health, and health behavior characteristics.

DISCUSSION: These findings suggest that initiation and maintenance of this positive lifestyle change may be more easily achieved when both marital partners are given information and support to quit smoking at the same time.

}, keywords = {Female, Health Behavior, Humans, Male, Marital Status, Marriage, Middle Aged, Smoking cessation, Social Support, Spouses}, issn = {0898-2643}, doi = {10.1177/08964302014003002}, author = {Melissa M Franks and Pienta, Amy M. and Linda A. Wray} } @article {6825, title = {Linking clinical variables to health-related quality of life in Parkinson{\textquoteright}s disease.}, journal = {Parkinsonism Relat Disord}, volume = {8}, year = {2002}, month = {2002 Jan}, pages = {199-209}, publisher = {8}, abstract = {

OBJECTIVE: Identify the point-in-time relationship between Parkinson{\textquoteright}s disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).

BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.

DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.

RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.

CONCLUSION: PD patients{\textquoteright} well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.

}, keywords = {Aged, Cross-Sectional Studies, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Parkinson Disease, Quality of Life}, issn = {1353-8020}, doi = {10.1016/s1353-8020(01)00044-x}, author = {Elizabeth A Chrischilles and Linda M. Rubenstein and Voelker, Margaret D. and Robert B Wallace and Rodnitzky, Robert L.} } @article {6807, title = {A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey.}, journal = {Prev Med}, volume = {34}, year = {2002}, month = {2002 Mar}, pages = {334-45}, publisher = {34}, abstract = {

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Attitude to Health, Chi-Square Distribution, Exercise, Female, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Longitudinal Studies, Male, Middle Aged, Risk Assessment, Risk Factors, Sex Distribution, Smoking, Socioeconomic factors, Survival Rate, United States}, issn = {0091-7435}, doi = {10.1006/pmed.2001.0991}, author = {Truls Ostbye and Donald H. Taylor Jr. and Sang-Hyuk Jung} } @article {6828, title = {Loss of health insurance and the risk for a decline in self-reported health and physical functioning.}, journal = {Med Care}, volume = {40}, year = {2002}, month = {2002 Nov}, pages = {1126-31}, publisher = {40}, abstract = {

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0\%) people continued to have private insurance, 229 (3.8\%) reported having lost all insurance, and 75 (1.2\%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6\% for those who lost all insurance versus 7.2\% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95\% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5\% vs. 20.4\%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95\% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

}, keywords = {Female, Health Services Accessibility, Health Status, Humans, Insurance, Health, Male, Medically Uninsured, Middle Aged, Regression Analysis, Risk, Self Efficacy}, issn = {0025-7079}, doi = {10.1097/00005650-200211000-00013}, author = {David W. Baker and Joseph J Sudano and Jeffrey M. Albert and Elaine A Borawski and Avi Dor} } @article {6793, title = {A national study of the quantity and cost of informal caregiving for the elderly with stroke.}, journal = {Neurology}, volume = {58}, year = {2002}, month = {2002 Jun 25}, pages = {1754-9}, publisher = {58}, abstract = {

BACKGROUND: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients.

OBJECTIVE: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke.

METHODS: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated.

RESULTS: Of 7,443 respondents, 656 (8.8\%) reported a history of stroke. Of those, 375 (57\%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke +/- SRHP (p < 0.01). Using the median 1999 home health aide wage (8.20 dollars/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from 3,500 dollars to 8,200 dollars. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to 6.1 billion dollars for stroke-related informal caregiving in the United States.

CONCLUSIONS: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Confidence Intervals, Female, Humans, Longitudinal Studies, Male, Multivariate Analysis, Stroke, United States}, issn = {0028-3878}, doi = {10.1212/wnl.58.12.1754}, author = {Hickenbottom, S.L. and A. Mark Fendrick and Kutcher, J.S. and Mohammed U Kabeto and Steven J. Katz and Kenneth M. Langa} } @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 {6808, title = {The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Ol}, journal = {J Am Geriatr Soc}, volume = {50}, year = {2002}, month = {2002 Apr}, pages = {691-9}, publisher = {50}, abstract = {

OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans.

DESIGN: Panel study; secondary data analysis.

SETTING: United States (national sample).

PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998).

MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses.

RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption.

CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Body Mass Index, Exercise, Female, Humans, Leg, Logistic Models, Longitudinal Studies, Male, Marital Status, Middle Aged, Risk Factors, Sex Distribution, Smoking, Smoking cessation, United States, Walking}, issn = {0002-8614}, doi = {10.1046/j.1532-5415.2002.50164.x}, author = {Truls Ostbye and Donald H. Taylor Jr. and Katrina M. Krause and Scoyoc, L.V.} } @article {6792, title = {State expenditures on home and community based services and use of formal and informal personal assistance: a multilevel analysis.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, note = {RDA 1996-025}, month = {2002 Mar}, pages = {107-24}, publisher = {43}, abstract = {

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults{\textquoteright} strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals{\textquoteright} demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Female, Financing, Government, Frail Elderly, Health Care Surveys, Health Expenditures, Home Care Services, Humans, Logistic Models, Male, State Government}, issn = {0022-1465}, doi = {10.2307/3090248}, author = {Muramatsu, Naoko and Richard T. Campbell} } @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 {6783, title = {Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older.}, journal = {Int Psychogeriatr}, volume = {13}, year = {2001}, month = {2001 Jun}, pages = {241-9}, publisher = {13}, abstract = {

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.

}, keywords = {Aged, Aged, 80 and over, Aging, Caregivers, Cognition Disorders, Cohort Studies, Delusions, depression, Female, Follow-Up Studies, Hallucinations, Humans, Male, Marital Status, Paranoid Disorders, Risk Factors, Stroke, Surveys and Questionnaires, United States, Vision Disorders}, issn = {1041-6102}, doi = {10.1017/s1041610201007621}, author = {Carolyn L. Turvey and Schultz, Susan K. and Arndt, Stephan and Ellingrod, Vicki and Robert B Wallace and A. Regula Herzog} } @article {6764, title = {Changes in driving patterns and worsening depressive symptoms among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {56}, year = {2001}, month = {2001 Nov}, pages = {S343-51}, publisher = {56B}, abstract = {

OBJECTIVES: This study examined whether changes in driving patterns-driving cessation and reduction-have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives.

METHODS: The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample (N = 5,239), and the second model focused on drivers only (n = 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms.

RESULTS: Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms.

DISCUSSION: Changes in driving patterns can be deleterious for older people{\textquoteright}s depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aged, Aged, 80 and over, Automobile Driving, depression, Female, Humans, Male, Quality of Life, Risk Factors, Social Environment}, issn = {1079-5014}, doi = {10.1093/geronb/56.6.s343}, author = {Stephanie J. Fonda and Robert B Wallace and A. Regula Herzog} } @article {6748, title = {Childlessness and the psychological well-being of older persons.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {56}, year = {2001}, month = {2001 Sep}, pages = {S311-20}, publisher = {56B}, abstract = {

OBJECTIVES: Rapid growth in the size of the childless elderly population has prompted concerns about the negative effects of childlessness on psychological well-being. This study adds to this line of inquiry by examining the effects of childlessness on two important dimensions of elderly persons{\textquoteright} psychological well-being: loneliness and depression.

METHODS: Using the 1993 Asset and Health Dynamics Among the Oldest Old data set, the authors estimated logistic and ordinary least squares regression models of psychological well-being for a nationally representative sample of people aged 70 and older (N = 6,517).

RESULTS: Childlessness per se did not significantly increase the prevalence of loneliness and depression at advanced ages, net of other factors. There also was no statistical evidence for the hypothesis that childlessness increases loneliness and depression for divorced, widowed, and never married elderly persons. Sex, however, altered how childlessness and marital status influenced psychological well-being. Divorced, widowed, and never married men who were childless had significantly higher rates of loneliness compared with women in comparable circumstances; divorced and widowed men who were childless also had significantly higher rates of depression than divorced and widowed women.

DISCUSSION: The findings suggest that it is important to understand the consequences of childlessness in the context of marital status and sex.

}, keywords = {Aged, Aged, 80 and over, depression, Family Planning Services, Female, Geriatric Assessment, Humans, Loneliness, Male, Marital Status, Risk Factors, Sex Factors}, issn = {1079-5014}, doi = {10.1093/geronb/56.5.s311}, author = {Zhang, Zhenmei and Mark D Hayward} } @article {6742, title = {Estimating the cost of informal caregiving for elderly patients with cancer.}, journal = {J Clin Oncol}, volume = {19}, year = {2001}, month = {2001 Jul 01}, pages = {3219-25}, publisher = {19}, abstract = {

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86\%) reported NC, 718 (10\%) reported CNT, and 303 (4\%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26\%, it was 34\% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Cost of Illness, Family, Female, Home Nursing, Humans, Male, Multivariate Analysis, Neoplasms, Regression Analysis, United States}, issn = {0732-183X}, doi = {10.1200/JCO.2001.19.13.3219}, author = {Hayman, James A. and Kenneth M. Langa and Mohammed U Kabeto and Steven J. Katz and DeMonner, Sonya M. and M.E. Chernew and Slavin, Mitchell B. and A. Mark Fendrick} } @article {6726, title = {The explosion in paid home health care in the 1990s: who received the additional services?}, journal = {Med Care}, volume = {39}, year = {2001}, month = {2001 Feb}, pages = {147-57}, publisher = {39}, abstract = {

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Family Characteristics, Female, Financing, Government, Frail Elderly, Geriatric Assessment, Health Care Surveys, Health Expenditures, health policy, Home Care Services, Home Nursing, Humans, Longitudinal Studies, Male, Marital Status, Multivariate Analysis, Social Support, Socioeconomic factors, Surveys and Questionnaires, United States, Utilization Review}, issn = {0025-7079}, doi = {10.1097/00005650-200102000-00005}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and Steven J. Katz} } @article {6733, title = {Life events and alcohol consumption among mature adults: a longitudinal analysis.}, journal = {J Stud Alcohol}, volume = {62}, year = {2001}, month = {2001 Jul}, pages = {501-8}, publisher = {62}, abstract = {

OBJECTIVE: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events.

METHOD: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated.

RESULTS: Most persons (68\%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking influenced the association between certain life events (e.g., divorce and retirement) and changes in drinking. Gender modified the association between losing a spouse and changes in drinking.

CONCLUSIONS: Even after controlling for problem drinking history, social support and coping skills, changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age. The magnitude of these relationships, however, varied by gender and problem drinking history.

}, keywords = {Adaptation, Psychological, Aged, Alcohol Drinking, Employment, Family, Health Status, Humans, Life Change Events, Longitudinal Studies, Middle Aged, Social Support, Stress, Psychological}, issn = {0096-882X}, doi = {10.15288/jsa.2001.62.501}, author = {Perreira, Krista M. and Frank A Sloan} } @article {6739, title = {Long-term care and nursing home coverage: are adult children substitutes for insurance policies?}, journal = {J Health Econ}, volume = {20}, year = {2001}, note = {RDA 1999-001}, month = {2001 Jul}, pages = {527-47}, publisher = {20}, abstract = {

Recent theoretical work suggests that in some cases, parents will forego the purchase of long-term care insurance and rely on child-provided care in old age. This paper uses data from the Asset and Health Dynamics survey and the Panel Study of Income Dynamics to examine whether the availability of children and other potential caregivers explains why so few elderly persons have long-term care insurance. In contrast to the notion that family members serve as substitutes for long-term care insurance, variables measuring the availability of informal caregivers have no statistically significant effect in models of insurance ownership and models of intentions to purchase insurance.

