@article {13772, title = {Depressive symptom trajectory of older adults with diabetes: exploring the role of physical activities using latent growth modeling.}, journal = {Aging \& mental health}, year = {Forthcoming}, pages = {1-9}, abstract = {

OBJECTIVES: The literature highlights the role of physical activities in reducing depression, primarily in clinical samples and international longitudinal studies on older adults with diabetes. Based on Andersen{\textquoteright}s Behavioral Model, this study aims to describe the trajectory of depressive symptoms in this population and examine whether physical activities are associated with this trajectory.

METHODS: This study used a longitudinal survey design, utilizing three waves of data from the Health and Retirement Study. The respondents were adults aged 50 or older ( = 4,278) with diabetes. After conducting descriptive analyses, latent growth modeling was performed including unconditional and conditional models.

RESULTS: The overall trajectory of depressive symptoms in adults with diabetes decreased over a 4-year period. Physical activities were significantly associated with the variance in the intercept of the trajectory (~.05), but not associated with the variance in the slope (~>~.05). Additionally, this study identified factors significantly associated with the variance in the intercept (e.g. age, gender, race, marriage, education, income, self-reported health) or the slope (e.g. race, marriage, education, self-reported health) of the depressive symptom trajectory (~.05).

CONCLUSION: The findings underscore the importance of implementing targeted interventions to encourage and promote physical activities among older adults with diabetes, recognizing the potential benefits for managing their mental health.

}, keywords = {Depressive symptoms, Diabetes, Mental Health, Older Adults, physical activities}, issn = {1364-6915}, doi = {10.1080/13607863.2024.2313722}, author = {Yoon, Young Ji} } @article {11156, title = {Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study}, journal = {Neuropsychology}, year = {Forthcoming}, abstract = {Objectives: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).Method: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically-driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. Results: For the eight domains of cognitive functioning identified theoretically (orientation, memory [immediate, delayed, \& recognition], set shifting, attention/speed, language/fluency, andvisuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where good fit is axiomatic. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). Discussion: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used as anchors for calibrating cross-national studies of cognitive performance, and to identify persons performing atthe low end as part of an algorithmic classification of probable dementia}, keywords = {Cognitive Ability, Confirmatory Factor Analysis, HCAP, Older Adults}, doi = {10.31234/osf.io/rvmhj}, author = {Richard N Jones and Jennifer J Manly and Kenneth M. Langa and Lindsay H Ryan and Deborah A Levine and Ryan J McCammon and David R Weir} } @article {13852, title = {Food insecurity, inflammation, and immune function among older US adults: Findings from the health and Retirement study.}, journal = {Brain, Behavior, and Immunity}, volume = {119}, year = {Forthcoming}, pages = {28-35}, abstract = {

BACKGROUND: Food insecurity (FI) is a pressing public health concern among older adults and has been associated with adverse cardiovascular outcomes. Greater systemic inflammation may provide a pathway to explain these associations, but few studies have examined the link between FI and markers of inflammation. Thus, the objective of the present study was to evaluate the associations between FI and multiple inflammatory and immune functioning biomarkers using a nationally representative study of US adults aged~>~50~years.

METHOD: Participants (n~=~3,924) were drawn from the longitudinal Health and Retirement Study (HRS). Household FI was assessed using the six-item Short Form Food Security Survey Module from the 2013 HRS Health Care and Nutrition Study. Markers of inflammation (neutrophil-lymphocyte ratio, albumin, hs-CRP, IL6, IL10, IL-1Ra, sTNFR-1, and TGFβ-1) and immune functioning (CMV) were collected during the 2016 HRS Venous Blood Study. Multivariate logistic and linear regression models were used to evaluate associations between household FI and inflammatory and immune functioning biomarkers, adjusting for individual and household sociodemographic characteristics.

RESULTS: The weighted prevalence of FI was 18.8~\%. Age and sex-adjusted mean showed that FI was associated with higher levels of inflammation and impaired immune functioning (Ps-value~<~0.05). Older adults with FI had higher mean levels of albumin, hs-CRP, IL6, IL10, IL-1Ra, TGF{\ss}-1, and CMV seronegative and borderline (Ps-value~<~0.05). Multivariate-adjusted regression model showed that FI was associated with high-risk categories of hs-CRP (OR 1.34, 95~\% CI 1.06, 1.68), IL-6 (OR 1.66, 95~\% CI 1.28, 2.14), IL-1Ra (OR 0.67, 95~\% CI 0.48, 0.93), TGF{\ss}-1 (OR 1.87, 95~\% CI 1.45, 2.42), seronegativity for CMV (OR 0.48, 95~\% CI 0.35, 0.64).

CONCLUSION: In this nationally representative sample of older adults, FI was positively associated with multiple markers of systemic inflammation and impaired immune functioning. Public health efforts that directly work to reduce FI among older adults are warranted and may result in further improvements in their health and well-being.

}, keywords = {chronic inflammation, Food insecurity, Health and Retirement Study, immune functioning, Inflammation, Inflammatory cytokines, Older Adults}, issn = {1090-2139}, doi = {10.1016/j.bbi.2024.03.034}, author = {Aljahdali, Abeer A and Ludwig-Borycz, Elizabeth and Leung, Cindy W} } @article {13787, title = {The Impact of Online Services on the COVID-19 Resilience of Korean Older Adults.}, journal = {Asia-Pacific Journal of Public Health}, year = {Forthcoming}, pages = {10105395241233066}, keywords = {COVID-19, korean, Older Adults, online services, Pandemic}, issn = {1941-2479}, doi = {10.1177/10105395241233066}, author = {Nam, Su-Jung and Yeo, JeongHee} } @article {13620, title = {Neighborhood Features and Cognitive Function: Moderating Roles of Individual Socioeconomic Status.}, journal = {American journal of preventive medicine}, year = {Forthcoming}, abstract = {

INTRODUCTION: There is an interest in exploring the associations between neighborhood characteristics and individual cognitive function; however, little is known about whether these relationships can be modified by individual socioeconomic status, such as educational attainment and income.

METHODS: Drawing from the 2010-2018 Health and Retirement Study, this study analyzed 10,621 older respondents (aged 65+) with a total of 33,931 person-waves. These respondents did not have dementia in 2010 and stayed in the same neighborhood throughout the study period. Cognitive function was measured with a 27-point indicator biennially, and neighborhood characteristics (i.e., walkability, concentrated disadvantage, and social isolation) were assessed in 2010. All analyses were performed in 2023.

RESULTS: Cognitive function is positively associated with neighborhood walkability and negatively related to concentrated disadvantage, suggesting that exposures to these neighborhood characteristics have long-lasting impacts on cognitive function. Furthermore, individual socioeconomic status modifies the relationship between neighborhood characteristics and cognitive function. Compared with those graduating from college, respondents without a bachelor{\textquoteright}s degree consistently have lower cognitive function but the educational gap in cognitive function narrows with increases in walkability (b= -0.152, SE=0.092), and widens when neighborhood concentrated disadvantage (b=0.212, SE=0.070) or social isolation (b=0.315, SE=0.125) rises. The income gap in cognitive function shrinks with increases in walkability (b= -0.063, SE=0.027).

CONCLUSIONS: The moderating role of socioeconomic status indicates that low-socioeconomic status older adults who also live in disadvantaged neighborhoods face a higher risk of poor cognitive function. Low-education and low-income aging adults may have the most to gain from investments to improve neighborhood characteristics.

}, keywords = {cognitive function, low-education, low-income, Older Adults, socioeconomic status}, issn = {1873-2607}, doi = {10.1016/j.amepre.2023.10.012}, author = {Yang, Tse-Chuan and Kim, Seulki and Choi, Seung-Won Emily and Halloway, Shannon and Mitchell, Uchechi A and Shaw, Benjamin A} } @article {13688, title = {Purpose in Life Links Positive Aging Views to Life Satisfaction: A Within-Person Analysis Spanning 13 Years.}, journal = {Journal of Applied Gerontology}, year = {Forthcoming}, pages = {7334648231217643}, abstract = {

This study aimed to examine the relationship between positive perceptions of aging, purpose in life, and life satisfaction in older adults. It was hypothesized that purpose in life mediates the relationship between positive perceptions of one{\textquoteright}s aging and life satisfaction. This hypothesis was tested in a sample of older American adults from four waves of the Health and Retirement Study collected at 4-year intervals between 2008 and 2020 ( = 11,546, mean age in 2008 = 62.772). The random intercept cross-lagged panel model was used to separate within-person and between-person sources of variance. Mediation was tested at the longitudinal within-person level and was supported. Results suggest that an increase in positive perceptions of aging is associated with a future increase in purpose in life, which in turn is associated with higher future levels of life satisfaction. The findings inform interventions promoting positive aging, purpose, and life satisfaction in older adults.

}, keywords = {Aging, Older Adults, Purpose in life, Satisfaction}, issn = {1552-4523}, doi = {10.1177/07334648231217643}, author = {Joshanloo, Mohsen} } @article {13839, title = {The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach.}, journal = {Psychology of Medicine}, year = {Forthcoming}, pages = {1-14}, abstract = {

BACKGROUND: A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS: We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from ;2006/2008 to ;2010/2012) were associated with subsequent loneliness 4 years later (;2014/2016).

RESULTS: Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS: Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

}, keywords = {Health behaviors, Loneliness, Older Adults, Physical Health, predictors, Psychosocial factors, Public Health}, issn = {1469-8978}, doi = {10.1017/S0033291723002581}, author = {Hong, Joanna H and Nakamura, Julia S and Sahakari, Sakshi S and Chopik, William J and Shiba, Koichiro and VanderWeele, Tyler J and Kim, Eric S} } @article {13783, title = {Unrelenting Growth and Diversification: Using the Health and Retirement Study to Illuminate Cannabis Use among Aging Americans.}, journal = {The Gerontologist}, year = {Forthcoming}, abstract = {

BACKGROUND AND OBJECTIVES: Cannabis use among aging Americans continues to increase. We examine correlates of cannabis use including attitudes, state of residence, health status and service use.

RESEARCH DESIGN AND METHODS: Using the 2018 Health and Retirement Study Cannabis module completed by 1,372 respondents aged 50 and older, we distinguished current cannabis users from those who have never used or have some prior use. We linked 2018 and 2016 core HRS data and used multinomial regressions to identify associations among current use, attitudes, place of residence, as well as current (2018) and past (2016) medical conditions, pain and sleep issues. We also examined associations among cannabis use, hospital stays and outpatient medical visits.

