@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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {12430, title = {Defining Childlessness Among Middle-Aged and Older Americans: A Research Note.}, journal = {Demography}, volume = {59}, year = {2022}, pages = {813-826}, abstract = {

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2\% to 13.6\% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

}, keywords = {Aged, Child, Family Characteristics, Gender Identity, Marital Status, Middle Aged, Residence Characteristics}, issn = {1533-7790}, doi = {10.1215/00703370-9987649}, author = {Xu, Xiao and Liang, Jersey and Raymo, James M and Kim, BoRin and Ofstedal, Mary Beth} } @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 {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 {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 {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 {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 {Lappan202018, title = {Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking}, journal = {Nicotine \& tobacco research : official journal of the Society for Research on Nicotine and Tobacco}, volume = {22}, year = {2020}, note = {cited By 1}, pages = {18-23}, abstract = {INTRODUCTION: Smoking cessation treatments currently succeed at a rate of approximately 20\%-30\%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults. METHODS: Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55\% women, 89\% white, mean age = 64 years, mean years of education = 13, 25\% smokers in 2006 and 21\% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life. RESULTS: Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010. CONCLUSIONS: Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments. IMPLICATIONS: Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments. {\textcopyright} The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.}, keywords = {Adult, Aged, Article, Education, Female, human, Life Satisfaction, Male, Middle Aged, Optimism, people by smoking status, psychological well-being, Retirement, Smoking cessation, structural equation modeling}, issn = {1469994X}, doi = {10.1093/ntr/nty185}, author = {Lappan, S. and Thorne, C.B. and Long, D. and Hendricks, P.S.} } @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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {8009, title = {Are people healthier if their partners are more optimistic? The dyadic effect of optimism on health among older adults.}, journal = {J Psychosom Res}, volume = {76}, year = {2014}, month = {2014 Jun}, pages = {447-53}, publisher = {76}, abstract = {

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

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

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

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

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

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

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

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran{\textquoteright}s Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

}, keywords = {Aged, Female, Genetic Predisposition to Disease, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Physical Fitness, Retirement, United States}, issn = {1464-3685}, doi = {10.1093/ije/dyu067}, author = {Amanda Sonnega and Jessica Faul and Mary Beth Ofstedal and Kenneth M. Langa and John W R Phillips and David R Weir} } @article {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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. 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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. 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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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {8741, title = {Evidence on early-life income and late-life health from America{\textquoteright}s Dust Bowl era.}, journal = {Proceedings of the National Academy of Sciences }, volume = {104}, year = {2007}, month = {2007 Aug 14}, pages = {13244-9}, abstract = {

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

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

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

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

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

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

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

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

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

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

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

}, keywords = {Aged, Cardiovascular Diseases, depression, Diabetes Mellitus, Female, Health Status, Health Surveys, Humans, Longitudinal Studies, Male, Medically Uninsured, Medicare, Middle Aged, Outcome Assessment, Health Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.298.24.2886}, author = {J. Michael McWilliams and Meara, Ellen and Alan M. Zaslavsky and John Z. Ayanian} } @article {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {6733, title = {Life events and alcohol consumption among mature adults: a longitudinal analysis.}, journal = {J Stud Alcohol}, volume = {62}, year = {2001}, month = {2001 Jul}, pages = {501-8}, publisher = {62}, abstract = {

OBJECTIVE: Four waves of the Health and Retirement Study were used to examine changes in alcohol consumption co-occurring and following stress associated with major health, family and employment events.

METHOD: The final sample consisted of 7,731 (3,907 male) individuals between the ages of 51 and 61 at baseline. We used multinomial logit analysis to study associations between important life events and changes in alcohol consumption over a 6-year study period. Interactions between stressful life events, gender and problem drinking were also evaluated.

RESULTS: Most persons (68\%) did not change their use of alcohol over the entire 6 years. Hospitalization and onset of a chronic condition were associated with decreased drinking levels. Retirement was associated with increased drinking. Widowhood was associated with increased drinking but only for a short time. Getting married or divorced was associated with both increases and decreases in drinking, with a complex lag structure. A history of problem drinking influenced the association between certain life events (e.g., divorce and retirement) and changes in drinking. Gender modified the association between losing a spouse and changes in drinking.

CONCLUSIONS: Even after controlling for problem drinking history, social support and coping skills, changes in drinking behavior were related to several life events occurring over a 6-year period for a national cohort of individuals in late middle-age. The magnitude of these relationships, however, varied by gender and problem drinking history.

}, keywords = {Adaptation, Psychological, Aged, Alcohol Drinking, Employment, Family, Health Status, Humans, Life Change Events, Longitudinal Studies, Middle Aged, Social Support, Stress, Psychological}, issn = {0096-882X}, doi = {10.15288/jsa.2001.62.501}, author = {Perreira, Krista M. and Frank A Sloan} } @article {6737, title = {Predictors of transitions in disease and disability in pre- and early-retirement populations.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Aug}, pages = {379-409}, publisher = {13}, abstract = {

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period.

METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses.

RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes.

DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Chronic disease, Disabled Persons, Female, Health Status, Hispanic or Latino, Humans, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/089826430101300304}, author = {Namkee G Choi and Schlichting-Ray, L.} } @article {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 {6746, title = {Socioeconomic status and the prevalence of health problems among married couples in late midlife.}, journal = {Am J Public Health}, volume = {91}, year = {2001}, month = {2001 Jan}, pages = {131-5}, publisher = {91}, abstract = {

OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

}, keywords = {Activities of Daily Living, Cohort Studies, Female, Health Status, Humans, Male, Marital Status, Middle Aged, Odds Ratio, Risk Factors, Socioeconomic factors, Spouses, United States}, issn = {0090-0036}, doi = {10.2105/ajph.91.1.131}, author = {Sven E. Wilson} } @article {6680, title = {The effect of smoking on health using a sequential self-selection model.}, journal = {Health Econ}, volume = {9}, year = {2000}, note = {ProCite field 3 : SUNY, Albany; SUNY, Albany}, month = {2000 Sep}, pages = {491-511}, publisher = {9}, abstract = {

We estimate a structural model of individual smoking behaviour emphasizing the role of individual risk belief on smoking choices. Our model consists of five equations: two selection equations for initiation and cessation decisions, and three switching outcome regressions for nonsmokers, ex-smokers, and current smokers. The presence of significant self-selectivity implies that the health effects of smoking based on sample proportions do not correctly indicate the true risk of cigarette smoking. Further, our evidence suggests that the self-selection in the cessation decision, but not in the initiation decision, is consistent with economic rationality. We estimate the model by full information maximum likelihood (FIML) with starting values from heteroskedasticity corrected Heckman-Lee two-step method using newly released Health and Retirement Study (HRS) data.

}, keywords = {Adult, Aged, Aged, 80 and over, Attitude to Health, Decision making, Health Behavior, Health Status, Health Surveys, Humans, Middle Aged, Models, Econometric, Predictive Value of Tests, Reproducibility of Results, Risk Factors, Risk-Taking, Selection Bias, Smoking, Smoking cessation, Surveys and Questionnaires, United States}, issn = {1057-9230}, doi = {10.1002/1099-1050(200009)9:6<491::aid-hec541>3.0.co;2-$\#$}, author = {Kajal Chatterji Lahiri and Song, Jae G.} } @article {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 {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 {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 {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 {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 {6715, title = {The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions.}, journal = {Arthritis Care Res}, volume = {13}, year = {2000}, month = {2000 Jun}, pages = {168-76}, publisher = {13}, abstract = {

OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later.

METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression.

RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2\%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one{\textquoteright}s job (12.1\%), scheduling more breaks during the work day (9.5\%), changing the time that the work day started and stopped (6.3\%), having a shorter work day (5.6\%), getting special equipment (5.3\%), and changing the work tasks (5.3\%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one{\textquoteright}s job--was associated with a higher rate of employment in 1994.

CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.

}, keywords = {Disabled Persons, Employment, Supported, Female, Health Status, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Morbidity, Musculoskeletal Diseases, Personnel Turnover, Program Evaluation, Surveys and Questionnaires, United States, Workload, Workplace}, issn = {0893-7524}, doi = {10.1002/1529-0131(200006)13:3<168::aid-anr6>3.0.co;2-r}, author = {Yelin, Edward and Sonneborn, Dean and Laura S. Trupin} } @article {6698, title = {Uninsured status and out-of-pocket costs at midlife.}, journal = {Health Serv Res}, volume = {35}, year = {2000}, month = {2000 Dec}, pages = {911-32}, publisher = {35}, abstract = {

OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period.

DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline.

STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage.

PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance.

CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years.

}, keywords = {Age Factors, Female, Financing, Personal, Health Care Surveys, Health Services, Health Status, Humans, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Models, Econometric, Multivariate Analysis, Surveys and Questionnaires, United States}, issn = {0017-9124}, author = {Richard W. Johnson and Crystal, Stephen} } @article {6639, title = {The associations between self-rated vision and hearing and functional status in middle age.}, journal = {Ophthalmology}, volume = {106}, year = {1999}, month = {1999 Feb}, pages = {401-5}, publisher = {106}, abstract = {

OBJECTIVES: To describe the associations between self-reported visual and hearing impairment and an index of global functional status among community-dwelling, middle-aged Americans.

DESIGN: Cross-sectional.

PARTICIPANTS: A total of 9744 U.S. community-dwelling persons 51 to 61 years of age participated.

METHODS: Multivariate analyses of functional status based on cross-sectional data from Wave I (1992) of the Health and Retirement Study (HRS), controlling for demographic and socioeconomic status, common chronic medical conditions, and general health status, were performed.

MAIN OUTCOME MEASURE: A global index of functional status based on self-reported limitations in 17 activities was measured.

RESULTS: Approximately 3\% of respondents in the HRS rated their vision or hearing as poor. Even after controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. In addition, controlling for income, wealth, and education reduced the strength of the associations between vision and hearing impairment and function, but did not eliminate them. The magnitude of effect of poor vision exceeded all medical conditions except stroke.

CONCLUSIONS: Visual and hearing impairment appear to have a significant relationship with overall functional status, among even community-dwelling, middle-aged Americans and even after controlling for general health status, medical comorbidities, and socioeconomic status.

}, keywords = {Cross-Sectional Studies, Female, health, Health Status, Health Surveys, Hearing Disorders, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Quality of Life, Self Disclosure, Vision Disorders}, issn = {0161-6420}, doi = {10.1016/S0161-6420(99)90082-9}, url = {http://www.ncbi.nlm.nih.gov/pubmed/9951498?dopt=Abstract}, author = {Paul P Lee and James P Smith and Raynard Kington} } @article {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 {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 {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 {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 {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 {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 {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 {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 {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 {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 {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} }