}, keywords = {Adult, Aged, Caregivers, Family, Female, Home Nursing, Humans, Insurance Coverage, Insurance, Long-Term Care, Intergenerational Relations, Long-term Care, Male, Models, Statistical, Nursing homes}, issn = {0167-6296}, doi = {10.1016/s0167-6296(01)00078-9}, author = {Jennifer M Mellor} } @article {6738, title = {National estimates of the quantity and cost of informal caregiving for the elderly with dementia.}, journal = {J Gen Intern Med}, volume = {16}, year = {2001}, month = {2001 Nov}, pages = {770-8}, publisher = {16}, abstract = {

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Dementia, Female, Health Care Costs, Humans, Male, Multivariate Analysis, Regression Analysis, Severity of Illness Index, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2001.10123.x}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and A. Regula Herzog and Mary Beth Ofstedal and Robert J. Willis and Robert B Wallace and Mucha, L.M. and Walter L. Straus and A. Mark Fendrick} } @article {6740, title = {New methods and data sources for measuring economic consequences of workplace injuries.}, journal = {Am J Ind Med}, volume = {40}, year = {2001}, month = {2001 Oct}, pages = {452-63}, publisher = {40}, abstract = {

BACKGROUND: Evaluation of programs and policies to reduce the incidence of workplace injuries require that the consequences of injury are estimated correctly. Because workplace injuries are complex events, the availability of data that reflects this complexity is the largest obstacle to this estimation.

METHODS: We review the literature on the consequences of workplace injuries for both workers and employers, focusing on data sources, particularly linked administrative data from different public agencies. We also review other approaches to obtaining data to examine workplace injuries, including public-use longitudinal survey data, primary data collection, and linked employee-employer databases. We make suggestions for future research.

RESULTS: Recent advances in the literature on the economic consequences of workplace injuries for workers have been driven to a great extent by the availability of new data sources. Much remains unexplored. We find longitudinal survey databases including the National Longitudinal Survey of Youth, and the Health and Retirement Survey, to be very promising though largely untapped sources of data on workplace injuries. We also find that linked employee-employer databases are well suited for the study of consequences for employers.

CONCLUSIONS: We expect that new data sources should lead to rapid advances in our understanding of the economic consequences of workplace injuries for both workers and employers.

}, keywords = {Accidents, Occupational, Cost of Illness, Data collection, Database Management Systems, Employer Health Costs, Evaluation Studies as Topic, Forecasting, Humans, Income, Insurance Claim Reporting, Registries, Research Design, Workplace}, issn = {0271-3586}, doi = {10.1002/ajim.1115}, author = {Reville, Robert T. and Bhattacharya, Jay and Sager Weinstein, L.R.} } @article {6751, title = {Patterns and risk factors of change in somatic and mood symptoms among older adults.}, journal = {Ann Epidemiol}, volume = {11}, year = {2001}, month = {2001 Aug}, pages = {361-8}, publisher = {11}, abstract = {

PURPOSE: This paper was concerned with patterns of individual-level, longitudinal change in depressive symptoms and factors related to those patterns among Americans 70+ years of age. Two types of depressive symptoms were considered, somatic and mood symptoms. The paper focused on whether the patterns of change and the risk factors for these two types of symptoms differed, as we might expect among old and oldest-old adults.

METHODS: The analytic sample included self-respondents of the 1993--1995 Asset and Health Dynamics among the Oldest Old (AHEAD) study who were born in 1923 or earlier. Depressive symptoms were assessed using an abbreviated Center for Epidemiologic Studies-Depression (CES-D) Scale. The analyses involved examination of respondents{\textquoteright} change scores in depressive symptoms and multivariate models using ordinary least squares (OLS) and seemingly unrelated regressions (SUR).

RESULTS: In aggregate, somatic symptoms were more common than mood symptoms initially and over time. Despite differences in aggregate rates, AHEAD respondents{\textquoteright} individual-level patterns of change for the two types of symptoms were similar; i.e., stability was the principal trend (53--60\%), followed by improvement (21--26\%). A number of factors related to change in one aspect of depressive symptoms and not the other, or had greater effects on one aspect of depressive symptoms than the other; e.g., physical health had greater effects on somatic than mood symptoms.

CONCLUSIONS: This study suggests that, in investigations of the course and risk factors for depressive symptoms among people 70+ years of age, it is important to separate somatic symptoms from mood symptoms; their etiology may differ. In general, factors reflecting respondents{\textquoteright} social milieu (e.g., bereavement, residential relocation) may have greater effects on mood than somatic symptoms, whereas certain factors representing physical health may have greater effects on somatic symptoms.

}, keywords = {Age Factors, Aged, Depressive Disorder, Female, Follow-Up Studies, Geriatric Assessment, Humans, Least-Squares Analysis, Longitudinal Studies, Male, Mood Disorders, Regression Analysis, Risk Factors, Severity of Illness Index, Somatoform Disorders, United States}, issn = {1047-2797}, doi = {10.1016/s1047-2797(00)00219-2}, author = {Stephanie J. Fonda and A. Regula Herzog} } @article {6737, title = {Predictors of transitions in disease and disability in pre- and early-retirement populations.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Aug}, pages = {379-409}, publisher = {13}, abstract = {

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period.

METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses.

RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes.

DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Chronic disease, Disabled Persons, Female, Health Status, Hispanic or Latino, Humans, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/089826430101300304}, author = {Namkee G Choi and Schlichting-Ray, L.} } @article {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 {6729, title = {Proportional treatment effects for count response panel data: effects of binary exercise on health care demand.}, journal = {Health Econ}, volume = {10}, year = {2001}, note = {ProCite field 3 : Sungkyunkwan U; Mitsubishi Trust and Banking Corp, Tokyo}, month = {2001 Jul}, pages = {411-28}, publisher = {10}, abstract = {

We define conditional and marginal treatment effects appropriate for count data, and then conduct an empirical analysis for the effects of exercise on health care demand using panel data from the Health Retirement Study. The response variables are office visits to doctors and hospitalization days, and the treatments of interest are light and vigorous exercises. We found that short-run light exercise increases health care demand by 3-5\%, whereas long-run light exercise decreases it by 3-6\%. We also found that short-run vigorous exercise decreases health care demand by 1-2\%, whereas long-run vigorous exercise decreases it by 1-3\%. However, many of these numbers are not statistically significantly different from zero. These findings suggest that it will be difficult to reduce health care cost much by encouraging people to do more exercise--at least in the short-run.

}, keywords = {Adult, Aged, Aged, 80 and over, Bias, Cost Control, Cross-Sectional Studies, Data Interpretation, Statistical, Effect Modifier, Epidemiologic, Exercise Therapy, Female, Health Promotion, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Needs Assessment, Regression Analysis, Research Design, Treatment Outcome, United States}, issn = {1057-9230}, doi = {10.1002/hec.626}, author = {Lee, Myoung Jae and Satoru Kobayashi} } @article {6759, title = {The role of job-related rewards in retirement planning.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {56}, year = {2001}, month = {2001 May}, pages = {P160-9}, publisher = {56B}, abstract = {

The authors used data from the first wave of the Health and Retirement Study ( F. Juster and R. Suzman 1995) to evaluate whether certain job-related gratifications might reduce retirement planning. Three definitions of retirement planning were evaluated and then regressed separately on a set of variables that included 3 types of job-related satisfactions (intrinsic gratification, positive social relations, and ascendance in the workplace) and 7 covariates: education, age, sex, health, marital status, race, and pension eligibility. Findings indicated that jobs high in ascendance were related to an increase in certain types of retirement planning, but jobs high in intrinsic rewards and positive social relations were related to less planning, regardless of how planning was defined. The findings suggest that information about work-related rewards may be useful in targeting individuals who might benefit from retirement planning programs, in developing planning programs to help workers realize more complex retirement plans, and in assisting employers who hope to retain older workers.

}, keywords = {Career Mobility, Decision making, Employment, Factor Analysis, Statistical, Female, Florida, Health Surveys, Humans, Interpersonal Relations, Job Satisfaction, Male, Middle Aged, Models, Psychological, Planning Techniques, Regression Analysis, Retirement, Reward, Salaries and Fringe Benefits, Sampling Studies}, issn = {1079-5014}, doi = {10.1093/geronb/56.3.p160}, author = {Karl Kosloski and David J Ekerdt and Stanley DeViney} } @article {6741, title = {Self-restriction of medications due to cost in seniors without prescription coverage.}, journal = {J Gen Intern Med}, volume = {16}, year = {2001}, month = {2001 Dec}, pages = {793-9}, publisher = {16}, abstract = {

OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk.

DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older.

MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction.

MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8\% of subjects with no prescription coverage, 3\% with partial coverage, and 2\% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95\% confidence interval [95\% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95\% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95\% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21\%, 16\%, and 13\%, respectively. Almost half (43\%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01).

CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Cross-Sectional Studies, Female, Humans, Insurance, Pharmaceutical Services, Male, Prescription Fees, Risk Factors, Socioeconomic factors, Treatment Refusal, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2001.10412.x}, author = {Michael A Steinman and Laura Sands and Kenneth E Covinsky} } @article {6746, title = {Socioeconomic status and the prevalence of health problems among married couples in late midlife.}, journal = {Am J Public Health}, volume = {91}, year = {2001}, month = {2001 Jan}, pages = {131-5}, publisher = {91}, abstract = {

OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

}, keywords = {Activities of Daily Living, Cohort Studies, Female, Health Status, Humans, Male, Marital Status, Middle Aged, Odds Ratio, Risk Factors, Socioeconomic factors, Spouses, United States}, issn = {0090-0036}, doi = {10.2105/ajph.91.1.131}, author = {Sven E. Wilson} } @article {6784, title = {Valuation of life: a concept and a scale.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Feb}, pages = {3-31}, publisher = {13}, abstract = {

OBJECTIVES: The objective was to derive and test the psychometric characteristics of a scale to measure Valuation of Life (VOL).

METHODS: Four samples were used in successive phases of exploratory factor analysis, confirmatory factor analysis, reliability and validity testing, and exploration of response-error effects. Estimates of Years of Desired Life were obtained under a variety of hypothetical quality-of-life (QOL)-compromising conditions of poor health.

RESULTS: Confirmed 13-item (Positive VOL) and 6-item (Negative VOL) factors were obtained. A significant relationship between VOL and most Years of Desired Life estimates remained when demographic, health, quality of life, and mental health measures were controlled. Analysis of Negative VOL revealed that some respondents misunderstand the meaning of an agree response to negatively phrased items.

DISCUSSION: VOL is a cognitive-affective schema whose function as a mediator and moderator between health and end-of-life decisions deserves further research.