RESULTS: Past year cannabis use reached 10.3\% among aging Americans. Attitudes toward cannabis have changed over time with 4 of 5 survey respondents currently holding a favorable attitude. Attitude and state of residence were associated with current use. Cannabis users reported higher levels of pain, were more likely to use prescription opioids, and report activity limitations in both 2016 and 2018. Associations between cannabis use and sleep issues or concurrent healthcare use were not observed.

DISCUSSION AND IMPLICATIONS: Changing attitudes and state legalization appear important for late middle age and older persons, and as many as 1 of every 5 persons over 50 may be using cannabis by 2030. Cannabis use among aging Americans warrants increased attention from care providers, program administrators and policy makers, especially as a prevention or harm reduction strategy relative to prescription opioids.

}, keywords = {health retirement survey, Marijuana, Older Adults, Opioids, pain}, issn = {1758-5341}, doi = {10.1093/geront/gnae016}, author = {Kaskie, Brian and Bhagianadh, Divya and Bobitt, Julie and Martinos, Fadi and Milavetz, Gary and Arora, Kanika} } @article {13711, title = {The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic.}, journal = {Journal of Aging and Health}, year = {Forthcoming}, pages = {8982643231223555}, abstract = {

To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms ( < .01). Older adults racialized as White with CIND reported higher somatic ( < .01) symptoms compared to cognitively normal older adults racialized as White. The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time.

}, keywords = {Cognition, COVID, Dementia, depression, Older Adults}, issn = {1552-6887}, doi = {10.1177/08982643231223555}, author = {Brown, Monique J and Adkins-Jackson, Paris B and Sayed, Linda and Wang, Fei and Leggett, Amanda and Ryan, Lindsay H} } @article {13710, title = {Association of perceived discrimination with the risk of depression among US older adults: A prospective population-based cohort study.}, journal = {Heliyon}, volume = {10}, year = {2024}, pages = {e23843}, abstract = {

AIMS: Association between perceived discrimination and depression has been demonstrated in some sources of discrimination, such as age, sex, and race. However, the effects of perceived discrimination both in any domain and each domain on development of depression are still unclear. We aimed to estimate the association of any and each domain of perceived discrimination with the risk of depression among US older adults.

METHODS: We did a population-based cohort study using eight waves (from 2006 to 2020) of data from the Health and Retirement Study (HRS), a nationally representative study of US older adults aged 51 years and above. Perceived discrimination was measured by the shortened 5-item version of Williams{\textquoteright} discrimination scale, including five domains (less courtesy, service setting, not smart, threatened or harassed, and medical setting). Depressive symptoms were assessed with shortened 8-item version of the Center for Epidemiological Depression scale (8-item CES-D). Cox proportional hazards models were used to estimate the crude and adjusted hazards ratio (HRs) and their 95~\% confidence intervals (CIs) between perceived discrimination and risk of depression, after controlling for potential confounders.

RESULTS: A total of 18502 participants were included in our final analyses. 42.8~\% of them had any perceived discrimination at baseline, and the most prevalent perceived discrimination was feeling less courtesy, which was observed in 5893 people (31.6~\%). During a median of 9.8 years follow-up, 44.7~\% of participants developed depression. The risk of depression was 46~\% (adjusted HR: 1.46, 95~\% CI: 1.39-1.52) higher among people with perceived discrimination than those without. The associations between perceived discrimination in each domain and risk of depression were all prominent.

CONCLUSIONS: Both any and each domain of perceived discrimination were associated with an increased risk of depression. Considering the high prevalence of perceived discrimination and the following poor health outcomes, our findings suggested the integrated measures of providing public education and diversified communication to reduce discrimination, as well as accessible emotional supports to prevent depression are urgently needed.

}, keywords = {depression, Dose-response relationship, Older Adults, Perceived Discrimination}, issn = {2405-8440}, doi = {10.1016/j.heliyon.2023.e23843}, author = {Wang, Yaping and Liao, Jiaojiao and Chen, Hongguang and Tao, Liyuan and Liu, Jue} } @article {13816, title = {Cognitive Functioning is Higher among Older Adults in Walkable Neighborhoods that Have Low Economic Disadvantage}, year = {2024}, institution = {Syracuse University}, address = {Syracuse}, keywords = {cognitive, economic disadvantage, Older Adults, walkable neighborhoods}, url = {https://surface.syr.edu/cgi/viewcontent.cgi?article=1244\&context=lerner}, author = {Tse-Chuan Yang and Seulki Kim and Seung-won Emily Choi and Shannon Halloway and Uchechi A. Mitchell and Benjamin A. Shaw} } @article {13817, title = {Cognitive Functioning is Higher among Older Adults in Walkable Neighborhoods that Have Low Economic Disadvantage}, year = {2024}, institution = {Syracuse University}, address = {Syracuse}, keywords = {cognitive, economic disadvantage, Older Adults, walkable neighborhoods}, url = {https://surface.syr.edu/cgi/viewcontent.cgi?article=1244\&context=lerner}, author = {Tse-Chuan Yang and Seulki Kim and Seung-won Emily Choi and Shannon Halloway and Uchechi A. Mitchell and Benjamin A. Shaw} } @mastersthesis {13892, title = {DOES SEVERITY OF DISEASE IMPACT ATTITUDE TOWARD ONE{\textquoteright}S OWN AGING?}, volume = {Doctor of Philosophy}, year = {2024}, pages = {112}, school = {Miami University}, address = {Oxford, Ohio}, abstract = {Attitude toward own aging (ATOA) is a subjective perception of one{\textquoteright}s own aging experience that can be influenced by age, health problems, and ageist stereotypes. The increasing prevalence of chronic diseases attributable largely to the growing population of older adults has raised concerns about how these illnesses may adversely affect older adults. Existing evidence indicates a negative association between the number of diseases and ATOA, and negative ATOA also impacts health and increases mortality rates, thereby creating a vicious cycle. However, research on how changes in the number and general severity of diseases may affect ATOA remains limited. This study explored the relationship between the number of diseases, change in disease number, and the severity of diseases and ATOA among individuals aged 65 and above (n = 2,324) using data from the Health and Retirement Study. A change model was used to examine the relationship between changes in disease count and ATOA within the same cohort for the 2012 and 2016 waves. To investigate whether disease severity affected ATOA, the Charlson Comorbidity Index (CCI) was utilized as a measure of disease burden, and multiple linear regression was used to examine the relationships between variables. There was a statistically significant negative association between the number of diseases and ATOA among participants, with a greater number of diseases leading to a more negative ATOA score. Additionally, the relationship between the change in disease count between 2012 and 2016 with ATOA was statistically significant. Furthermore, older adults with a higher CCI score tended to have more negative ATOA after a threshold. These findings suggest that number of diseases, change in disease number, and severity of diseases have a detrimental effect on ATOA. Future research should focus on longerterm follow-up investigations to enhance understanding of the complex relationship between health, disease burden, and ATOA. Also, exploring the relationship between the change in disease count and ATOA can enhance our understanding of ATOA-related research and unveil potential avenues for future investigations. Such investigations will provide valuable insights that will facilitate development of interventions to improve ATOA and overall well-being among older adults.}, keywords = {ATOA, Diseases, Mortality rates, Older Adults}, url = {https://etd.ohiolink.edu/acprod/odb_etd/ws/send_file/send?accession=miami1712658312004887\&disposition=inline}, author = {Da Jung Chang} } @article {FARINA2024101648, title = {The embodiment of parental death in early life through accelerated epigenetic aging: Implications for understanding how parental death before 18 shapes age-related health risk among older adults}, journal = {SSM - Population Health}, year = {2024}, pages = {101648}, abstract = {Parental death in early life has been linked to various adverse health outcomes in older adulthood. This study extends prior research to evaluate how parental death in early life is tied to accelerated epigenetic aging, a potentially important biological mechanism from which social and environmental exposures impact age-related health. We used data from the 2016 Venous Blood Study (VBS), a component of the Health and Retirement Study (HRS), to examine the association between parental death in early life and accelerated epigenetic aging as measured by three widely used epigenetic clocks (PCPhenoAge, PCGrimAge, and DunedinPACE). We also assessed whether some of the association is explained by differences in educational attainment, depressive symptoms, and smoking behavior. Methods included a series of linear regression models and formal mediation analysis. Findings indicated that parental death in early life is associated with accelerated epigenetic aging for PCPhenoAge and DunedinPACE. The inclusion of educational attainment, depressive symptoms, and smoking behavior attenuated this association, with formal mediation analysis providing additional support for these observations. Parental death in early life may be one of the most difficult experiences an individual may face. The elevated biological risk associated with parental death in early life may operate through immediate changes but also through more downstream risk factors. This study highlights how early life adversity can set in motion biological changes that have lifelong consequences.}, keywords = {health risks, Older Adults, parental death}, issn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2024.101648}, author = {Mateo P. Farina and Eric Klopack and Debra Umberson and Eileen Crimmins} } @article {TAMARGO202442, title = {High-Impact Pain and Epigenetic Aging: Findings from the Health and Retirement Study}, journal = {The Journal of Pain}, volume = {25}, year = {2024}, pages = {42}, abstract = {High-impact chronic pain (i.e., pain that interferes with activities and function) is a leading cause of disability disproportionately affecting middle-aged and older adults in the United States. Epigenetic aging, a proxy of biological aging measured via DNA methylation (DNAm) clocks, may help provide valuable insights into mechanisms at the intersection of chronic pain and aging. We examined the association between pain impact and epigenetic aging in a nationally representative sample of U.S. adults >=50 years old. Cross-sectional data from the 2016 Health and Retirement Study was used to evaluate associations between pain impact (no pain, low-impact pain, high-impact pain) and 13 first, second and third generation epigenetic clocks (Bocklandt, Garagnani, Horvath DNAmAge, Hannum, Weidner, Lin, Vidal-Bralo, Yang epiTOC, Zhang, PhenoAge, Skin\&Blood, GrimAge, and DunedinPoAm). The sample consisted of 3,855 adults with data on pain impact, epigenetic clocks, and sampling weights. As compared to no pain controls (n=2,242, 59.8\%), individuals reporting high-impact pain (n=1,023, 25.8\%) showed accelerated epigenetic aging (Zhang, PhenoAge, GrimAge, and DunedinPoAm), adjusted for demographic and lifestyle factors (Bonferroni adjusted p{\textquoteright}s<0.05). Additionally, individuals with high-impact pain showed accelerated GrimAge compared to low-impact pain. There were no significant differences in any of the 13 epigenetic clocks between individuals reporting low-impact pain and no pain controls. Our findings support accelerated epigenetic aging in middle-to-older-aged adults with high-impact chronic pain in the U.S. population. Further research is needed to assess the potentially bidirectional relationship between high-impact pain and biological aging processes across the lifespan. Funded by the National Institute on Aging (T32AG049673).}, keywords = {Disability, Epigenetic aging, Older Adults, pain}, issn = {1526-5900}, doi = {https://doi.org/10.1016/j.jpain.2024.01.197}, author = {Javier A. Tamargo and Larissa J. Strath and Yenisel Cruz-Almeida} } @article {CHEN2024, title = {Inter-relationships of depression and insomnia symptoms with life satisfaction in stroke and stroke-free older adults: Findings from the Health and Retirement Study based on network analysis and propensity score matching}, journal = {Journal of Affective Disorders}, year = {2024}, abstract = {Background Depression and insomnia are common co-occurring psychiatric problems among older adults who have had strokes. Nevertheless, symptom-level relationships between these disorders remain unclear. Objectives In this study, we compared inter-relationships of depression and insomnia symptoms with life satisfaction among older stroke patients and stroke-free peers in the United States. Methods The study included 1026 older adults with a history of stroke and 3074 matched controls. Data were derived from the US Health and Retirement Study. Depression, insomnia and life satisfaction were assessed. Propensity score matching was employed to identify demographically-similar groups of stroke patients and controls. Central and bridge symptoms were assessed using Expected influence (EI) and bridge EI, respectively. Results The prevalence of depression in the stroke group (25.0 \%) was higher than that of controls (14.3 \%, P < 0.001). In stroke group, {\textquotedblleft}Feeling depressed{\textquotedblright} (CESD1; EI: 5.80), {\textquotedblleft}Feeling sad{\textquotedblright} (CESD7; EI: 4.67) and {\textquotedblleft}Not enjoying life{\textquotedblright} (CESD6; EI: 4.51) were the most central symptoms, while {\textquotedblleft}Not feel rested in the morning{\textquotedblright} (JSS4; BEI: 1.60), {\textquotedblleft}Everything was an effort{\textquotedblright} (CESD2; BEI: 1.21) and {\textquotedblleft}Waking up during the night{\textquotedblright} (JSS2; BEI: 0.98) were key bridge symptoms. In controls, the most central symptoms were {\textquotedblleft}Lack of happiness{\textquotedblright} (CESD4; EI: 6.45), {\textquotedblleft}Feeling depressed{\textquotedblright} (CESD1; EI: 6.17), and {\textquotedblleft}Feeling sad{\textquotedblright} (CESD7; EI: 6.12). Furthermore, {\textquotedblleft}Feeling tired in the morning{\textquotedblright} (JSS4; BEI: 1.93), {\textquotedblleft}Everything was an effort{\textquotedblright} (CESD2; BEI: 1.30), and {\textquotedblleft}Waking up too early{\textquotedblright} (JSS3; BEI: 1.12) were key bridge symptoms. Life satisfaction had the most direct associations with {\textquotedblleft}Not enjoying life{\textquotedblright} (CESD6) and {\textquotedblleft}Feeling lonely{\textquotedblright} (CESD5) in the two groups, respectively. Conclusion Older adults with stroke exhibited more severe depression and insomnia symptoms. Interventions targeting central and bridge symptoms may help to mitigate the co-occurrence of these symptoms.}, keywords = {depression, insomnia, Life Satisfaction, Network analysis, Older Adults, Stroke}, issn = {0165-0327}, doi = {https://doi.org/10.1016/j.jad.2024.04.036}, author = {Pan Chen and He-Li Sun and Ling Zhang and Yuan Feng and Sha Sha and Zhaohui Su and Teris Cheung and Katrine K. Wong and Gabor S. Ungvari and Todd Jackson and Qinge Zhang and Yu-Tao Xiang} } @article {Rene101156, title = {Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis}, journal = {General Psychiatry}, volume = {37}, year = {2024}, abstract = {Background Depressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function, their developmental trajectories and the associations with all-cause dementia, Alzheimer{\textquoteright}s disease (AD) and all-cause death in older adults.Methods Data were from the Health and Retirement Study. Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status, respectively. All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses. All-cause death was determined by interviews. The restricted cubic spline, group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found, especially in women (p for interaction \<0.05). Independent trajectory analysis showed that emerging or high (vs no) depressive trajectories and poor or rapidly decreased cognitive trajectories (vs very good) from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia, AD and all-cause death. 15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined, where rapidly decreased cognitive function was more common in those with no depressive symptoms. Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function, those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death, with subdistribution hazard ratios (95\% confidence intervals) of 4.47 (2.99 to 6.67) and 1.84 (1.43 to 2.36), especially in women.Conclusions To effectively mitigate the risk of dementia and death, it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms, particularly in women.Data are available upon reasonable request.}, keywords = {Cognitive decline, Dementia, Depressive symptoms, Older Adults}, doi = {10.1136/gpsych-2023-101156}, author = {Ziyang Ren and Lirong Nie and Yushan Du and Jufen Liu} } @article {13631, title = {Involuntary delayed retirement and mental health of older adults.}, journal = {Aging \& mental health}, volume = {28}, year = {2024}, pages = {169-177}, abstract = {