}, keywords = {Factor Analysis, Statistical, Humans, Psychometrics, Quality of Life, United States}, issn = {0898-2643}, doi = {10.1177/089826430101300101}, author = {Lawton, M. Powell and Moss, Miriam and Hoffman, Christine and Kleban, Morton H. and Ruckdeschel, Katy and Winter, Laraine} } @article {6680, title = {The effect of smoking on health using a sequential self-selection model.}, journal = {Health Econ}, volume = {9}, year = {2000}, note = {ProCite field 3 : SUNY, Albany; SUNY, Albany}, month = {2000 Sep}, pages = {491-511}, publisher = {9}, abstract = {

We estimate a structural model of individual smoking behaviour emphasizing the role of individual risk belief on smoking choices. Our model consists of five equations: two selection equations for initiation and cessation decisions, and three switching outcome regressions for nonsmokers, ex-smokers, and current smokers. The presence of significant self-selectivity implies that the health effects of smoking based on sample proportions do not correctly indicate the true risk of cigarette smoking. Further, our evidence suggests that the self-selection in the cessation decision, but not in the initiation decision, is consistent with economic rationality. We estimate the model by full information maximum likelihood (FIML) with starting values from heteroskedasticity corrected Heckman-Lee two-step method using newly released Health and Retirement Study (HRS) data.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Decision making, Health Behavior, Health Status, Health Surveys, Humans, Middle Aged, Models, Econometric, Predictive Value of Tests, Reproducibility of Results, Risk Factors, Risk-Taking, Selection Bias, Smoking, Smoking cessation, Surveys and Questionnaires, United States}, issn = {1057-9230}, doi = {10.1002/1099-1050(200009)9:6<491::aid-hec541>3.0.co;2-$\#$}, author = {Kajal Chatterji Lahiri and Song, Jae G.} } @article {6723, title = {Expectations among the elderly about nursing home entry.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {1181-202}, publisher = {35}, abstract = {

OBJECTIVE: To assess whether the covariates that explain expectations of nursing home entry are consistent with the characteristics of those who enter nursing homes.

DATA SOURCES: Waves 1 and 2 of the Assets and Health Dynamics Among the Oldest Old (AHEAD) survey.

STUDY DESIGN: We model expectations about nursing home entry as a function of expectations about leaving a bequest, living at least ten years, health condition, and other observed characteristics. We use an instrumental variables and generalized least squares (IV-GLS) method based on Hausman and Taylor (1981) to obtain more efficient estimates than fixed effects, without the restrictive assumptions of random effects.

PRINCIPAL FINDINGS: Expectations about nursing home entry are reasonably close to the actual probability of nursing home entry. Most of the variables that affect actual entry also have significant effects on expectations about entry. Medicaid subsidies for nursing home care may have little effect on expectations about nursing home entry; individuals in the lowest asset quartile, who are most likely to receive these subsidies, report probabilities not significantly different from those in other quartiles. Application of the IV-GLS approach is supported by a series of specification tests.

CONCLUSIONS: We find that expectations about future nursing home entry are consistent with the characteristics of actual entrants. Underestimation of risk of nursing home entry as a reason for low levels of long-term care insurance is not supported by this analysis.

}, keywords = {Activities of Daily Living, Aged, Attitude to Health, Data Interpretation, Statistical, Effect Modifier, Epidemiologic, Female, Geriatric Assessment, Health Care Surveys, Health Services Research, Health Status, Homes for the Aged, Humans, Least-Squares Analysis, Longevity, Male, Medicaid, Nursing homes, Patient Admission, Probability, Risk Factors, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard C Lindrooth and Hoerger, Thomas J. and Edward C Norton} } @article {6699, title = {Gender disparities in the receipt of home care for elderly people with disability in the United States.}, journal = {JAMA}, volume = {284}, year = {2000}, month = {2000 Dec 20}, pages = {3022-7}, publisher = {284}, abstract = {

CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources.

OBJECTIVE: To address gender differences in receipt of informal and formal home care.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.

MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors.

RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4\% vs 16.8\%, P<.001) and much less likely to be living with a spouse (27.8\% vs 73.6\%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95\% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95\% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95\% CI, 13.7-15.8 vs 26.2 hours; 95\% CI, 24.6-27.9). Children (>80\% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95\% CI, 2.5-3.1 vs 2.1 hours for men; 95\% CI, 1.7-2.4).

CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.

}, keywords = {Activities of Daily Living, Aged, Disabled Persons, Family, Female, Geriatrics, Home Care Services, Home Nursing, Humans, Male, Regression Analysis, Sex Distribution, United States}, issn = {0098-7484}, doi = {10.1001/jama.284.23.3022}, author = {Steven J. Katz and Mohammed U Kabeto and Kenneth M. Langa} } @article {6705, title = {Health effects of involuntary job loss among older workers: findings from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 May}, pages = {S131-40}, publisher = {55B}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Adaptation, Psychological, Aging, Female, Geriatric Assessment, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Unemployment, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.3.s131}, author = {William T Gallo and Elizabeth H Bradley and Michele J. Siegel and Stanislav V Kasl} } @article {6677, title = {Health insurance and retirement behavior: evidence from the health and retirement survey.}, journal = {J Health Econ}, volume = {19}, year = {2000}, month = {2000 Jul}, pages = {529-39}, publisher = {19}, abstract = {

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

}, keywords = {Aged, Career Mobility, Data collection, Decision making, Employment, Health Services Accessibility, Humans, Insurance, Health, Male, Retirement, Social Class, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(00)00038-2}, author = {Jeannette Rogowski and Lynn A Karoly} } @article {6691, title = {Health-promoting behaviors among adults with type 2 diabetes: findings from the Health and Retirement Study.}, journal = {Prev Med}, volume = {30}, year = {2000}, month = {2000 May}, pages = {407-14}, publisher = {30}, abstract = {

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

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

RESULTS: The sample consisted of 733 persons with type 2 diabetes, ages 50-62. The most common behaviors were being on a special diet (79.6\%), and not smoking (76.6\%). Sixty-six percent were engaged in some physical activity, and 58.4\% were trying to lose weight. Reports of being on a special diet, trying to lose weight, and exercising all diminished over time.

CONCLUSIONS: The prevalence of these behaviors is disappointing. Worse, they declined over the 4-year period. A better understanding of factors contributing to a person{\textquoteright}s decision to begin or discontinue health-promoting behaviors is needed to plan effective supportive or preemptive interventions.

}, keywords = {Adult, Behavior Therapy, Black or African American, Data collection, Diabetes Mellitus, Type 2, Diet, Diabetic, Exercise, Female, Health Behavior, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, White People}, issn = {0091-7435}, doi = {10.1006/pmed.2000.0658}, author = {Nothwehr, F. and Timothy E. Stump} } @article {6716, title = {HRS data set: Respondent Earnings and Social Security Benefits Files.}, journal = {Soc Secur Bull}, volume = {63}, year = {2000}, month = {2000}, pages = {72-3}, publisher = {63}, keywords = {Humans, Income, Social Security, United States}, issn = {0037-7910}, author = {Unattributed} } @article {6703, title = {Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Sep}, pages = {S288-97}, publisher = {55B}, abstract = {

OBJECTIVES: This study explores the analytic implications of using questions about difficulty with daily activities that do not specify whether to consider assistance.

METHODS: For 1,054 Asset and Health Dynamics of the Oldest Old Study Wave 2 respondents, we compared responses to questions about difficulty without reference to assistance (ambiguous difficulty) to those about difficulty without help or equipment (underlying difficulty) and difficulty with help or equipment, if used (residual difficulty). We modelled predictors of discordance by means of logistic regression.

RESULTS: Discordance exists for 15\% of respondents between summary variables indicating underlying and ambiguous difficulty with one or more activities. Discrepancies are evenly split between respondents reporting (a) underlying but no ambiguous difficulty and (b) ambiguous but no underlying difficulty. Discordance also exists for 15\% of respondents between summary variables indicating residual and ambiguous difficulty with one or more activities: most of these discrepancies involve reports of ambiguous but no residual difficulty. Most respondent characteristics investigated are not significant predictors of discrepancies.

DISCUSSION: Analysts should be aware that (a) ambiguously worded questions appear to be a better proxy for underlying than for residual difficulty, (b) discrepancies seem to be lower for separate activities than for summary variables indicating difficulty with one or more activities, and (c) being Hispanic and receiving help may affect reporting discrepancies.

}, keywords = {Activities of Daily Living, Aged, Cognition, Female, Health Status, Humans, Male, Prospective Studies, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/55.5.s288}, author = {Vicki A Freedman} } @article {6685, title = {Job characteristics and leisure physical activity.}, journal = {J Aging Health}, volume = {12}, year = {2000}, month = {2000 Nov}, pages = {538-59}, publisher = {12}, abstract = {

OBJECTIVES: This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically.

METHODS: Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one{\textquoteright}s job.

RESULTS: Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise.

DISCUSSION: The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

}, keywords = {Demography, Exercise, Female, Humans, Job Description, Job Satisfaction, Leisure activities, Male, Middle Aged, Stress, Psychological, United States}, issn = {0898-2643}, doi = {10.1177/089826430001200405}, author = {Bei Wu and Frank Porell} } @article {6722, title = {Measuring morbidity: disease counts, binary variables, and statistical power.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 May}, pages = {S173-89}, publisher = {55B}, abstract = {

OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach.

METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses.

RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable.

DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.

}, keywords = {Adult, Aged, Chronic disease, Cross-Sectional Studies, Female, Geriatric Assessment, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.3.s173}, author = {Kenneth F Ferraro and Janet M Wilmoth} } @article {6701, title = {Memory complaint in a community sample aged 70 and older.}, journal = {J Am Geriatr Soc}, volume = {48}, year = {2000}, month = {2000 Nov}, pages = {1435-41}, publisher = {48}, abstract = {

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person{\textquoteright}s metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community-dwelling older persons.

PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam.

RESULTS: In general, people{\textquoteright}s assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people{\textquoteright}s self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognition, Depressive Disorder, Educational Status, Female, Geriatric Assessment, Humans, Longitudinal Studies, Male, Marital Status, Memory, Self-Assessment}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2000.tb02634.x}, author = {Carolyn L. Turvey and Schultz, Susan K. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @article {6684, title = {Nativity and older women{\textquoteright}s health: constructed reliance in the health and retirement study.}, journal = {J Women Aging}, volume = {12}, year = {2000}, month = {2000}, pages = {21-37}, publisher = {12}, abstract = {

Gender and nativity are known risk factors for physical and economic dependency. Immigrant women are particularly disadvantaged because of their greater lack of social and economic resources. In this study, we investigate how women immigrants coordinate and utilize various support systems as they approach retirement age, as well as how choices and constraints affect their physical wellbeing. Experiences throughout the life course play a role in the maintenance of health, but the pre-retirement years are particularly crucial to the establishment of patterns of reliance to be used in later life. We examine the effects of economic resources, social support, and family ties (as well as several exogenous variables) on women{\textquoteright}s physical health using data from the Health and Retirement Survey. For the women in this study, demographic characteristics, such as Hispanic ethnicity and low education are strong risk factors for poor health. Findings also indicate that reliance patterns across resource domains do not differ significantly by nativity and that both economic and familial resource access significantly lessens the risk of poor health for both native and foreign born women.

}, keywords = {Aged, Emigration and Immigration, ethnicity, Female, Florida, Health Status, Humans, Middle Aged, Retirement, Social Support, Socioeconomic factors, Women{\textquoteright}s Health}, issn = {0895-2841}, doi = {10.1300/J074v12n03_03}, author = {Cynthia J. Buckley and Jacqueline L. Angel and Donahue, Dennis} } @article {6724, title = {Older adults and financial bequests.}, journal = {Int J Aging Hum Dev}, volume = {50}, year = {2000}, month = {2000}, pages = {227-44}, publisher = {50}, abstract = {

Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult{\textquoteright}s assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Attitude, Female, Health Care Costs, Health Status, Humans, Male, Mental Health, Michigan, Models, Economic, Sampling Studies, Sex Factors, Socioeconomic factors, Spouses, Surveys and Questionnaires, Wills}, issn = {0091-4150}, doi = {10.2190/AJJ3-AVG7-QKMW-R21R}, author = {Goetting, Marsha A. and Peter Martin and Johnson, Christine} } @article {6707, title = {Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Jan}, pages = {S14-27}, publisher = {55B}, abstract = {

OBJECTIVES: This study examines the pre-retirement labor force participation behavior of Black, White, and Hispanic men and women to determine how patterns of labor market exit differ among groups.

METHODS: We combine data from the first and second waves of the Health and Retirement Study and apply multinomial logit regression techniques to model labor force status in the first wave of the HRS and change over time.

RESULTS: Black, Hispanic, and female elderly persons experience more involuntary job separation in the years immediately prior to retirement, and the resulting periods of joblessness often eventuate in "retirement" or labor force withdrawal. Minority disadvantage in human capital, health, and employment characteristics accounts for a large part of racial and ethnic differences in labor force withdrawal. Nevertheless, Black men and Hispanic women experience more involuntary labor market exits than Whites with similar socioeconomic and demographic characteristics.

DISCUSSION: Workers most vulnerable to labor market difficulties during their youth confront formidable obstacles maintaining their desired level of labor force attachment as they approach their golden years. This has significant policy implications for the contours of gender and race/ethnic inequality among elderly persons, particularly as life expectancy and the size of the minority elderly population continue to increase.

}, keywords = {Aged, Black or African American, Cross-Cultural Comparison, Employment, Female, Hispanic or Latino, Humans, Logistic Models, Male, Middle Aged, Personnel Downsizing, Regression Analysis, Retirement, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1079-5014}, doi = {10.1093/geronb/55.1.s14}, author = {Chenoa Flippen and Tienda, Marta} } @article {6704, title = {Pension decisions in a changing economy: gender, structure, and choice.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Sep}, pages = {S271-7}, publisher = {55B}, abstract = {

OBJECTIVES: As responsibility for financial security in retirement becomes more individualized, understanding the distribution and determinants of savings behavior grows in importance. Employed men and women often gain access to their pension assets when they change jobs. In this study gender differences in pre-retirement access to and disposition of accumulated pension assets are examined.

METHODS: The authors used data from the Health and Retirement Study to model pension participation, disposition of pension assets, and use of cash settlements derived from a pension plan in a previous job. Logit models provided estimates of gender differences in access to pensions and the preservation of pension funds for retirement.

RESULTS: Women were less likely to have participated in employer-sponsored pension plans; more likely to cash out accumulated pension assets when they changed jobs; and, when job changes occurred at relatively young ages, equally likely to spend the settlement. However, by their late 40s, women were more likely to save the settlement, a net gender difference that increased with age at which the settlement was received.

DISCUSSION: The structure of employment compensation continues to place women at a disadvantage. Gender differences in earnings and fringe benefits not only affect current financial status, but also cast a shadow over future financial security. Although the gender gap in pension coverage has been reduced, women with pensions have access to lower benefits and less in accumulated assets. As these continuing deficits are addressed, enhancing women{\textquoteright}s tendency to save pension assets for retirement can help them build financial security.

}, keywords = {Age Factors, Choice Behavior, Decision making, Female, Humans, Male, Middle Aged, Models, Economic, Pensions, United States}, issn = {1079-5014}, doi = {10.1093/geronb/55.5.s271}, author = {Melissa A. Hardy and Kim Shuey} } @article {6693, title = {Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: results from a national study.}, journal = {Gerontologist}, volume = {40}, year = {2000}, month = {2000 Aug}, pages = {449-57}, publisher = {40}, abstract = {

This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school- and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Black or African American, Choice Behavior, Communication, Educational Status, Family, Female, Health education, Health Status, Humans, Logistic Models, Male, Needs Assessment, Surveys and Questionnaires, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/40.4.449}, author = {Faith P. Hopp} } @article {6715, title = {The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions.}, journal = {Arthritis Care Res}, volume = {13}, year = {2000}, month = {2000 Jun}, pages = {168-76}, publisher = {13}, abstract = {

OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later.

METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression.

RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2\%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one{\textquoteright}s job (12.1\%), scheduling more breaks during the work day (9.5\%), changing the time that the work day started and stopped (6.3\%), having a shorter work day (5.6\%), getting special equipment (5.3\%), and changing the work tasks (5.3\%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one{\textquoteright}s job--was associated with a higher rate of employment in 1994.

CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.

}, keywords = {Disabled Persons, Employment, Supported, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Personnel Turnover, Program Evaluation, Surveys and Questionnaires, United States, Workload, Workplace}, issn = {0893-7524}, doi = {10.1002/1529-0131(200006)13:3<168::aid-anr6>3.0.co;2-r}, author = {Yelin, Edward and Sonneborn, Dean and Laura S. Trupin} } @article {6702, title = {Race and ethnic variation in the disablement process.}, journal = {J Aging Health}, volume = {12}, year = {2000}, month = {2000 May}, pages = {229-49}, publisher = {12}, abstract = {

OBJECTIVES: This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS: Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS: Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION: The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

}, keywords = {Activities of Daily Living, Black or African American, Cognition Disorders, Disabled Persons, Hispanic or Latino, Humans, Socioeconomic factors, White People}, issn = {0898-2643}, doi = {10.1177/089826430001200205}, author = {Zsembik, Barbara A. and M. Kristen Peek and Chuck W Peek} } @article {6697, title = {The racial crossover in comorbidity, disability, and mortality.}, journal = {Demography}, volume = {37}, year = {2000}, note = {RDA 2002-016}, month = {2000 Aug}, pages = {267-83}, publisher = {37}, abstract = {

This study analyzed one respondent per household who was age 70 or more at the time of the household{\textquoteright}s inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Birth Certificates, Black People, Chronic disease, Comorbidity, Cross-Over Studies, Death Certificates, Disabled Persons, Female, Humans, Male, United States, White People}, issn = {0070-3370}, author = {Nan E. Johnson} } @article {6694, title = {Racial variations in end-of-life care.}, journal = {J Am Geriatr Soc}, volume = {48}, year = {2000}, month = {2000 Jun}, pages = {658-63}, publisher = {48}, abstract = {

OBJECTIVES: To identify differences in advanced care planning and end-of-life decision-making between whites and blacks aged 70 and older.

DESIGN: The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end-of-life decisions that were made for their family member who died.

SETTING: Respondents were interviewed at home by telephone (n = 444) or in person (n = 95).

PARTICIPANTS: The 540 proxy respondents included 454 whites and 86 blacks.

MEASUREMENTS: Questions were asked about advance care planning and end-of-life decisions.

RESULTS: Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors.

CONCLUSIONS: These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end-of-life decision-making. Health professionals need to understand the diverse array of end-of-life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end-of-life decision-making.

}, keywords = {Advance care planning, Advance directives, Aged, Aged, 80 and over, Attitude to Health, Black or African American, Cross-Cultural Comparison, Decision making, Female, Follow-Up Studies, Humans, Logistic Models, Male, Patient Care Planning, Terminal Care, United States, White People}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2000.tb04724.x}, author = {Faith P. Hopp and Sonia A. Duffy} } @article {6698, title = {Uninsured status and out-of-pocket costs at midlife.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {911-32}, publisher = {35}, abstract = {

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

}, keywords = {Age Factors, Female, Financing, Personal, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Models, Econometric, Multivariate Analysis, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6639, title = {The associations between self-rated vision and hearing and functional status in middle age.}, journal = {Ophthalmology}, volume = {106}, year = {1999}, month = {1999 Feb}, pages = {401-5}, publisher = {106}, abstract = {

OBJECTIVES: To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans.

DESIGN: Cross-sectional.

PARTICIPANTS: A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated.

METHODS: Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed.

MAIN OUTCOME MEASURE: A global index of functional status based on self-reported limitations in 17 activities was measured.

RESULTS: Approximately 3\% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

}, keywords = {Cross-Sectional Studies, Female, health, Health Status, Health Surveys, Hearing Disorders, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Quality of Life, Self Disclosure, Vision Disorders}, issn = {0161-6420}, doi = {10.1016/S0161-6420(99)90082-9}, url = {http://www.ncbi.nlm.nih.gov/pubmed/9951498?dopt=Abstract}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {6641, title = {At risk on the cusp of old age: living arrangements and functional status among black, white and Hispanic adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 May}, pages = {S136-44}, publisher = {54B}, abstract = {

OBJECTIVES: We examine the relationship between living arrangements and multiple measures of physical, cognitive, and emotional functioning in late midlife.

METHODS: Using cross-sectional data from the Health and Retirement Study, we first assess the bivariate relationship between living arrangements and functioning; we then take into account demographic characteristics and measures of household resources and demands.

RESULTS: We find evidence of differential functioning among individuals in various living arrangements. Married couples living alone or with children show the highest levels of functioning, whereas single adults living in complex households show the lowest levels. Functional deficits for those in complex households are reduced but not eliminated when we take demographic characteristics and household resources and demands into account. We find few differences by gender and race/ethnicity in the relationship between living arrangements and functioning.

DISCUSSION: We show a pattern of poorer functioning among those in arguably the most demanding and least supportive household environments. This points to a vulnerable and risk-filled transition from middle to old age for these persons. Because Blacks and Hispanics show lower levels of functioning than Whites and are more likely to live in complex households, they may be particularly disadvantaged.

}, keywords = {Activities of Daily Living, Aging, Black or African American, Cultural Characteristics, Family Relations, Female, Hispanic or Latino, Housing, Humans, Male, Middle Aged, Quality of Life, Retirement, Risk Factors, White People}, issn = {1079-5014}, doi = {10.1093/geronb/54b.3.s136}, url = {http://www.ncbi.nlm.nih.gov/pubmed/10363044?dopt=Abstract}, author = {Linda J. Waite and Mary Elizabeth Hughes} } @article {7308, title = {Characteristics of individuals with integrated pensions.}, journal = {Soc Secur Bull}, volume = {62}, year = {1999}, month = {1999}, pages = {28-40}, publisher = {49}, abstract = {

Employer pensions that integrate benefits with Social Security have been the focus of relatively little research. Since changes in Social Security benefit levels and other program characteristics can affect the benefit levels and other features of integrated pension plans, it is important to know who is covered by these plans. This article examines the characteristics of workers covered by integrated pension plans, compared to those with nonintegrated plans and those with no pension coverage. Integrated pension plans are those that explicitly adjust their benefit structure to help compensate for the employer{\textquoteright}s contributions to the Social Security program. There are two basic integration methods used by defined benefit (DB) plans. The offset method causes a reduction in employer pension benefits by up to half of the Social Security retirement benefit; the excess rate method is characterized by an accrual rate that is lower for earnings below the Social Security taxable maximum than above it. Defined contribution (DC) pension plans can be integrated along the lines of the excess rate method. To date, research on integrated pensions has focused on plan characteristics, as reported to the Bureau of Labor Statistics (BLS) through its Employee Benefits Survey (EBS). This research has examined the prevalence of integration among full-time, private sector workers by industry, firm size, and broad occupational categories. However, because the EBS provides virtually no data on worker characteristics, analyses of the effects of pension integration on retirement benefits have used hypothetical workers, varying according to assumed levels of earnings and job tenure. This kind of analysis is not particularly helpful in examining the potential effects of changes in the Social Security program on workers{\textquoteright} pension benefits. However, data on pension integration at the individual level are available, most recently from the Health and Retirement Study (HRS), a nationally representative survey of individuals aged 51-61 in 1992. This dataset provides the basis for the analysis presented here. The following are some of the major findings from this analysis. The incidence of pension integration in the HRS sample is 32 percent of all workers with a pension (14 percent of all workers). The HRS can also identify integrated DC plans, a statistic that is not available from BLS data. The rate of integration for workers with only DC plans is 8 percent. After controlling for other variables, several socio-demographic characteristics are significantly related to the incidence of integration. The probability of having an integrated pension is 4.6 percentage points less for men compared to women. Non-Hispanic blacks are 6.4 percentage points less likely than non-Hispanic whites to have integrated pensions. Union members are 14 percentage points less likely to have integrated pensions, while workers with less than a graduate level education are at least 15 percentage points more likely to have a pension that is integrated. Some earnings and pension characteristics are also significantly correlated with pension integration. Earnings are positively related, with the probability of having an integrated pension increasing by 2 percentage points for an increase of $1,000 in annual pay. An even larger effect comes from earning at or above the Social Security taxable maximum. Workers at or above this income level are 10 percentage points more likely to have an integrated plan, but for those with more than one plan the probability of pension integration goes up by 13 percentage points.