OBJECTIVE: This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (>= 65 years) in the USA.

METHODS: Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95\% confidence intervals (CIs).

RESULTS: Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age.

CONCLUSION: The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.

}, keywords = {Great Recession, involuntary delayed retirement, Mental Health, Older Adults}, issn = {1364-6915}, doi = {10.1080/13607863.2023.2230927}, author = {Raihan, Mohammad M H and Chowdhury, Nashit and Chowdhury, Mohammad Z I and Turin, Tanvir C} } @article {geriatrics9020049, title = {Qualities of Older Adults{\textquoteright} Family and Friendship Relationships and Their Association with Life Satisfaction}, journal = {Geriatrics}, volume = {9}, year = {2024}, pages = {49}, abstract = {While family and friendship relationship qualities are associated with life satisfaction, evidence on how these types of relationships interact to contribute to older adults{\textquoteright} life satisfaction is sparse. This study examined how family and friendship relationship qualities may be supportive of (compensatory) or conflict with (competing) older adults{\textquoteright} life satisfaction. We adopted a cross-sectional design to analyze data from the Health and Retirement Study (n = 1178, females = 54.8\%, mean age = 67.9 years, SD = 9.3 years) to examine compensatory (as in social support) and competing (as in social strain) qualities of family and friendship social relationships and their association with life satisfaction in older adults. For greater explanatory power, we also controlled for life satisfaction by sociodemographic variables of age, gender, education, self-reported general health, physical health and activity, depression, and personality traits. Our findings indicate that the spouse/partner support relationship contributes to older adults{\textquoteright} life satisfaction overall and is associated with greater social support and less social strain. Friendship support is associated with improved life satisfaction for older adults reporting spouse/partner strain. Relationship support for the life satisfaction of older adults should consider their need for social support from their social network while minimizing the risk of social strain from adversarial relationships in life situations.}, keywords = {family relationship quality, friendship quality, interaction, Life Satisfaction, Older Adults}, issn = {2308-3417}, doi = {10.3390/geriatrics9020049}, author = {Mpofu, Elias and Zhan, Rong-Fang and Yin, Cheng and Brock, Kaye} } @article {https://doi.org/10.1111/jomf.12963, title = {Racial/ethnic differences in living arrangements, distant relations, and later-life mental health}, journal = {Journal of Marriage and Family}, year = {2024}, abstract = {Abstract Objective This research investigates associations between living arrangements and older adults{\textquoteright} depressive symptoms and whether these associations are moderated by extended family, friends, and neighborhoods for White, Black, and Hispanic older adults. Background The drastic marriage and kinship decline since the 1970s has raised growing concerns about aging alone in both the public and scholarship. This paper adopts critical race theory to examine the social convoy model which argues that distant networks will fill in to protect individuals from stressors in the absence of proximal relations. Methods This paper applies multilevel mixed-effects linear models to 2006{\textendash}2018 waves of Health and Retirement Study (N = 44,304 obs., with 32,599 White, 7028 Black, and 4677 Hispanics). Results While married couples living alone have the best mental health among Whites, co-residing with both spouses/partners and children (the intergenerational coresidence) is associated with the lowest depressive symptoms for Black and Hispanic older adults. Moreover, strong social support from extended family and friends and a high level of neighborhood social cohesion can significantly mitigate increased depressive symptoms associated with living alone or with others only (people other than spouses/partners and children) for Whites, but not for Blacks and Hispanics. Conclusion This research challenges the paradigm that considers {\textquotedblleft}married couples living alone{\textquotedblright} as a normalized family structure. It also emphasizes the {\textquotedblleft}double plight{\textquotedblright} of Black and Hispanic older adults, who show both a disproportionate decline in family ties and a lack of supportive distant relations serving as buffer zones in the absence of spouses and children.}, keywords = {Family Relations, friendship, Mental Health, Neighborhoods, Older Adults, race}, doi = {https://doi.org/10.1111/jomf.12963}, author = {Liu, Jingwen} } @mastersthesis {13731, title = {Using the Self-Regulation Model to Understand Factors Influencing Medication Adherence Among Older Adults Living with Hypertension in the United States Utilizing the Health and Retirement Study Data}, volume = {Doctor of Philosophy}, year = {2024}, pages = {181}, school = {Case Western Reserve University}, address = {Cleveland, Ohio}, abstract = {The study investigates the multifaceted landscape of medication adherence and its intricate ties to health outcomes among older adults living with hypertension in the United States. Employing the Self-Regulation Model (SRM) as a guiding framework, this research delves into the interplay between psychological, demographic, and health-related factors, shedding light on their collective influence on adherence behavior and its consequential impact on blood pressure control, stroke risk, and activities of daily living (ADL). The research reveals significant correlations between psychological perceptions and medication adherence, aligning with the SRM{\textquoteright}s emphasis on beliefs and attitudes as key determinants of health-related behaviors. Older adults exhibiting positive perceptions of hypertension demonstrated heightened medication adherence, suggesting that viewing hypertension positively fosters a greater commitment to medication regimens as a fundamental self-management strategy. Furthermore, the study uncovers a substantial link between depression and medication non-adherence, underscoring the significance of addressing mental health concerns to improve adherence rates. The impact of medication adherence on health outcomes becomes evident in its correlation with blood pressure control and ADL performance. Adherence to antihypertensive medication emerges as a key determinant of systolic blood pressure levels, emphasizing the pivotal role of consistent adherence in optimizing cardiovascular health. Additionally, medication adherence is linked to enhanced ADL performance, showcasing its broader influence on functional independence and overall well-being. Notably, the study unveils an intriguing aspect of medication tolerability, revealing its potential influence on stroke incidence. Older adults reporting minimal medication side effects demonstrated a lower likelihood of stroke, illustrating the importance of medication tolerability in sustaining adherence and subsequently reducing stroke risk. By examining the mediating role of medication adherence, this research demonstrates how psychological factors like emotional and psychiatric problems influence health outcomes. The study reveals that depression{\textquoteright}s impact on ADL impairment is partially mediated by medication adherence, highlighting the role of adherence in translating psychological well-being into functional outcomes. The findings contribute to a holistic understanding of the diverse factors shaping adherence behavior and offer insights for tailored interventions aimed at optimizing medication adherence, addressing mental health concerns, and enhancing overall well-being in this vulnerable population.}, keywords = {demographic aspect, hyperextension, Medication, Older Adults, Psychological}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=case1701952672637902}, author = {Ruksakulpiwat, Suebsarn} } @article {13422, title = {Association between perceived risk of Alzheimer{\textquoteright}s disease and related dementias and cognitive function among U.S. older adults.}, journal = {Arch Gerontol Geriatr}, volume = {115}, year = {2023}, pages = {105126}, abstract = {

INTRODUCTION: The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer{\textquoteright}s disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function.

METHODS: We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7{\textquoteright}s test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range~=~0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0\% probability), "unlikely" (1-49\%), "uncertain" (50\%), and "more than likely" (>50-100\%). Additional baseline measures included participants{\textquoteright} sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization.

RESULTS: Of 1457 respondents (median age 74 [IQR~=~69-80] and 59.8\% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (β~=~-2.10, P~<~0.001) and "definitely not" (β~=~-1.50, P~<~0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status.

CONCLUSIONS: Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals{\textquoteright} perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.

}, keywords = {Alzheimer{\textquoteright}s disease, cognitive function, Dementia, Older Adults, United States}, issn = {1872-6976}, doi = {10.1016/j.archger.2023.105126}, author = {Wang, Nan and Xu, Hanzhang and West, Jessica S and {\O}stbye, Truls and Wu, Bei and Xian, Ying and Dupre, Matthew E} } @article {13171, title = {Associations between diagnosis with stroke, comorbidities, and activity of daily living among older adults in the United State}, year = {2023}, abstract = {Background Stroke is the leading cause of mortality. This study aimed to investigate the association between stroke, comorbidities, and activity of daily living (ADL) among older adults in the United States. Methods Participants were 1165 older adults aged 60 and older from two waves (2016 and 2018) of the Health and Retirement Study who had a stroke. Descriptive statistics were used to describe demographic information and comorbidities. Logistic regressions and multiple regression analyses were used to determine associations between stroke, comorbidities, and ADL. Results The mean age was 75.32 {\textpm} 9.5 years, and 55.6\% were female. An adjusted analysis shows that older stroke adults living with diabetes as comorbidity are significantly associated with difficulty in dressing, walking, bedding, and toileting. Moreover, depression was significantly associated with difficulty in dressing, walking, bathing, eating, and bedding. At the same time, heart conditions and hypertension as comorbidity were rarely associated with difficulty in ADL. After adjusting for age and sex, heart condition and depression are significantly associated with seeing a doctor for stroke (odds ratio [OR]: 0.66; 95\% confidence interval [CI]: 0.49{\textendash}0.91; p = 0.01) and stroke therapy (OR: 0.46; 95\% CI: 0.25{\textendash}0.84; p = 0.01). Finally, stroke problem (unstandardized β [B] = 0.58, p = 0.017) and stroke therapy (B = 1.42, p < 0.001) significantly predict a lower level of independence. Conclusion This study could benefit healthcare professionals in developing further interventions to improve older stroke adults{\textquoteright} lives, especially those with a high level of dependence.}, keywords = {Older Adults, Stroke, United States}, doi = { https://doi.org/10.1002/cdt3.60}, author = {Suebsarn Ruksakulpiwat and Wendie Zhou and Lalipat Phianhasin and Chitchanok Benjasirisan and Saeideh Salehizadeh and Limin Wang and Joachim G. Voss} } @mastersthesis {13476, title = {Cognitively Stimulating Leisure Activities, Emotional Health, and Cognitive Functions Among Older Adults with Mild Cognitive Impairment: A Longitudinal Analysis}, year = {2023}, pages = {89}, type = {phd}, abstract = {Objectives: The purpose of this study was to investigate the longitudinal relationship between different levels of Cognitively Stimulating Leisure Activity (CSLA) participation and emotional health and cognitive function among older adults with Mild Cognitive Impairment (MCI). Methods: The current study employed the Health and Retirement Study (HRS) data from 2012 to 2020 (n = 5,932). Three cognitive function tests based on Montreal Cognitive Assessment (MoCA) were used to assess three domains of cognition (i.e., memory, working memory, attention and processing speed) and screen whether the respondents have MCI. Using a Repeated-Measured Multivariate Analysis of Covariance (RM-MANCOVA), this study investigated (a) group mean differences in the positive and negative affect and (b) group mean differences in three cognitive functions in three CSLA groups (low, mid, and high participation).Results: (a) The high CSLA group showed higher positive affect and lower negative affect than the mid and low groups. Also, the mid-CSLA group presented higher positive affect and lower negative affect than the low CSLA group. (b) Both positive and negative affect showed significant differences between years and indicated a continuously declining slope year by year without exceptions. (c) The high CSLA group not only presented higher positive affect and lower negative affect during the period but also solely showed a rebounding feature in the declining slope on both emotions. (d) The high CSLA group indicated higher memory, working memory, and attention and processing speed than the mid and low groups. The mid-CSLA group showed higher working memory and attention and processing speed than the low CSLA group but not in working memory. (e) All three cognitive functions displayed significant differences between years and display a declining slope but the differences between the year 2014 and other years are not significant. (f) The high CSLA group always exhibited higher cognitive functions during the period and maintained a similar level of cognitive functions compared to the other groups. Discussion: The findings of this study provide valuable support for the design and implementation of CSLA participation programs and clinical guidelines for older adults with MCI. The results highlight the importance of determining the optimal level of CSLA engagement that is required to promote emotional health and cognitive function in this population. By incorporating the findings of this study into clinical guidelines, healthcare providers are able to offer an optimal level of CSLA programs offered at least four to three times a week. Further, efforts should be made to create strategies to overcome the barriers to CSLA participation, such as caregiver support and financial constraints, by establishing public care services, subsidies, and community support networks. These implications will contribute to the promotion of cognitive function and the potential prevention of dementia in older adults with MCI, and enhance their overall well-being and quality of life.}, keywords = {0347:Mental health, 0351:Gerontology, 0573:Public health, cognitive functions, cognitive impairment, Emotional Health, Gerontology, Leisure activities, Mental Health, Older Adults, Public Health}, isbn = {9798380122030}, url = {https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/cognitively-stimulating-leisure-activities/docview/2852386350/se-2}, author = {Lee,Jungjoo} } @article {13231, title = {Depression trajectories, genetic risk, and cognitive performance in older adults: multilevel model with a 10-year longitudinal cohort.}, journal = {Gerontology}, year = {2023}, abstract = {

BACKGROUND: Cognitive performance in older ages is strongly affected by individuals{\textquoteright} genetic predispositions. We investigated whether depression trajectories were associated with subsequent cognitive performance independent of participants{\textquoteright} genetic predispositions.

METHODS: Participants from the Health and Retirement Study with European ancestry and aged over 50 were included in the analysis. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale, and the 6-year trajectories were fitted using latent class linear mixed models. Linear multilevel regression was applied to model the associations between depression trajectory and subsequent cognitive performance. Stratified analyses were performed to investigate these associations in participants with different genetic predispositions of cognitive performance and APOE ε4 allelic status.

RESULTS: A total of 5942 eligible participants were included in the study. Four depression trajectories were identified. Compared with the non-depression trajectory, all other depression trajectories were associated with worse cognitive performance (β [95\% CI]: mild-depression trajectory: -0.20 [-0.56, -0.06], p = 0.007; worsening-depression trajectory: -0.29 [-0.47, -0.12], p = 0.001; persistent-depression trajectory: -0.32 [-0.53, -0.13], p = 0.001). Although these associations were independent of participants{\textquoteright} inherent genetic risk, the participants with a low polygenetic score for cognitive performance were more likely to have an enhanced association between depression trajectories and cognitive decline. Similar relationships were also found in APOE ε4 noncarriers.

CONCLUSION: Among older participants with European ancestry, even a mild-depression trajectory was associated with worse cognitive performance. Early intervention in participants with any degree of depression might benefit regarding preventing cognitive performance decline.

}, keywords = {depression, genetic risk, Older Adults}, issn = {1423-0003}, doi = {10.1159/000530200}, author = {Liu, Zheran and Su, Yonglin and Huang, Rendong and Li, Ruidan and Wei, Zhigong and He, Ling and Pei, Yiyan and Min, Yu and Hu, Xiaolin and Peng, Xingchen} } @article {13411, title = {Effects of California{\textquoteright}s Paid Family Leave Law on Caregiving by Older Adults.}, journal = {J Aging Soc Policy}, year = {2023}, pages = {1-18}, abstract = {

In 2004, California became the first state to require that employers provide paid family leave (PFL) to their employees. This paper examines the effect of California{\textquoteright}s PFL law on time spent caregiving to parents and to grandchildren by older adults aged 50-79. To identify the effect of the law, the paper uses the 1998-2016 waves of the Health and Retirement Study and a difference-in-differences approach comparing outcomes in California to other states before and after the implementation of the law. Results suggest that the law induced a switch in caregiving behavior with older adults spending less time caring for grandchildren and more time helping parents. Focusing on women, results further suggest that PFL affected older adults both through their own leave-taking and through reallocations of their caregiving time in response to leave-taking by new parents. The findings motivate thinking more broadly when calculating the costs and benefits of PFL policies; to the extent that California{\textquoteright}s PFL law enabled older adults to provide more care for their parents they otherwise would not have received, such an outcome represents an indirect benefit of the policy.