}, keywords = {Bias, Data collection, Educational Status, ethnicity, Female, Humans, Income, Labor Unions, Male, Middle Aged, Occupations, Pensions, Regression Analysis, Reproducibility of Results, Retirement, Sex Factors, Social Security, Socioeconomic factors, United States}, issn = {0037-7910}, author = {Bender, K A} } @article {6672, title = {A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 Sep}, pages = {S291-301}, publisher = {54B}, abstract = {

OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States.

METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning.

RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments.

DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cognition, Cross-Cultural Comparison, depression, Educational Status, Female, Geriatric Assessment, Health Status, Humans, Male, Multivariate Analysis, Regression Analysis, Sex Factors, Socioeconomic factors, Surveys and Questionnaires, Taiwan, United States}, issn = {1079-5014}, doi = {10.1093/geronb/54b.5.s291}, author = {Mary Beth Ofstedal and Zachary Zimmer and Hui-Sheng Lin} } @article {6646, title = {Conjugal loss and syndromal depression in a sample of elders aged 70 years or older.}, journal = {Am J Psychiatry}, volume = {156}, year = {1999}, month = {1999 Oct}, pages = {1596-601}, publisher = {156}, abstract = {

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse{\textquoteright}s death predicted bereavement-related depression.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Bereavement, Cohort Studies, depression, Depressive Disorder, Female, Humans, Logistic Models, Longitudinal Studies, Male, Marital Status, Odds Ratio, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Widowhood}, issn = {0002-953X}, doi = {10.1176/ajp.156.10.1596}, author = {Carolyn L. Turvey and Carney, C. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @article {6648, title = {Financial assistance from middle-aged couples to parents and children: racial-ethnic differences.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 May}, pages = {S145-53}, publisher = {54B}, abstract = {

OBJECTIVES: To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples.

METHODS: Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey.

RESULTS: Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors{\textquoteright} health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially.

DISCUSSION: Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator.

}, keywords = {Aged, Child, ethnicity, Family Relations, Female, Financing, Personal, Humans, Intergenerational Relations, Male, Middle Aged, Parent-Child Relations, Racial Groups}, issn = {1079-5014}, doi = {10.1093/geronb/54b.3.s145}, author = {Rebeca Wong and Capoferro, C. and Beth J Soldo} } @article {6644, title = {Gender differences in pension wealth: estimates using provider data.}, journal = {Gerontologist}, volume = {39}, year = {1999}, month = {1999 Jun}, pages = {320-33}, publisher = {39}, abstract = {

Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76\% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women{\textquoteright}s employment experiences increasingly resemble those of men.

}, keywords = {Female, Humans, Male, Occupations, Pensions, Sex Factors, United States, Women, Working}, issn = {0016-9013}, doi = {10.1093/geront/39.3.320}, author = {Richard W. Johnson and Sambamoorthi, Usha and Crystal, Stephen} } @article {6636, title = {Health problems as determinants of retirement: are self-rated measures endogenous?}, journal = {J Health Econ}, volume = {18}, year = {1999}, note = {RDA ProCite field 3 : US Social Security Administration; U PA}, month = {1999 Apr}, pages = {173-93}, publisher = {18}, abstract = {

We explore alternative measures of unobserved health status in order to identify effects of mental and physical capacity for work on older men{\textquoteright}s retirement. Traditional self-ratings of poor health are tested against more objectively measured instruments. Using the Health and Retirement Study (HRS), we find that health problems influence retirement plans more strongly than do economic variables. Specifically, men in poor overall health expected to retire one to two years earlier, an effect that persists after correcting for potential endogeneity of self-rated health problems. The effects of detailed health problems are also examined in depth.

}, keywords = {Health Services Research, Health Status Indicators, Humans, Male, Models, Statistical, Retirement, Self-Assessment, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(98)00034-4}, author = {Debra S. Dwyer and Olivia S. Mitchell} } @article {6634, title = {Healthy bodies and thick wallets: the dual relation between health and economic status.}, journal = {J Econ Perspect}, volume = {13}, year = {1999}, note = {ProCite field 3 : RAND}, month = {1999 Spring}, pages = {144-66}, publisher = {13}, abstract = {

The first section of this paper documents the size of the association between health and one prominent economic status measure--household wealth. The next section deals with how health influences economic status by sketching out reasons why health may alter household savings (and eventually wealth) and then providing estimates of the empirical magnitude of these effects. The third section shifts attention to the other pathway--the links between economic status and health--and summarizes major controversies and evidence surrounding these issues.

}, keywords = {Financing, Personal, Health Expenditures, Health Status, Humans, Socioeconomic factors, United States}, issn = {0895-3309}, url = {http://www.aeaweb.org/jep/}, author = {James P Smith} } @article {6663, title = {The influence of personal care and assistive devices on the measurement of disability.}, journal = {Soc Sci Med}, volume = {48}, year = {1999}, month = {1999 Feb}, pages = {427-43}, publisher = {48}, abstract = {

The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Life Expectancy, Logistic Models, Long-term Care, Male, Self-Help Devices}, issn = {0277-9536}, doi = {10.1016/s0277-9536(98)00369-4}, author = {Agree, E M} } @article {6671, title = {Measuring disability with parsimony.}, journal = {Disabil Rehabil}, volume = {21}, year = {1999}, month = {1999 May-Jun}, pages = {295-306}, publisher = {21}, abstract = {

PRIMARY OBJECTIVE: Health surveys, especially those for older persons, include numerous detailed items about disability. There has been little effort to develop a global disability item, that is, one question that covers the concept of disability briefly but well. This article discusses how parsimony can be achieved through a single item, or less desirably by reductions of detailed items.

MAIN OUTCOME AND RESULTS: Results of three analyses on the issue of compact disability indicators, using public-use data sets (AHEAD, HRS, BRFSS), are presented. The analyses study relationships of global disability to both detailed disability items and global health. Overall, the results show that a global disability item has good coverage of specific disabilities and is distinct from self-rated health.

CONCLUSIONS: Routine inclusion of a global disability item in surveys is recommended, and specific suggestions are made to aid its design.

}, keywords = {Activities of Daily Living, Disability Evaluation, Disabled Persons, Health Status Indicators, Health Surveys, Humans, Surveys and Questionnaires}, issn = {0963-8288}, doi = {10.1080/096382899297729}, url = {https://pubmed.ncbi.nlm.nih.gov/10381242}, author = {Verbrugge, Lois M. and Merrill, Susan S. and Xian Li} } @article {6660, title = {Multiple roles and well-being among midlife women: testing role strain and role enhancement theories.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 Nov}, pages = {S329-38}, publisher = {54B}, abstract = {

OBJECTIVE: Research on women{\textquoteright}s multiple roles frequently adopts one of two perspectives: role strain, which argues that assuming multiple roles is detrimental to mental well-being, or role enhancement, which argues that engaging in multiple roles enhances mental well-being. We argue that the relationship between role occupancy and well-being is manifested through multiple dimensions of role experiences. We investigate the association between depressive symptomatology and various dimensions of the roles of wife, mother, paid worker, and informal caregiver to aging parents.

METHODS: Data are from the 1992 wave of the Health and Retirement Study. Depressive symptomatology, measured by a subset of the CES-D scale, is the dependent variable. To assess the robustness of findings relative to different functional forms of the dependent variable, we estimate multiple regression, log-linear regression, and multinomial logit models. Independent variables include demographic characteristics, measures of role occupancy, role demands, and role satisfaction.

RESULTS: Although the number of roles women assume affects their reports of depressive symptoms, once the demand and satisfaction associated with these roles is controlled, number has no effect; that is, the effect of the number of roles is indirect.

DISCUSSION: Our results highlight the importance of women{\textquoteright}s perceptions of the quality of their roles in relation to their overall well-being. Future investigations of women{\textquoteright}s multiple roles should examine how roles may provide rewards, impose constraints, or generate conflict, as well as the extent to which the willingness to assume multiple roles and the reported levels of role satisfaction and mental well-being may be jointly endogenous.

}, keywords = {Caregivers, depression, Employment, Female, Humans, Marriage, Middle Aged, Personal Satisfaction, Psychological Theory, Role, Women{\textquoteright}s Health}, issn = {1079-5014}, doi = {10.1093/geronb/54b.6.s329}, url = {https://pubmed.ncbi.nlm.nih.gov/10625968/}, author = {Reid, Jennifer and Melissa A. Hardy} } @article {6626, title = {Parental marital disruption and intergenerational transfers: an analysis of lone elderly parents and their children.}, journal = {Demography}, volume = {36}, year = {1999}, note = {ProCite field 3 : Johns Hopkins U; Agency for Health Care Policy and Research}, month = {1999 Aug}, pages = {287-97}, publisher = {36}, abstract = {

Although one of the most marked demographic trends observed over the twentieth century is the increased rate of divorce, relatively little research has explored the effects of these changing marital patterns in the context of an aging society. Using a sample of lone elderly parents and their adult children, we analyze the direct and indirect effects of marital disruption on four important dimensions of intergenerational transfers: coresidence, financial assistance, adult children{\textquoteright}s provision of informal care, and parental purchase of paid care. Our findings suggest that divorce has deleterious effects on intergenerational transfers, particularly for elderly fathers. Remarriage further reduces exchange. Our results reveal that parents engage in lower levels of transfers with stepchildren relative to biological children. Moreover, intergenerational transfers are sensitive to characteristics of biological children but not to those of stepchildren. Taken together, these results suggest that exchange at the end of the life course continues to be adversely affected by marital disruption.

}, keywords = {Activities of Daily Living, Adult, Aged, Analysis of Variance, Caregivers, Chi-Square Distribution, Divorce, Family, Father-Child Relations, Female, Financial Support, Frail Elderly, Home Nursing, Humans, Intergenerational Relations, Loneliness, Male, Marriage, Parent-Child Relations, Parents, Sample Size, Sampling Studies, Socioeconomic factors}, issn = {0070-3370}, author = {Liliana E Pezzin and Barbara Steinberg Schone} } @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 {6638, title = {Racial differences in the multiple social roles of older women: implications for depressive symptoms.}, journal = {Gerontologist}, volume = {39}, year = {1999}, month = {1999 Aug}, pages = {465-72}, publisher = {39}, abstract = {

The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles.

}, keywords = {Analysis of Variance, Black or African American, Chi-Square Distribution, Cross-Sectional Studies, Demography, depression, Female, Humans, Middle Aged, Regression Analysis, Self Concept, Social Environment, Social Support, White People, women}, issn = {0016-9013}, doi = {10.1093/geront/39.4.465}, author = {Cochran, Donna and Brown, Diane R. and McGregor, Karl C.} } @article {6673, title = {The relationship of self-rated vision and hearing to functional status and well-being among seniors 70 years and older.}, journal = {Am J Ophthalmol}, volume = {127}, year = {1999}, month = {1999 Apr}, pages = {447-52}, publisher = {127}, abstract = {

PURPOSE: To describe the relationship between self-reported visual and hearing impairment and an index of global functional status among seniors age 70 years or older.