}, keywords = {California, Caregiving, Older Adults}, issn = {1545-0821}, doi = {10.1080/08959420.2023.2226283}, author = {Abramowitz, Joelle and Dillender, Marcus} } @article {13219, title = {Frequency and implications of coexistent manifestations of serious illness in older adults with dementia.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: In older adults, serious illness comprises three manifestations: dementia, activity of daily living (ADL) impairment, and other advanced medical conditions (AMC; e.g., end-stage renal disease). Little is known about how dementia and other manifestations of serious illness co-occur. We aim to describe the prevalence of persons with dementia (PWD) who are living with additional manifestations of serious illness, and the implications on healthcare utilization, Medicare costs, caregiving hours and out-of-pocket expenses.

METHODS: In this cross-sectional study, we use data from the 2016 Health and Retirement Study (HRS) linked to Medicare fee-for-service claims. We limited inclusion to adults >65 years. Dementia was determined using validated methodology that incorporates functional and cognitive test scores from HRS. We classified PWD as having dementia alone, dementia and an AMC (irrespective of ADL impairment) or dementia and ADL impairment (without an AMC). Healthcare utilization and Medicare costs were measured in claims, caregiving hours and out-of-pocket expenses were self-reported.

RESULTS: Most PWD (67\%) met criteria for another manifestation of serious illness (24\% advanced medical condition, 44\% ADL impairment). PWD and an AMC had the highest proportion of hospital use and the highest median total Medicare costs ($17,900 vs. $8962 dementia + ADL impairment vs. $4376 dementia alone). Mean total hours of caregiving per month were similar for PWD and an AMC and PWD and ADL impairment (142.9 and 141.9~h, respectively), while mean hours were much lower for PWD alone (47.7~h). Median out-of-pocket costs were highest for PWD and ADL impairment ($13,261) followed by PWD and an AMC ($10,837) and PWD alone ($7017).

CONCLUSIONS: PWD commonly face another manifestation of serious illness. Dementia and ADL impairment was associated with the highest costs for PWD and families while dementia and an AMC was associated with the highest costs for Medicare.

}, keywords = {Dementia, Older Adults, serious illness}, issn = {1532-5415}, doi = {10.1111/jgs.18309}, author = {Nothelle, Stephanie and Bollens-Lund, Evan and Covinsky, Kenneth E and Kelley, Amy} } @article {13440, title = {Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels.}, journal = {J Appl Gerontol}, year = {2023}, pages = {7334648231191667}, abstract = {

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51~years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8\% had normal cognition, and 22\% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP measure was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

}, keywords = {Advance care planning, cognitive levels, Healthcare, Older Adults}, issn = {1552-4523}, doi = {10.1177/07334648231191667}, author = {Rahemi, Zahra and Malatyali, Ayse and Bacsu, Juanita-Dawne R and Sefcik, Justine S and Petrovsky, Darina V and Baker, Zachary G and Ma, Kris Pui Kwan and Smith, Matthew L and Adams, Swann A} } @article {13237, title = {How Medicaid Financial Eligibility Rules Exclude Financially and Medically Vulnerable Older Adults.}, journal = {J Aging Soc Policy}, year = {2023}, pages = {1-16}, abstract = {

Millions of older Americans rely on Medicaid because it is the largest payer of long-term services and supports. To qualify for the program, low-income individuals age 65 and over must meet income standards based on the dated Federal Poverty Level as well as asset tests that are often viewed as quite stringent. There has long been concern that current eligibility standards exclude many adults with significant health and financial vulnerabilities. We use updated household socio-demographic and financial information to simulate the impacts of five alternative financial eligibility standards on the number and profile of older adults that would gain Medicaid coverage. The study clearly demonstrates that a large number of financially- and health-vulnerable older adults are excluded from the Medicaid program under current policy. The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them.

}, keywords = {Finances, Medicaid, Older Adults}, issn = {1545-0821}, doi = {10.1080/08959420.2023.2195784}, author = {Cohen, Marc A and Tavares, Jane} } @article {13621, title = {Identifying the Relationships between Types of Leisure Activities and Cognitive Functions in Older Adults}, journal = {American Journal of Health Behavior}, volume = {47}, year = {2023}, pages = {650 {\textendash} 659}, abstract = {Objectives: We investigated the relationship between types of leisure-time physical activity (LTPA) activities, intellectually stimulating activities, and community-based activities and the cognitive functions of older adults. Methods: We extracted 3,767 samples from the 2020 Health and Retirement Study (N=15,723). We defined cognitive functions as: (1) memory as assessed by both immediate and delayed recall tests, (2) working memory measured by a subtraction-by-7 test, and (3) attention and processing speed assessment through the use of the counting backward test. We used hierarchical regression analysis to assess the relationships between types of leisure and cognitive functions. Results: LTPA, intellectual leisure, and community-based leisure were significantly associated with improved memory function. Intellectual activity was significantly associated with improved working memory, and improved attention and processing speed. Conclusion: These findings provide data-based implications for the design and implementation of various types of leisure activities for older adults by healthcare providers and therapists. {\textcopyright} 2023 PNG Publications. All rights reserved.}, keywords = {cognitive functions, healthy aging, Leisure activities, Older Adults, Successful aging}, doi = {10.5993/AJHB.47.4.2}, author = {Kim, Junhyoung and Lee, Jungjoo and Rodriguez, Miriam and Han, Areum and Ju, Hyo-Jin} } @article {doi:10.1177/0192513X221150988, title = {Interpersonal Discrimination and Relationship Quality among Married Mid-Life and Older Black Adults}, journal = {Journal of Family Issues}, year = {2023}, pages = {0192513X221150988}, abstract = {Theories of minority stress contagion suggest that the consequences of racial discrimination may extend beyond the individual to impact close others. We empirically test direct and spillover associations between racialized stress and marital support and strain among mid-life and older Black spouses. We use actor-partner interdependence models to analyze dyadic data from 280 different-sex, married Black couples from the 2014 and 2016 Health and Retirement Study who completed the psychosocial leave-behind module. We find significant actor effects for husbands{\textquoteright} racial discrimination on their own marital support and strain, while wives{\textquoteright} racial discrimination is positively associated with their own marital strain. We find no evidence of partner effects nor significant gender differences in the association between racial discrimination and marital quality. The findings highlight pathways by which racial discrimination affects the marriage quality of Black men and women in mid- to late-life.}, keywords = {Black adults, Interpersonal discrimination, Older Adults, relationship quality}, doi = {10.1177/0192513X221150988}, author = {Andrea K. Henderson and Jaclyn S. Wong and Adrianne Dues and Katrina M. Walsemann} } @article {13409, title = {Longitudinal impact of volunteering on the cognitive functioning of older adults: A secondary analysis from the US Health and Retirement Study.}, journal = {Int J Nurs Sci}, volume = {10}, year = {2023}, pages = {373-382}, abstract = {

OBJECTIVES: To examine the relationship of volunteering with cognitive activity, social activity, and physical activity among older adults and, ultimately, with later cognitive functioning across different time periods.

METHODS: We used individual responding to three waves of the US Health and Retirement Study panel data from 2008, 2012, and 2016 (~=~2,862). Self-reported questionnaires were used to assess annual volunteering frequency (non volunteering, volunteering <100~h and >=100~h), and an adapted version of the Telephone Interview for Cognitive Status (TICS) was used to assess memory, mental processing, knowledge, language, and orientation. A structural equation model was estimated to assess effects on cognitive functioning throughout waves.

RESULTS: Those participants that were part of volunteering activities in 2012 showed an increase between 2008 and 2012 in moderate physical activity (~=~0.19, ~<~0.001 for those volunteering less than 100~h and 0.21, ~<~0.001 for those volunteering at least 100~h), increase in social activity ( 0.10, 0.052 for those volunteering less than 100~h and 0.12, 0.018 for those volunteering at least 100~h) and increase in higher cognitive activity ( 0.13, ~<~0.001 for those volunteering at least 100~h), compared to participants who did not volunteer. Higher levels of cognitive activity in 2008 and 2012 were associated with higher cognitive functioning on the following waves (~0.66 and 0.60, ~<~0.001, respectively).

DISCUSSION: Volunteering is a modifiable activity that can be increased to bolster cognitive functioning in older adulthood, primarily mediated by increased cognitive activity.

}, keywords = {cognitive functioning, Older Adults, Volunteering}, issn = {2352-0132}, doi = {10.1016/j.ijnss.2023.06.018}, author = {Villalonga-Olives, Ester and Majercak, Kayleigh R and Almansa, Josue and Khambaty, Tasneem} } @article {13228, title = {Older adult loneliness on the rise around the world}, journal = {IUSSP{\textquoteright}s online news magazine}, year = {2023}, keywords = {Loneliness, Older Adults}, url = {https://www.niussp.org/individual-and-population-ageing/older-adult-loneliness-on-the-rise-around-the-world/$\#$:~:text=Expected\%20demographic\%20changes\%20imply\%20massive,to\%20333\%20million\%20in\%202050.}, author = {Lauren Newmyer and Ashton M. Verdery and Haowei Wang and Rachel Margolis} } @article {13175, title = {Physical Disability, Psychological Resilience and COVID-related Changes in Depressive Symptoms among U.S. Older Adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, month = {2023 Feb 21}, abstract = {

OBJECTIVES: This study pursued three goals: (1) to determine how depressive symptoms among U.S. older adults changed in 2018-2020, a period transitioning to the first wave of COVID pandemic, compared to in pre-pandemic periods, (2) to determine whether physical disability predicts change in depressive symptoms in 2018-2020, and (3) to assess whether psychological resilience moderates the association between physical disability and change in depressive symptoms in 2018-2020.

METHODS: Based on biennial longitudinal data of the Health and Retirement Study from 2010 to 2020, we used a before-after design and latent change score model to examine whether depressive symptoms change in 2018-2020 represents a continuation or departure from the overall trend of between-wave changes in 2010-2018. We also used physical disability in 2018 and psychological resilience in 2016-2018 to predict depressive symptoms change score in 2018-2020.

RESULTS: In contrast to the relatively stable between-wave change trend in 2010-2018, there was an abrupt elevation in the latent change score of depressive symptoms in 2018-2020, which was primarily driven by increased affective symptoms (e.g., depressed mood, loneliness, unhappiness, and sadness). Increase in depressive symptoms in 2018-2020 was associated positively with physical disability but negatively with psychological resilience. Moderation effect of psychological resilience, however, was not significant.

DISCUSSION: Our findings reveal heavier COVID-related mental health burden for older adults with physical disabilities and the potential benefits of enhancing individual psychological resilience. They also suggest that health interventions addressing the COVID impacts need to particularly focus on the affective aspects of depressive symptoms.

}, keywords = {COVID-19, Depressive symptoms, Older Adults, Physical disability, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbad025}, author = {Li, Miao and Luo, Ye} } @article {13197, title = {Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data.}, journal = {Arch Phys Med Rehabil}, year = {2023}, abstract = {

OBJECTIVE: To determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Older adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9\% women).

MAIN OUTCOME MEASURE: Physical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used.

RESULTS: Positive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5\%, P=.004). This mediation effect was fully driven by those with previous falls.

CONCLUSION: Positive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

}, keywords = {Aging, Older Adults, physical resilience}, issn = {1532-821X}, doi = {10.1016/j.apmr.2023.02.006}, author = {Zhang, Zeyi and Wang, Jingjing and Ma, Bin and Wang, Jingyi and Jia, Yuanmin and Chen, Ou} } @article {13078, title = {Risk Factors Associated with Falls in Older Adults with Dementia and Alzheimer{\textquoteright}s Diseases among Older Adults in the United States.}, journal = {medRxiv}, year = {2023}, abstract = {

OBJECTIVE: This study aimed to examine the risk of fall, fall injury, and fall numbers among older adults with dementia and Alzheimer diseases. Additionally, this study explored the relationship of falls by medication use of neurodegenerative diseases.

METHODS: The survey data from the years 2020 of Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS) was used. The HRS CAMS includes information of demographic characteristics, fall information, and medical background including dementia and Alzheimer diseases, and medication record. A regression model was used to test whether neurodegenerative diseases and medications was associated with fall risk factors.

RESULTS: The sample (n = 8782) was predominately female (54.7\%) and white (60.7\%) with a mean age of 70.4 years. When controlled for covariates, the findings show 10 percent higher risk of fall for elderly people with dementia and Alzheimer. People with dementia were 9\% more likely to have higher risk of injury by fall and those with dementia and Alzheimer{\textquoteright}s had more than 7 times of higher chance of a higher number of falls. Using Alzheimer{\textquoteright}s prescription was associated with lower 90\% lower risk of fall than controls.

CONCLUSIONS: Dementia and Alzheimer diseases are significant risk factor for falls in older adults. This study suggests that older adults with neurodegenerative diseases have higher risk, and needs more regular medical checkups to decrease the risk of fall.

}, keywords = {Alzheimer{\textquoteright}s disease, Falls. dementia, Older Adults, Risk Factors}, doi = {10.1101/2023.01.10.23284411}, author = {Baniasadi, Tayebeh} } @article {13419, title = {Sociodemographic characteristics, lifestyle behaviors, and symptoms associated with fluid overload among non-hospitalized and community-dwelling older adults with heart failure: A population-based approach.}, journal = {Geriatr Nurs}, volume = {53}, year = {2023}, pages = {66-71}, abstract = {

BACKGROUND: Fluid overload is a major complication in patients with heart failure (HF) and the main reason for hospitalization. The purpose of the study was to explore the associations of fluid overload with sociodemographic characteristics, lifestyle behaviors, and symptoms among non-hospitalized and community-dwelling older adults with HF using large population data.

METHODS: Descriptive and multivariate analyses were conducted on the Health and Retirement Study 2016.

RESULTS: Fluid overload was prevalent in almost half of the sample. Female older adults with HF were more likely to have fluid overload (OR:1.43, p~=~0.037) as well as being Black (OR:1.40, p~=~0.041). Higher physical activity scores were associated with less likelihood of having fluid overload (OR:0.99, p~=~0.025). Symptoms of shortness of breath (OR=2.18, p~=~0.001), pain (OR=1.82, p~<~0.001), and fatigue (OR=1.45, p~=~0.025) were significantly associated with fluid overload.

CONCLUSION: Female and Black community-dwelling older adults with HF are at higher risk of fluid overload. Symptoms of shortness of breath, pain, and fatigue are significant manifestations of fluid overload. Effective patient-centered interventions to promote fluid flow via physical activity may help older adults with HF manage fluid overload and alleviate associated symptoms.

}, keywords = {fluid overload, Heart Failure, lifestyle behaviors, non-hospitalized, Older Adults, sociodemographic characteristics}, issn = {1528-3984}, doi = {10.1016/j.gerinurse.2023.06.017}, author = {Gharzeddine, Rida and Cypress, Brigette and Dahan, Thomas and Fu, Mei R} } @article {HSU2023e304, title = {Spousal Loneliness, Depression, and Closeness Among Older Adults Married to Persons with Dementia: A Nationally Representative Study (SA314B)}, journal = {Journal of Pain and Symptom Management}, volume = {65}, year = {2023}, pages = {e304-e305}, abstract = {Outcomes 1. Analyze the role of marriage in serious illness and dementia 2. Discuss interactive biopsychosocial model underlying marriage and health among older adults with serious illness, and key social measures 3. Describe the prevalence of loneliness, depression, or both among spouses married to persons with dementia 4. Discuss how one{\textquoteright}s partner{\textquoteright}s cognitive decline is associated with higher levels of loneliness and depression Background Older adults married to persons with dementia (PWD) may be at risk for loneliness and depression. However, it is unclear how often each occur and the extent to which they are distinct. Research objectives To determine the prevalence of loneliness and depression among older adults married to PWD or mild cognitive impairment (MCI) and the role of marital closeness in mediating these outcomes Methods We used a nationally representative sample of 3,666 married couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PWD (N=201), married to persons with MCI (N=778), or married to persons with normal cognition (N=2,687). We determined the prevalence of loneliness using multivariable logistic regression adjusting for socio-demographic characteristics, then tested for interaction between marital closeness and degree of spousal cognitive impairment. We assessed the prevalence of depression, and both loneliness and depression, using the same method. Results The sample was 54\% women and on average 67 years old (Range: 50{\textendash}97). After adjustment, older adults married to PWD were more likely to be lonely (Normal: 20\%, MCI: 21\%, PWD: 30\%; p=0.02), depressed (Normal: 7\%, MCI: 14\%, PWD: 16\%; p< 0.01), and both (Normal: 4\%, MCI: 8\%, PWD: 9\%; p< 0.01). The association between spousal cognition and loneliness differed by marital closeness (interaction p-value=0.01); among {\textquotedblleft}close{\textquotedblright} couples, spousal cognitive impairment was associated with higher likelihood of loneliness (p=0.01). In contrast, no association existed between spousal cognitive impairment and loneliness among {\textquotedblleft}not close{\textquotedblright} couples (p=0.24). Conclusion Nearly 1 in 3 spouses of PWD experienced loneliness and 1 in 6 experienced depression. The association between spousal cognition and loneliness was stronger among those with close marital bonds. Implications Findings highlight substantial opportunity to identify and address loneliness and depression among spouses of PWD with close relational bonds to improve quality of life.}, keywords = {closeness, depression, Loneliness, Older Adults}, issn = {0885-3924}, doi = {https://doi.org/10.1016/j.jpainsymman.2022.12.132}, author = {Kristie Hsu and Irena Cenzer and Krista Harrison and Christine Ritchie and Linda Waite and Linda Waite} } @article {13438, title = {Ten-year cross-sectional and longitudinal assessment and factors associated with unfavourable self-rated oral health in older adults in the United States.}, journal = {Gerodontology}, year = {2023}, abstract = {

OBJECTIVE: To investigate the association of demographic and socio-economic characteristics with self-reported oral health (SROH) among older adults who participated in the Health and Retirement Study (HRS) in 2008, 2018, or both, and to describe temporal changes.

METHODS: Data were from the University of Michigan{\textquoteright}s Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans aged 51 and older. Responses from participants who completed the Core HRS survey and Dental Module (DM) in 2008 (n = 1310), 2018 (n = 1330), and the "common group" at both timepoints (n = 559) were analysed. Using the common group, the outcome measure was 2018 self-rated oral health (Favourable vs Unfavourable). Potential explanatory variables included 2008 self-rated oral health (SROH), sociodemographic, and dental utilisation-related factors. Survey logistic regression analysis was used to identify factors that were associated with unfavourable 2018 SROH in 2018.

RESULTS: Unfavourable SROH prevalence was 28.5\% and 31.6\% in 2008 and 2018, respectively. Among the common, longitudinal group, the unfavourable prevalence remained the same, 26.1\% at both timepoints. A positive association was seen between 2018 unfavourable SROH and baseline variables of 2008 unfavourable SROH, male gender, less education, and lower levels of wealth.

CONCLUSIONS: Over a quarter of participants reported unfavourable SROH. There was little change in SROH during this period. Sociodemographic factors influence the SROH of the older population. Policies and programs to promote and protect the oral health of older adults should be designed and implemented to reduce social inequalities and improve the SROH of disadvantaged older adults.