METHODS: A total of 7,320 United States community-dwelling persons aged 70 years or older participating in the 1993 Assets and Health Dynamics of the Oldest Old Survey (AHEAD) completed detailed questionnaires about their demographic, socioeconomic, and health status. Multivariate analyses of functional status (using a global index of functional status based on self-reported limitations in 11 activities) were conducted, controlling for demographic and socioeconomic status and common medical conditions, as well as independently for hearing and vision.

RESULTS: Of the respondents, 27\% rated their vision as fair or poor, whereas 25\% rated their hearing as fair or poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing correlated independently with worsened functional status. Controlling for income, wealth, and education did not greatly reduce the strength of the association between visual and hearing impairment and function.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship to overall functioning in the oldest old, regardless of income or wealth. By confirming these findings across income and household wealth groups, adjusted for medical conditions and general health status, in a nationally representative population of Americans age 70 years or older, this study provides a powerful added impetus to efforts for improving vision and hearing for all other Americans, including the oldest old.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status, hearing, Hearing Disorders, Humans, Male, Multivariate Analysis, Quality of Life, Self Disclosure, Surveys and Questionnaires, Vision Disorders, Vision, Ocular, Visual Acuity}, issn = {0002-9394}, doi = {10.1016/s0002-9394(98)00418-8}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {5390, title = {Retirement patterns and bridge jobs in the 1990s.}, journal = {EBRI Issue Brief}, number = {206}, year = {1999}, month = {1999 Feb}, pages = {1-22}, publisher = {Employee Benefit Research Institute}, address = {Washington, D.C.}, abstract = {

During most of the post-World War II period, American men have been leaving the labor force at earlier and earlier ages. Evidence suggests that this trend has been under way for more than a century. However, in the mid-1980s, this trend came to an abrupt halt. Male labor force participation rates have been flat since 1985, and have actually increased over the past several years. Understanding these issues is especially important given the looming increase in the Social Security normal retirement age to 67 and the possibility of even more increases in the ages of eligibility under Social Security and Medicare reform. Because of the influx of married women into the labor market in the post-World War II period, older women{\textquoteright}s participation rates did not decline as men{\textquoteright}s did. In contrast, their rates were relatively steady, rising or falling very slowly. Since the mid-1980s, however, older women{\textquoteright}s participation rates have increased significantly. Many more older men and women are working today than the pre-1986 trends would have suggested. Many older Americans leave the labor force gradually, utilizing "bridge jobs" between employment on a full-time career job and complete labor force withdrawal. These bridge jobs are often part-time, often in a new line of work, and sometimes involve a switch from wage and salary work to self-employment. Estimates suggest that between one-third and one-half of older Americans will work on a bridge job before retiring completely, and for these workers retirement is best viewed as a process, not as a single event. These changes in retirement behavior are consistent with societal changes that have altered the relative attractiveness of work and leisure late in life. Mandatory retirement has been outlawed for most American workers. Social Security has become more age-neutral, no longer penalizing the average worker who wants to continue working after age 65. An increasing proportion of employer pension coverage has been in defined contribution plans, which do not contain the age-specific retirement incentives that many defined benefit plans do. The composition of jobs has shifted from manufacturing to service occupations. Americans are living longer and healthier lives, and many look forward to years to productive activity after age 65. These structural changes have been accompanied by an important cyclical factor: the strength of the American economy over the past decade. This has increased the demand for all types of labor, including older workers. Evidence suggests that there is more than this cyclical factor at work, however, and that new attitudes about work late in life are developing. Labor supply decisions late in life are correlated in expected ways with the individual{\textquoteright}s health (measured in several ways), age, and pension and health insurance status. Retirement patterns in America are much richer and more varied than the stereotypical one-step view of retirement suggests. Public policy is changing in ways that make continued work late in life more likely. If employers are willing to provide flexible job opportunities to meet the needs of these potential employees, then society can tap a growing pool of older, experienced, and willing workers for years to come.

}, keywords = {Aged, Attitude, Career Mobility, Data collection, Employment, Female, Humans, Male, Middle Aged, Multivariate Analysis, Retirement, United States}, issn = {0887-137X}, author = {Joseph F. Quinn} } @article {6647, title = {A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly.}, journal = {Int Psychogeriatr}, volume = {11}, year = {1999}, month = {1999 Jun}, pages = {139-48}, publisher = {11}, abstract = {

This study examines the psychometric properties of two new abbreviated versions of standard measures of depression, a revised eight-item Center for Epidemiological Studies-Depression Scale (CES-D) and a short-form Composite International Diagnostic Interview (short-form CIDI). A sample of 6,133 elders, age 70 years or older, completed both measures as part of the Asset and Health Dynamics Study of the Oldest Old. The revised CES-D had an internal consistency and factor structure comparable to that of prior versions of the CES-D. The sources of discordance between the two measures were examined and the two measures were compared on self-report of four clinical variables: medical illness, physician diagnosis, psychiatric treatment, and antidepressant or tranquilizer use. Both measures were associated with self-report of physician diagnosis and psychiatric treatment. Respondents positive for depression on the CES-D reported higher rates of antidepressant use. Respondents positive on the short-form CIDI only did not report more antidepressant use than nondepressed respondents.

}, keywords = {Aged, Antidepressive Agents, depression, Depressive Disorder, Major, Diagnosis, Differential, Female, Humans, Male, Prospective Studies, Psychiatric Status Rating Scales, Psychometrics, Severity of Illness Index, Surveys and Questionnaires}, issn = {1041-6102}, doi = {10.1017/s1041610299005694}, url = {https://pubmed.ncbi.nlm.nih.gov/11475428/}, author = {Carolyn L. Turvey and Robert B Wallace and A. Regula Herzog} } @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 {6610, title = {Do medical conditions affect cognition in older adults?}, journal = {Health Psychol}, volume = {17}, year = {1998}, month = {1998 Nov}, pages = {504-12}, publisher = {17}, abstract = {

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

}, keywords = {Aged, Aged, 80 and over, Aging, Cerebrovascular Disorders, Cognition, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Hypertension, Male, Mental Health}, issn = {0278-6133}, doi = {10.1037//0278-6133.17.6.504}, url = {https://pubmed.ncbi.nlm.nih.gov/9848800/}, author = {Elizabeth Zelinski and Eileen M. Crimmins and Sandra L Reynolds and Teresa Seeman} } @article {6608, title = {Life transitions and health insurance coverage of the near elderly.}, journal = {Med Care}, volume = {36}, year = {1998}, month = {1998 Feb}, pages = {110-25}, publisher = {36}, abstract = {

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance?

METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years.

RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage.

CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

}, keywords = {Death, Employment, health policy, Health Services Research, Health Status Indicators, Humans, Insurance Coverage, Life Change Events, Medicaid, Medically Uninsured, Medicare, Middle Aged, Retirement, Spouses, United States}, issn = {0025-7079}, doi = {10.1097/00005650-199802000-00002}, author = {Frank A Sloan and Conover, C.J.} } @article {6613, title = {Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994.}, journal = {Am J Public Health}, volume = {88}, year = {1998}, month = {1998 Nov}, pages = {1691-5}, publisher = {88}, abstract = {

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries.

METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers.

RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95\% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios.

CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

}, keywords = {Accidents, Occupational, Age Distribution, Aged, Aged, 80 and over, Analysis of Variance, Cross-Sectional Studies, Disabled Persons, Female, Health Surveys, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Prospective Studies, Retirement, Risk Factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.88.11.1691}, url = {https://pubmed.ncbi.nlm.nih.gov/9807538/}, author = {Zwerling, Craig and Nancy L. Sprince and Charles S. Davis and Paul S. Whitten and Robert B Wallace and Steven G Heeringa} } @article {6622, title = {Occupational injuries among older workers with visual, auditory, and other impairments. A validation study.}, journal = {J Occup Environ Med}, volume = {40}, year = {1998}, month = {1998 Aug}, pages = {720-3}, publisher = {40}, abstract = {

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

}, keywords = {Accidents, Occupational, Aged, Cohort Studies, Disabled Persons, Female, Health Surveys, Humans, Logistic Models, Male, Middle Aged, Persons With Hearing Impairments, Risk Factors, Visually Impaired Persons}, issn = {1076-2752}, doi = {10.1097/00043764-199808000-00010}, url = {https://pubmed.ncbi.nlm.nih.gov/9729756/}, author = {Zwerling, Craig and Paul S. Whitten and Charles S. Davis and Nancy L. Sprince} } @article {6614, title = {Women, marital status, and symptoms of depression in a midlife national sample.}, journal = {J Women Aging}, volume = {10}, year = {1998}, month = {1998}, pages = {41-57}, publisher = {10}, abstract = {

Previous studies of the correlates of depression among women have not generally been based on adequate midlife samples or precision in the specification of marital status categories. The present analysis is designed to address these deficiencies and is based on data from the Health and Retirement Survey-Wave 1 (i.e., respondents 51 to 61 years old). Results indicate that married women are less likely to report symptoms of depression than their unmarried counterparts. The mental health benefits of marriage are greater for men than for women. Moreover, other variables, such as marital satisfaction, self-rated health, and employment status are more powerful predictors of emotional well-being in midlife than marital status per se. The quality of marriage affects depressive symptoms more strongly for women than men.

}, keywords = {Age Factors, Depressive Disorder, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Surveys and Questionnaires}, issn = {0895-2841}, doi = {10.1300/j074v10n01_04}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9870051}, author = {J R Earle and M H Smith and C.T. Harris and Charles F Longino} } @article {6576, title = {Asset and Health Dynamics Among the Oldest Old (AHEAD): initial results from the longitudinal study. Introduction.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {v-viii}, publisher = {52B}, keywords = {Aged, Aged, 80 and over, Data collection, Health Status, Humans, Income, Longitudinal Studies, Research Design}, issn = {1079-5014}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215353}, author = {Myers, George C. and Juster, F. Thomas and Richard M. Suzman} } @article {6583, title = {A comparative analysis of ADL questions in surveys of older people.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {21-36}, publisher = {52B}, abstract = {

This article describes questions designed to assess limitations with respect to activities of daily living (ADLs) that were asked on the first wave of the AHEAD study, and it assesses their cross-sectional measurement properties. It also provides comparisons between those questions and parallel questions that have been asked on two other surveys of the elderly population in the United States: the 1984 Supplement on Aging (SOA) to the National Health Interview Survey and the screener for the 1982 National Long Term Care Survey (NLTCS). It also compares a single item from the 1990 Census. It then compares the ways in which the same individuals answer these different versions of ADL questions, using data from subsamples of the AHEAD respondents who were also asked the SOA, NLTCS, or Census questions. The analysis shows that there is a substantial amount of measurement error in the answers to ADL questions, and it suggests that this is a major contributor to apparent improvements and declines in functional health observed in longitudinal data.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Geriatric Assessment, Health Services, Health Status, Health Surveys, Humans, Regression Analysis, Reproducibility of Results, United States}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.21}, author = {Willard L Rodgers and Baila Miller} } @article {6566, title = {Demographic and economic correlates of health in old age.}, journal = {Demography}, volume = {34}, year = {1997}, note = {ProCite field 3 : RAND; UCLA and RAND}, month = {1997 Feb}, pages = {159-70}, publisher = {34}, abstract = {

In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (1) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.