}, keywords = {Older Adults, Oral Health, United States}, issn = {1741-2358}, doi = {10.1111/ger.12710}, author = {Tembhe, Amrita and Preisser, John S and Batorsky, Anna and Weintraub, Jane A} } @mastersthesis {13523, title = {Three Essays on Intergenerational Transfers}, volume = {Ph.D.}, year = {2023}, pages = {163}, school = {Syracuse University}, type = {phd}, address = {New York}, abstract = {Intergenerational transfers of money, time, and other resources are major drivers of wealth inequality in the United States (U.S.). Wealth confers a wide array of advantages, from financial security to social prestige, power, and health. Wealth also can be used to accumulate more wealth. Given that intergenerational transfers generate economic inequality, this three-essay dissertation will seek to examine the causes and consequences of intergenerational transfers in the U.S. The first two essays are devoted to the understanding of the precedents of intergenerational transfers, while the last essay assess the consequence of intergenerational transfers on mental health.Essay 1: Cumulative inequality theory (CIT) posits that disadvantage experienced in early life may not only adversely affect one{\textquoteright}s life course, it may also shape one{\textquoteright}s ability to provide assistance to the next generation. Since intergenerational exchanges can either promote or set back the next generation{\textquoteright}s success, this study therefore aims to determine how childhood disadvantages of parents are associated with the inter vivos downward transfers. Data from the Panel Study of Income Dynamics Childhood Retrospective Circumstances Survey and Rosters and Transfers Module were used to estimate linear regression models. Childhood experiences were measured in the following ways: an aggregate index, categorical variables, or as separate domains. Following CIT, domains included were economic, psychosocial (family, peer), environmental, and health. Downward transfers considered in this study were measured in terms of time transfers and money transfers in the past year, for aid in schooling, for home purchase, and for other purposes. Controlling for adult children{\textquoteright}s characteristics that reflect needs for parental assistance, and upward time and money transfers to account for reciprocity, the results indicate that parent{\textquoteright}s assistance to their adult children vary by their early-life experiences, and some childhood domains matter more (i.e., economic, family, environmental) than others (i.e., peer, health). Those with less affluent upbringing gave significantly more time transfers but less money to their adult children. Money earmarked for schooling purposes were at most $9,000 less for those with the worst level of childhood misfortunes. The forces that shape parental assistance to adult children, therefore, date as far back as the grandparent generation.Essay 2: Whether private intergenerational transfers crowd out or crowd in public welfare, have been subject to debate for almost half a century. Crowding out considers public and private transfers as substitutes, whereas when crowding in occurs the public sector frees up family{\textquoteright}s resources via social welfare provisions, allowing families to transfer resources amongst their members. Often, studies on this topic either use cross-country variation from different welfare regimes or average social welfare expenditure per capita, without consideration of the varied social welfare experiences among givers and receivers. This is the first study to document how parental financial transfers and time transfers in the form of grandchild care are associated with the relative welfare experiences of the parent (giver) and the adult child (beneficiary) by exploiting the heterogeneity of public welfare across U.S. states. Parent-child dyadic data come from the Health and Retirement Study (HRS), a longitudinal and nationally representative study of older adults in the U.S. I linked data from the HRS respondent file and the child-level file constructed by the RAND Corporation with state-specific public welfare expenditures per capita from the Government Finance Database. Controlling for parent, adult child, and reciprocity related determinants of downward transfers, mixed effects logistic regressions clustered by households showed that compared to dyads who both live in a state with low levels of welfare generosity: (1) dyads whose parents live in a less generous state compared to their children have lower odds of downward money and time transfers and (2) dyads whose parents live in a more generous state while the child lives in a relatively less generous states have lower odds of providing both money and time transfers. The results from this study provide partial support for both crowding out and crowding in while implying support for both altruistic and selfish transfer motives. These mixed results call for scholars to reevaluate the consensus of the crowding in hypothesis as the main explanation of downward transfers of money and time from aging parents to adult children, and suggest that better data on both givers{\textquoteright} and receivers{\textquoteright} public welfare experiences are needed to fully contextualize family transfers.Essay 3: Intergenerational transfers are potential social determinants of health, as multiple generations coexisting has become a commonplace in aging societies and austere social protections push families to support their members. This study therefore aims to assess the association between intergenerational transfers between parents, adult children, and other kin, and depressive symptoms among U.S. older adults aged 51+ using data from the Health and Retirement Study waves 2010-2018. Two subsamples were constructed to account for the effect of kin: (1) respondents with at least one adult child and deceased parents/ parents-in-law, and (2) respondents with at least one adult child and one living parent/ parent-in-law throughout the study period. Transfers were categorized as either giving or receiving money and time. Net of relevant sociodemographic factors, random effects logistic regression models revealed that for both subsamples, the odds of having high depressive symptoms were greater for those who have given money transfers. Receiving money transfers and time transfers were also found to be detrimental for mental health. The findings are consistent with the stress process model and also provide partial support for economic exchange theory and contingency exchange. Understanding the factors that are related to older adult well-being is vital as this age group is at risk of mental health decline due to the life course challenges that typically occur in advanced ages like social isolation, bereavement, as well as illnesses and functional limitations.}, keywords = {0347:Mental health, 0351:Gerontology, 0626:Sociology, 0938:Demography, childhood circumstances, Demography, depression, Gerontology, Intergenerational transfers, life course, Mental Health, Older Adults, Sociology, Transfer motives}, isbn = {9798380339124}, url = {https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/three-essays-on-intergenerational-transfers/docview/2864812703/se-2}, author = {Cheng,Kent J. G.} } @article {11777, title = {Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016.}, journal = {Journal of Gerontological Social Work}, volume = {65}, year = {2022}, pages = {241-251}, abstract = {

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68~years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51\% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52\% transient). Respondents who reported difficulty paying bills (68\%) and reduced medications due to cost (62\%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

}, keywords = {Financial hardship, Older Adults, Poverty, temporal trends}, issn = {1540-4048}, doi = {10.1080/01634372.2021.1953662}, author = {Gillian L Marshall and Bayaz-Ozturk, Gulgun and Eva Kahana and William T Gallo and Seghal, Ashwini} } @article {article, title = {HOUSEHOLD COMPOSITION AND THE RESILIENCE OF OLDER ADULTS AGING IN COMMUNITY DURING COVID-19}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, month = {12}, pages = {280-280}, abstract = {Household composition is associated with older residents{\textquoteright} access to resources. This research uses the pandemic period as a stress-test to detect differences in resilience between older adults who lived alone, with a partner, or with other co-residents. Using the Health and Retirement Study (HRS) from 2010 through 2018, we first developed a profile of pre-pandemic needs and resources for each household composition. Using the 2020 HRS survey wave, we then compared pandemicperiod experiences between the three household types. Older adults living in partner households had more economic resources prior to the pandemic and experienced the fewest disruptions to their finances and personal assistance compared with other types. Older adults living alone entered the pandemic with the least financial resources and personal assistance, particularly in the context of need. These residents also lost more assistance and experienced more loneliness during the pandemic. Co-resident households received the most informal personal care support, which remained relatively stable during the pandemic. They had more economic resources than singleperson households prior to the pandemic but experienced more pandemic-related financial hardships than other types. Household composition was systematically related to resilience during the pandemic, and Social Security policy might increase the capacity of older adults living alone to cope with large-scale disruptions.}, keywords = {Aging, household composition, Older Adults}, doi = {10.1093/geroni/igac059.1112}, author = {Scheckler, Samara and Molinsky, Jennifer and Herbert, Christopher} } @article {13148, title = {Sensory impairment and cognitive decline among older adults: An analysis of mediation and moderation effects of loneliness.}, journal = {Front Neurosci}, volume = {16}, year = {2022}, month = {2022}, pages = {1092297}, abstract = {

BACKGROUND: Multiple studies have reported that hearing and vision impairment are linked to cognitive decline. Yet little is known about factors that may influence the association between sensory impairment and cognitive decline. This study examined if loneliness mediates or moderates the impact of sensory impairment on cognitive decline as individuals age.

METHODS: This was a longitudinal study using data from the Health and Retirement Study (HRS) and The Aging, Demographics, and Memory Study (ADAMS) ( = 243). We used one timepoint of hearing and vision (ADAMS 2006-2008), one timepoint of loneliness (HRS 2006-2008), and five waves of cognition (HRS 2006-2014). Hearing impairment was defined by an inability to hear pure-tone stimuli of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Visual impairment was defined as having corrected binocular vision worse than 20/40. Longitudinal parallel-process (LPP) analysis was conducted at a significance level of α = 0.05 (one-tailed).

RESULTS: Loneliness moderated but did not mediate the association between visual impairment and the rate of cognitive decline (standardized β =-0.108, < 0.05). No moderation or mediation effect of loneliness was found for the association between hearing impairment and cognitive decline. Both vision and hearing impairment were significantly associated with increased severity of loneliness.

CONCLUSION: Visual impairment combined with an elevated level of loneliness may produce a more synergistic, deleterious impact on older adults{\textquoteright} cognitive function than visual impairment alone. This study highlights the importance of promoting a healthy social and psychological status for older adults with sensory impairment.

}, keywords = {Cognitive decline, Loneliness, Older Adults}, issn = {1662-4548}, doi = {10.3389/fnins.2022.1092297}, author = {Ge, Shaoqing and Pan, Wei and Wu, Bei and Plassman, Brenda L and Dong, XinQi and McConnell, Eleanor S} } @article {11554, title = {Biopsychosocial characteristics associated with engagement in art making among older adults.}, journal = {Geriatric Nursing}, volume = {42}, year = {2021}, pages = {727-733}, abstract = {

In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults{\textquoteright} characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.

}, keywords = {Art making, Holistic practice, Older Adults, Patient-centered intervention}, issn = {1528-3984}, doi = {10.1016/j.gerinurse.2021.03.011}, author = {Kim, Kyung Soo and Kristine L Kwekkeboom and Roberts, Tonya and Ward, Earlise} } @article {lu_shelley_liu_2020, title = {Government Transfers and Poverty Alleviation among Older Adults in the United States from 2002 to 2014}, journal = {Social Policy and Society}, volume = {20}, year = {2021}, pages = {561-579}, abstract = {Studies have indicated government transfers greatly alleviate poverty among older Americans. Yet recent social policy changes were suggested to increase older Americans{\textquoteright} fiscal insecurity. New evidence is needed to expand the evaluation of government transfers. Longitudinal Health and Retirement Study data from 2002 to 2014 were used. We computed individuals{\textquoteright} poverty status both when household income included and did not include government transfers. Results indicated the poverty rate dropped dramatically when household income included government transfers. The poverty alleviation effect was significantly greater among people who were female, older, members of a minority group, having fewer years of education, residing in the South, and living in a bigger household. Evidence from this study solidified the overall poverty alleviation effect of government transfers in old age. Differential effects among various demographic groups could be attributed to their initial status and divergent political beliefs about who should receive government transfers.}, keywords = {antipoverty policy, Government transfers, Older Adults}, doi = {10.1017/S147474642000041X}, author = {Lu, Peiyi and Shelley, Mack and Liu, Yi-Long} } @article {11034, title = {Intergenerational Ambivalence and Loneliness in Later Life}, journal = {Journal of Marriage and Family}, volume = {83}, year = {2021}, pages = {75-85}, abstract = {Abstract Objective This brief report examined the relationship between intergenerational ambivalence and loneliness in later life among a group of older adults with at least one child. Background Previous work has explored the links between intergenerational ambivalence and other indicators of well-being but has not examined loneliness. Although studies show an association between positive and negative relationship quality with children and loneliness, there are conflicting findings, and there is also insufficient exploration of the role of gender. Method Utilizing pooled data from the 2012 and 2014 waves of the Health and Retirement Study (HRS) (n = 10,967) ( https://hrs.isr.umich.edu/documentation), structural equation models were used to examine the hypothesized relationships, and multiple group analysis was utilized to assess potential gender differences. Results The results indicated that greater intergenerational ambivalence was associated with increased loneliness in later life. However, there were no significant gender or marital status differences in the relationships. Conclusion This study adds to the existing literature on ambivalence and well-being by showing that ambivalent relationships are related to loneliness. Results underscore the emotional complexity of parent?child relationships and suggest the need for investigating the consequences of holding contradictory feelings.}, keywords = {Aging, ambivalence, gender, intergenerational relationships, Older Adults}, isbn = {0022-2445}, doi = {https://doi.org/10.1111/jomf.12716}, author = {Cassandra L. Hua and J Scott Brown and Jennifer R. Bulanda} } @article {11017, title = {Longitudinal analysis of psychosocial stressors and body mass index in middle-aged and older adults in the United States.}, journal = {Journal of Gerontology: Series B }, volume = {76}, year = {2021}, pages = {1580-1589}, abstract = {

OBJECTIVE: Psychosocial stress may be a risk factor for obesity and overweight in middle-aged and older adults. However, research on psychosocial stress and excess body weight has typically been cross-sectional and focused on single stressors.