}, keywords = {Activities of Daily Living, Aged, Cohort Studies, Demography, Disabled Persons, ethnicity, Female, Health Status, Humans, Income, Male, Models, Econometric, Racial Groups, Socioeconomic factors, United States}, issn = {0070-3370}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9074837}, author = {James P Smith and Raynard Kington} } @article {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 {6580, title = {The division of family labor: care for elderly parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {102-9}, publisher = {52B}, abstract = {

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent{\textquoteright}s needs and the child{\textquoteright}s own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child{\textquoteright}s hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child{\textquoteright}s supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

}, keywords = {Aged, Caregivers, Family, Frail Elderly, Humans, Models, Theoretical, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.102}, author = {Douglas A. Wolf and Vicki A Freedman and Beth J Soldo} } @article {6572, title = {Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey.}, journal = {Am J Public Health}, volume = {87}, year = {1997}, month = {1997 May}, pages = {755-9}, publisher = {87}, abstract = {

OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect.

METHODS: People{\textquoteright}s expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys.

RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions.

CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.

}, keywords = {Cognition, Female, Health Surveys, Humans, Life Tables, Longevity, Male, Middle Aged, Retirement, Risk, Sex Factors, Smoking, Survival Analysis}, issn = {0090-0036}, doi = {10.2105/ajph.87.5.755}, author = {Michael Schoenbaum} } @article {6581, title = {The earnings, income, and assets of persons aged 51-61 with and without musculoskeletal conditions.}, journal = {J Rheumatol}, volume = {24}, year = {1997}, month = {1997 Oct}, pages = {2024-30}, publisher = {24}, abstract = {

OBJECTIVE: To describe the personal and family earnings, income, and assets of persons with musculoskeletal conditions.

METHODS: This study uses the Health and Retirement Survey, a national, community based probability sample of persons 51-61 years of age and their spouses in 1992 to estimate earnings, income, and assets (by kind) in the years immediately prior to the normal age of retirement.

RESULTS: Fifty-nine percent of persons 51-61 years of age (13.76 million) report one or more musculoskeletal condition; of these 38\% (8.74 million) also report at least one comorbid condition and 21\% (5.02 million) report no such comorbidity. Persons with musculoskeletal conditions and comorbidity report 18\% lower family earnings, 15\% lower family income, and 35\% fewer assets than the average among all persons these ages. Persons with musculoskeletal conditions and no comorbidity have earnings, incomes, and assets closer to the average among their peers.

CONCLUSION: Persons with musculoskeletal conditions and comorbidity have lower earnings and incomes now and fewer assets with which to face the future than the remainder of their peers.

}, keywords = {Comorbidity, Data collection, Disabled Persons, Economics, Female, Health Services Research, Humans, Income, Male, Middle Aged, Musculoskeletal Diseases, Retirement}, issn = {0315-162X}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9330948}, author = {Yelin, Edward} } @article {6590, title = {Employee benefits, retirement patterns, and implications for increased work life.}, journal = {EBRI Issue Brief}, year = {1997}, month = {1997 Apr}, pages = {1-23}, publisher = {No. 184}, abstract = {

This Issue Brief examines why policymakers are concerned about the trend toward early retirement and how it relates to Social Security, Medicare, and employee health and retirement benefits. It reviews the rationale for the effects of economic incentives on early retirement decisions and includes a summary of empirical literature on the retirement process. It presents data on how employee benefits influence workers{\textquoteright} expected retirement patterns. Finally, it examines the implications of public policies to reverse early-retirement trends and raise the eligibility age for Social Security and Medicare. An employee Benefit Research Institute/Gallup survey indicates that there is a direct link between a worker{\textquoteright}s decision to retire early and the availability of retiree health benefits. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. Participation in a pension plan can be an important determinant of retirement. Twenty-one percent of pension plan participants planned to stop working before age 65, compared with 12 percent among nonparticipants. Workers whose primary pension plan was a defined benefit plan were more likely to expect to stop working before age 65 (23 percent) than workers whose primary plan was a defined contribution plan (18 percent). Expected income replacement rates effect retirement patterns, indicating that as the expected replacement increases, the probability of expecting to stop working before age 65 increases. Twenty-two percent of workers with an expected income replacement rate below 60 percent expected to stop working before age 65, compared with 29 percent for those in the 60-69 percent replacement range, and 30 percent for those in the 70-79 percent replacement range. Workers expecting to receive retiree health insurance are more likely to expect to stop working before age 65 than workers who do not expect to have retiree health insurance. Twenty-one percent of workers with retiree health insurance expected to stop working before age 65, compared with 12 percent of workers not expecting to receive retiree health insurance. The Social Security Old-Age and Survivors Insurance (OASI) program depends on obtaining sufficient revenue from active workers{\textquoteright} payroll taxes to fund the benefits received by retired beneficiaries. Funding the program in the past was in large part effortless because of the relatively large number of workers per retiree. Today, funding the program is a greater challenge because the ratio of workers to retirees has fallen. Policymakers have been able to agree that reform of the program is necessary for its survival; however, the debate over options to reform the program is just beginning, and it is likely to be a long time before a consensus emerges.

}, keywords = {Age Factors, Aged, Employment, Female, Health Benefit Plans, Employee, Health Status Indicators, Humans, Male, Medicare, Middle Aged, Pensions, Private Sector, Retirement, Social Security, United States}, issn = {0887-137X}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10166809}, author = {Fronstin, Paul} } @article {6587, title = {Expectations of nursing home use in the Health and Retirement Study: the role of gender, health, and family characteristics.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52}, year = {1997}, month = {1997 Sep}, pages = {S240-51}, publisher = {52B}, abstract = {

Economic models of life cycle behavior suggest that expectations about future events may affect savings, insurance, and retirement planning. This article uses data from the first wave of the Health and Retirement Survey (HRS) to examine how personal characteristics and health conditions influence expectations of nursing home use. Subjective expectations of nursing home use are quite close to known probabilities of lifetime use. There are marked differences in the determinants of expectations for women and men that also conform to actual behavior. There is strong evidence that women and men incorporate what is known about nursing home risk into their own expectations, even many years prior to the time when they are most likely to need long-term care.

}, keywords = {Aged, Black or African American, Female, Humans, Male, Middle Aged, Nursing homes, Patient Satisfaction, Retirement, Sex Characteristics, White People}, issn = {1079-5014}, doi = {10.1093/geronb/52b.5.s240}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9310096}, author = {Karen C. Holden and Timothy D McBride and Maria Perozek} } @article {6575, title = {Health insurance coverage at midlife: characteristics, costs, and dynamics.}, journal = {Health Care Financ Rev}, volume = {18}, year = {1997}, month = {1997 Spring}, pages = {123-48}, publisher = {18}, type = {Journal}, abstract = {

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

}, keywords = {Age Factors, Costs and Cost Analysis, Demography, Female, Health Benefit Plans, Employee, Health Care Surveys, Humans, Insurance Coverage, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0195-8631}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6584, title = {Measures of cognitive functioning in the AHEAD Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {37-48}, publisher = {52B}, abstract = {

Decline in cognitive functioning and onset of cognitive impairment are potentially important predictors of elderly persons needing informal assistance and formal health care. This article describes the measures of cognitive functioning that were developed for the Asset and Health Dynamics Among the Oldest Old (AHEAD) study of some 6,500 Americans aged 70 years and older. The study was designed to investigate the impact of health on disbursement of family and economic resources. Evaluation of the cognitive measures in terms of psychometric properties and missing data, telephone administration, and formation of an aggregate index is encouraging. Their construct validity is evidenced by their correlations with sociodemographic characteristics and health indicators that replicate existing findings as well as by their prediction of IADL and ADL functioning that are consistent with theory.

}, keywords = {Aged, Aged, 80 and over, Cognition, Geriatric Assessment, Health Status, Health Surveys, Humans, Longitudinal Studies, Memory, Mental Status Schedule, Psychological Tests, Socioeconomic factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.37}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215356}, author = {A. Regula Herzog and Robert B Wallace} } @article {6588, title = {Medical insurance and the use of health care services by the elderly.}, journal = {J Health Econ}, volume = {16}, year = {1997}, month = {1997 Apr}, pages = {129-54}, publisher = {16}, abstract = {

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

}, keywords = {Activities of Daily Living, Aged, Health Care Surveys, Health Services for the Aged, Health Status Indicators, Hospitalization, Humans, Insurance, Health, Medicare, Office Visits, Patient Acceptance of Health Care, Private Sector, Probability, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(96)00515-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10169091}, author = {Michael D Hurd and Kathleen McGarry} } @article {6570, title = {Patterns of in-home care among elderly black and white Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {52 Spec No}, year = {1997}, month = {1997 May}, pages = {93-101}, publisher = {52B}, type = {Journal}, abstract = {

This study examines the use of informal and formal sources of care by elderly Black and White Americans (n = 2,847) who are functionally impaired and noninstitutionalized. The data are from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Detailed baseline characteristics are provided and logistic regressions are used to assess the likelihood of (a) receiving in-home assistance from any source, (b) using any informal sources of in-home care, (c) using any formal sources, and (d) using formal sources of in-home care with informal sources of home care. Results of the logistic regressions indicate that, compared to Whites, Black elders were less likely to receive assistance and to use informal sources of home care.

}, keywords = {Aged, Aged, 80 and over, Black or African American, Caregivers, Female, Home Care Services, Humans, Male, Socioeconomic factors, United States, White People}, issn = {1079-5014}, doi = {10.1093/geronb/52b.special_issue.93}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9215361}, author = {Norgard, T.M. and Willard L Rodgers} } @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} } @article {6546, title = {Complex marital histories and economic well-being: the continuing legacy of divorce and widowhood as the HRS cohort approaches retirement.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {383-90}, publisher = {36}, abstract = {

We use data from the first wave of the Health and Retirement Survey (HRS) to examine the marital histories of this cohort of women and men on the verge of retirement. The legacy of past increases in divorce rates is evident in the complex marital histories of HRS households and the relationship between those histories and current economic status. Couples in a first marriage now make up only one-quarter of black households and fewer than half of all white and Hispanic households. In over one-third of all married-couple households, at least one spouse had a previous marriage that ended in divorce or widowhood. These couples have significantly lower incomes and assets than couples in first marriages. Contrary to the popular notion that private and public insurance better provide for the security of widows than divorced persons, currently widowed households and couples in which the prior marriage of one spouse had ended in widowhood are no better off than are their divorced peers. This holds true for both black and white households. From a single cross-section, one cannot tell what caused these differences in income and wealth across marital status groups although it is clear that women and blacks spend a higher percentage of their lifetime outside of marriage than do men and whites. We also speculate from estimates of widowhood expectations for a subset of married respondents that underestimating the chances of widowhood--because both men and women overestimate their chances of joint survival--may be a factor in the relatively low economic status of widows. Because couples in life-long marriages have been the traditional standard upon which marital property reform and the survivorship rules of private and public programs are based, their diminishing importance among all households raises concern about the protection provided by these institutions against the long-term economic consequences of past and future marital dissolution.

}, keywords = {Cross-Sectional Studies, Divorce, Female, Humans, Life Tables, Male, Middle Aged, Poverty, Retirement, United States, Widowhood}, issn = {0016-9013}, doi = {10.1093/geront/36.3.383}, author = {Karen C. Holden and Kuo, H.H.} } @article {6550, title = {Cross pressures on middle-aged adults: a broader view.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {51}, year = {1996}, month = {1996 Nov}, pages = {S271-3}, publisher = {51B}, keywords = {Adult, Age Distribution, Aged, Aged, 80 and over, Family, Female, Humans, Male, Middle Aged}, issn = {1079-5014}, doi = {10.1093/geronb/51b.6.s271}, author = {Beth J Soldo} } @article {6545, title = {Disentangling the effects of disability status and gender on the labor supply of Anglo, black, and Latino older workers.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {299-310}, publisher = {36}, abstract = {

Utilizing data from the 1991 Health and Retirement Study Early Release File, this article examines the effects of disability status on labor force participation and earnings of preretirement workers aged 50 to 64. Results from our hierarchical regression models suggest that poor health and the presence of a work disability significantly reduced the labor force participation and earnings of older men and women. These analyses also suggest that economic well-being was constrained by the costs associated with additional "minority statuses." For example, the odds of being employed were reduced by approximately 46\% for black men with disabilities. Further, the earnings of black men were 17\% lower than the earnings of their nondisabled counterparts.

}, keywords = {Black or African American, Disabled Persons, Employment, Female, Hispanic or Latino, Humans, Male, Middle Aged, Models, Theoretical, Multivariate Analysis, Sex Factors, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.299}, author = {Santiago, A.M. and Clara G. Muschkin} } @article {6555, title = {The extent of private and public health insurance coverage among adult Hispanics.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {332-40}, publisher = {Vol. 36}, abstract = {

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

}, keywords = {Adult, Aged, Employment, Female, Health Services Accessibility, Hispanic or Latino, Humans, Insurance, Health, Male, Medical Assistance, Middle Aged, Multivariate Analysis, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.332}, author = {Ronald J. Angel and Jacqueline L. Angel} } @article {6549, title = {The health-wealth connection: racial differences.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {342-9}, publisher = {36}, abstract = {

This article examines the theoretical connection between health capital and financial capital in an economic life-cycle model, exploring possible explanations for racial differences in capital accumulation behavior. Using data from the Health and Retirement Survey, detailed descriptive analysis and a comparison of regression models for health and financial capital are presented. The results, although preliminary and based on cross-section data, suggest possible racial differences in the connection between health and wealth and deserve further study.

}, keywords = {Black or African American, Cross-Sectional Studies, Female, Health Status, Humans, Income, Male, Middle Aged, Models, Theoretical, Regression Analysis, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.342}, author = {Dennis G. Shea and Toni Miles and Mark D Hayward} } @article {6548, title = {Minority perspectives from the Health and Retirement Study. Introduction: health and retirement among ethnic and racial minority groups.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {282-4}, publisher = {36}, keywords = {Aged, Health Status, Humans, Minority Groups, Prospective Studies, Quality of Life, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.282}, author = {James S Jackson and Lockery, Shirley A. and Juster, F. Thomas} } @article {6541, title = {Physical activity and smoking: gender comparisons among older African American adults.}, journal = {J Health Care Poor Underserved}, volume = {7}, year = {1996}, month = {1996 Aug}, pages = {232-51}, publisher = {7}, abstract = {

Little effort has been expended on the examination of systematic health risk behaviors among adult African Americans by gender. Using data from the national Health and Retirement Study (HRS), this article compares differences between male and female physical activity and smoking behaviors of African Americans aged 50 to 61. The analysis highlights a clear pattern of socioeconomic differences with current male smokers, who are more likely to be unmarried and in the lower income and educational levels. Among women, the relationship between smoking patterns, income, and education is less definitive and consistent. Our findings, confirmed by earlier studies, indicate that the largest percentage of the study population, both male and female, are not engaged in any form of regular physical exercise. Thus human service providers must be more attentive to gender and sociodemographic differences in smoking habits and patterns of physical activities to tailor policies and programs accordingly.

}, keywords = {Age Factors, Black or African American, Education, Exercise, Female, Humans, Income, Male, Marital Status, Middle Aged, Risk Factors, Sampling Studies, Sex Factors, Smoking, Smoking cessation}, issn = {1049-2089}, doi = {10.1353/hpu.2010.0617}, author = {Lockery, Shirley A. and Stanford, E. Percil} } @article {6543, title = {Physical function among retirement-aged African American men and women.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {322-31}, publisher = {36}, abstract = {

Prior attempts to identify factors associated with physical function (here, major lower body movements) among African Americans have been constrained by a narrow range of measures, small sample sizes, or both. The 1992 Health and Retirement Study (HRS) contains a substantial over-sample of African Americans (649 men and 957 women self-respondents aged 51 to 61 years), and detailed measures of high-risk behaviors, disease prevalence and severity, impairment, and physical function. We extend the natural history of disease to the natural history of functional status and model sociodemographic characteristics, high-risk behaviors, disease prevalence and severity, and impairments as direct and indirect influences on physical function in this African American sample. This natural history of functional status model fits the data well for both men (ROC = .88) and women (ROC = .83), although there are gender differences. Slightly over one-half of the women report some difficulty in physical function, compared with one-third of the men. Women also have a higher mean body-mass and report a greater prevalence and severity in 6 of 9 chronic diseases and more pain, but are less likely to smoke or abuse alcohol than men. Importantly, many of the factors with the largest direct and indirect associations with difficulty in physical function among these African American men (alcohol abuse, smoking, body mass, diabetes, heart disease, cerebrovascular disease, arthritis, and pain) and women (alcohol abuse, body mass, arthritis, and respiratory illness) are all potentially preventable or manageable.

}, keywords = {Black or African American, Female, Health Behavior, Health Status, Humans, Male, Middle Aged, Models, Theoretical, Odds Ratio, Retirement, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.322}, author = {Daniel O. Clark and Christopher M. Callahan and Mungai, S.M. and Frederic D Wolinsky} } @article {6547, title = {Retirement expectations: differences by race, ethnicity, and gender.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {373-82}, publisher = {36}, abstract = {

Analyses by race and ethnicity of several important dimensions of labor market behavior have been constrained in the past by limited samples of the African American and Hispanic populations. This article uses data from the first wave of the Health and Retirement Survey, which oversamples these populations, to compare the retirement plans of African American, Hispanic, and white married men and women. Findings suggest that retirement expectations may accurately forecast retirement behavior and that the differences by race and ethnicity, as well as by gender, that are evident in retirement plans are likely to be reflected in retirement outcomes.

}, keywords = {ethnicity, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Models, Theoretical, Pensions, Retirement, Sex Factors, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.373}, author = {Honig, Marjorie} } @article {6552, title = {Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.}, journal = {Am J Public Health}, volume = {86}, year = {1996}, month = {1996 Sep}, pages = {1306-9}, publisher = {86}, abstract = {

OBJECTIVES: This study examined risk factors for occupational injury among older workers.

METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers{\textquoteright} impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

}, keywords = {Accidents, Occupational, Cross-Sectional Studies, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Occupational Diseases, Regression Analysis, Retirement, Risk Factors, Sex Factors, United States, Wounds and Injuries}, issn = {0090-0036}, doi = {10.2105/ajph.86.9.1306}, author = {Zwerling, Craig and Nancy L. Sprince and Robert B Wallace and Charles S. Davis and Paul S. Whitten and Steven G Heeringa} } @article {6551, title = {The role of ethnicity in the disability and work experience of preretirement-age Americans.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {287-98}, publisher = {36}, abstract = {

Using the 1992 HRS, this study examines the effects of social and demographic risk factors, including ethnicity, as well as health and job characteristics on disability and work status among 8,701 preretirement-age Americans with work history. Analytic results indicated that non-Anglo ethnicity was not a significant predictor of disability status but that being African American was a strong significant predictor of being a past versus current worker. The primary predictors of disability and work status were health behaviors, effects of health conditions, job characteristics, and workplace adaptations, factors that lend themselves to policy manipulation.

}, keywords = {Activities of Daily Living, Analysis of Variance, Disabled Persons, Employment, ethnicity, Female, Humans, Male, Middle Aged, Odds Ratio, Regression Analysis, Risk Factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.287}, author = {Linda A. Wray} } @article {6544, title = {Who takes early Social Security benefits? The economic and health characteristics of early beneficiaries.}, journal = {Gerontologist}, volume = {36}, year = {1996}, note = {RDA}, month = {1996 Dec}, pages = {789-99}, publisher = {36}, abstract = {

Using the 1992 and 1994 Waves of the Health and Retirement Survey, we compare individuals who first take Social Security benefits at age 62 with those who don{\textquoteright}t and find that the income and net assets of these two groups are similar in the years just prior to eligibility. However, there is great diversity within the groups, so that poor health appears to be more closely related to lower economic well-being than is early Social Security acceptance status. Our results suggest that raising the Social Security retirement age is not likely to dramatically lower the economic well-being of the typical person aged 62 since only 3\% of men aged 62 are receiving Social Security retirement benefits, are in poor health, and have Social Security retirement benefits as their only source of pension income.

}, keywords = {Aged, Eligibility Determination, Female, Health Status, Health Surveys, Humans, Income, Male, Middle Aged, Pensions, Retirement, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.6.789}, author = {R.V. Burkhauser and Kenneth A. Couch and John W R Phillips} } @article {6534, title = {Effect of recall period on the reporting of occupational injuries among older workers in the Health and Retirement Study.}, journal = {Am J Ind Med}, volume = {28}, year = {1995}, month = {1995 Nov}, pages = {583-90}, publisher = {28}, abstract = {

Studies of injury morbidity often rely on self-reported survey data. In designing these surveys, researchers must chose between a shorter recall period to minimize recall bias and a longer period to maximize the precision of rate estimates. Using data from the Health and Retirement Study, which employed a recall period of 1 year, we examined the effect of the recall period on rates of occupational injuries among older workers as well as upon rate ratios of these injuries for nine risk factors. We fit a stochastic model to the occupational injury rates as a function of time before the interview and used this model to estimate what the injury rates would have been had we used a 4-week recall period. The adjusted occupational injury rate of 5.9 injuries per 100 workers per year was 36\% higher than the rate based on a 1-year recall period. Adjustment for recall period had much less effect on rate ratios, which typically varied by < 10\%. Our work suggests that self-reported surveys with longer recall periods may be used to estimate occupational injury rates and also may be useful in studying the associations between occupational injuries and a variety of risk factors.

}, keywords = {Accidents, Occupational, Adult, Aged, Bias, Cross-Sectional Studies, Data collection, Female, Humans, Incidence, Linear Models, Male, Mental Recall, Middle Aged, Models, Statistical, Reproducibility of Results, Retirement, Risk Factors, Time Factors, United States}, issn = {0271-3586}, doi = {10.1002/ajim.4700280503}, author = {Zwerling, Craig and Nancy L. Sprince and Robert B Wallace and Charles S. Davis and Paul S. Whitten and Steven G Heeringa} } @article {7402, title = {Physician perspectives on the role of religion in the physician-older patient relationship.}, journal = {J Fam Pract}, volume = {28}, year = {1989}, month = {1989 Apr}, pages = {441-8}, abstract = {

A study of 160 family physicians and general practitioners found that the majority of physicians believed that religion has a positive effect on the mental health of older patients, and many believed that religion has a positive effect on physical health. While more than one half reported that patients only rarely, if ever, mentioned religious issues during a medical visit, a significant proportion of the physicians felt they should address religious issues when an older person indicates religion{\textquoteright}s importance and that religious issues should not be reserved completely for the clergy. Nearly two thirds of the physicians felt that prayer with patients was appropriate under certain circumstances, and over one third reported having prayed with older patients during extreme physical or emotional distress. Older physicians were less likely than younger to have positive attitudes toward addressing religious issues. The strongest predictors of physicians{\textquoteright} belief in the appropriateness of addressing religious concerns were two attitudinal variables that indicated an understanding of the importance of religion in the lives of older adults and an awareness that patients might desire to engage in prayer with them. Hence, the beliefs and attitudes of the physician appear to be important factors in determining their receptivity to discussion of religious issues, which in turn may influence whether patients mention such issues in the context of the medical visit.

}, keywords = {Aged, Attitude of Health Personnel, Cross-Sectional Studies, Humans, Illinois, Middle Aged, Physician-Patient Relations, Physicians, Family, Religion and Medicine}, issn = {0094-3509}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1883437991andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Koenig, H G and Bearon, L B and Dayringer, R} }