METHODS: Using three waves of data from the Health and Retirement Study, we conducted longitudinal analyses to assess associations between five psychosocial stressors-individually and in combination-and body mass index (BMI), adjusting for sociodemographic factors, alcohol use, and smoking history. We tested interaction effects between race and gender with stressors on BMI.

RESULTS: A total of 3,956 participants were included in the main analyses. Most participants were White (88.04\%) and more than half were female (60.39\%). Perceived discrimination, financial stress, and relationship stress were positively associated with BMI. A greater cumulative stress burden was associated with higher BMI. In stratified analyses, greater financial stress was associated with higher BMI among White participants, whereas greater neighborhood stress was associated with lower BMI among Black participants. Greater relationship stress, financial stress, cumulative high-stress, and overall cumulative stress burden were associated with higher BMI for women, but not men.

DISCUSSIONS: Different sources of stress may be risk factors to weight gain and impact BMI in adults. White and female adults may be more susceptible to the obesogenic effects of stressors. Reducing exposure to stress may help reduce the burden of high BMI among middle-aged and older adults.

}, keywords = {BMI, middle-aged, Older Adults, Psychosocial stress}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa142}, author = {Cuevas, Adolfo G and Greatorex-Voith, Siobhan and Shervin Assari and Slopen, Natalie and Economos, Christina D} } @article {11660, title = {Longitudinal Associations Between Physical Activity and Purpose in Life Among Older Adults: A Cross-Lagged Panel Analysis.}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {941-952}, abstract = {

The purpose of the current study was to examine the bidirectional relationship between physical activity (PA) and purpose in life in an older adult sample using longitudinal data. Data were collected from three waves (2006, 2010, and 2014) of the Health and Retirement Study. A total of 4591 participants who had complete information of PA and purpose in life at baseline were included in the current study. A series of cross-lagged models were tested separately for vigorous-intensity PA, moderate-intensity PA, and light-intensity PA. While higher levels of purpose in life were associated with more frequent engagement in future vigorous-intensity PA, moderate-intensity PA, and light-intensity PA, none of the PA variables predicted subsequent purpose in life. The results did not support a reciprocal relationship between PA and purpose in life in older adults. It is more likely that purpose in life predicts PA, rather than vice versa.

}, keywords = {meaning, Older Adults, Physical activity, purpose}, issn = {1552-6887}, doi = {10.1177/08982643211019508}, author = {Zhang, Zhanjia and Chen, Weiyun} } @article {11358, title = {Longitudinal effects of nocturnal insomnia symptom subtypes and nonrestorative sleep on the incidence of depression among community-dwelling older adults: Results from the Health and Retirement Study}, journal = {Sleep Medicine}, volume = {79}, year = {2021}, pages = {155-163}, abstract = {Objective The relationships between different insomnia symptom subtypes and the onset of depression among older adults are inconsistent. It may be that each subtype has a distinct temporal effect on depression not easily captured by the different follow-up intervals used in past studies. We systemically investigated the temporal effects by examining the links between subtypes and the onset of depression at different follow-up intervals among community-dwelling older adults. Methods We used the 2006 wave of the Health and Retirement Study as baseline (n=9,151). The outcome was the onset of depression at 2-year (2008 wave), 4-year (2010 wave), and 6-year (2012 wave) follow-ups. The independent variables were difficulty with falling asleep (initial insomnia), waking up during the night (middle insomnia), waking up too early and being unable to fall asleep again (late insomnia), and nonrestorative sleep at baseline. Factors known to be related to depression among older adults were included as covariates. Results Our findings showed that each insomnia symptom subtype had distinct temporal effects on the onset of depression. It appeared that the effects of initial insomnia may take longer to emerge than indicated in previous studies. Middle insomnia and late insomnia had weak relationships with depression. Nonrestorative sleep predicted the onset of depression at every follow-up period. Conclusions We found that documenting the temporal effects of insomnia symptom subtypes helps both to classify individuals{\textquoteright} insomnia symptoms and predict the onset of depression. We recommend taking temporal effects of insomnia symptom subtypes into account in future investigations and clinical practice.}, keywords = {depression, insomnia subtypes, Older Adults, temporal effects}, isbn = {1389-9457}, doi = {https://doi.org/10.1016/j.sleep.2021.01.003}, author = {Chen, Tuo-Yu and Saito, Yasuhiko} } @mastersthesis {11402, title = {MODERATION EFFECTS OF SPOUSAL INTERACTIONS ON THE RELATIONSHIP BETWEEN PAIN INTENSITY AND DEPRESSIVE SYMPTOMS IN OLDER ADULTS WITH PAIN}, volume = {Doctor of Philosophy}, year = {2021}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {This dissertation investigated the relationship between pain intensity and depressive symptoms for older married adults, and examined whether positive and negative spousal interactions buffered and/or exacerbated the impact of pain intensity on depressive symptoms. The stress process theory (Pearlin, 1989) and social interaction theories (Cohen \& Wills, 1985; Rook, 1984) provide the theoretical grounds for hypotheses in this dissertation. The sample consisted of 863 married adults with pain, age 60 and older, obtained from the Health and Retirement Study 2014 data. Hierarchical negative binomial regression models were applied. Results partially supported the relationship between pain intensity (i.e., mild, moderate, or severe pain) and depressive symptoms. The severe pain intensity group showed significantly higher depressive symptoms than the moderate pain group. There was no significant difference in depressive symptoms between the mild and moderate pain groups. Results also partially supported the exacerbating effects of negative spousal interactions (NSI). NSI increased the effect of pain intensity only when respondents reported mild or moderate pain. NSI did not exacerbate the relationship between severe pain intensity and depressive symptoms. This dissertation found inconsistent results about the buffering effect of positive spousal interactions (PSI). PSI buffered the relationship between pain intensity and number of depressive symptoms across all levels of pain intensity when moderating effects of NSI were not controlled. However, PSI was not a significant moderator when the moderating effects of NSI were controlled. Social workers need to educate other healthcare professionals about the necessity of adequate pain treatment, emphasizing that older adults with severe pain are at risk of having higher depressive symptoms. Pain management interventions need to be tailored for older adults with co-occurring severe pain and depressive symptoms. Interventions also need to integrate psychoeducational contents about negative spousal interactions with content about pain management for older adults with mild or moderate pain. The inconsistent results about the buffering effects of PSI suggest caution in a hasty conclusion that only NSI, not PSI, is a significant moderator. Future studies are needed to clarify the relationship between PSI and NSI and gain further insight into differences between pain intensity groups.}, keywords = {Depressive symptoms, Older Adults, pain, spousal interactions}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=case1599085431244253}, author = {Lee, Jeong Woo} } @article {ijerph18052661, title = {Perceived Neighborhood Characteristics and Cognitive Functioning among Diverse Older Adults: An Intersectional Approach}, journal = {International Journal of Environmental Research and Public Health}, volume = {18}, year = {2021}, pages = {1-14}, abstract = {Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults >=65 years old (n = 8023) in the 2010{\textendash}2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics{\textemdash}cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one{\textquoteright}s neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults.}, keywords = {cognitive functioning, Health Disparities, Intersectionality, Neighborhoods, Older Adults}, issn = {1660-4601}, doi = {10.3390/ijerph18052661}, author = {Amy D Thierry and Kyler J. Sherman-Wilkins and Armendariz, Marina and Allison R Sullivan and Heather R. Farmer} } @article {11318, title = {Prevalence and predictors of depressive symptoms in older adults with cancer.}, journal = {Journal of Geriatric Oncology}, volume = {12}, year = {2021}, pages = {618-622}, abstract = {

INTRODUCTION: Older adults with cancer are at risk of developing depressive symptoms. However, little is known about the prevalence and predictors of depressive symptoms in older adults with cancer.

MATERIALS AND METHODS: This study examined the prevalence and predictors of depressive symptoms among older adults with cancer in the United States using the data from the 2012 and 2014 wave of the Health and Retirement Study. This analysis included 1799 older adults aged 65 and over with a self-reported diagnosis of cancer. Multivariate regression analysis was used to examine the predictors of depressive symptoms. The main predictors included age, gender, race, education, marital status, chronic conditions, and functional limitations.

RESULTS: Results revealed that the prevalence of depressive symptoms in older adults with cancer was 14.9\%. Results of Poisson regression revealed that greater age, belonging to a race other than White or African American, not being married, presence of more chronic conditions, and higher levels of functional limitations were associated with higher levels of depressive symptoms.

DISCUSSION: The prevalence of depressive symptoms is high in older adults with cancer and several factors predict depressive symptoms in this population. Individuals who are at high risk of developing depressive symptoms should be identified and appropriate timely interventions should be initiated to reduce the rates of depressive symptoms in older adults with cancer.

}, keywords = {Cancer, Chronic conditions, depression, Depressive symptoms, Functional limitations, Older Adults}, issn = {1879-4076}, doi = {10.1016/j.jgo.2020.12.009}, author = {Parajuli, Jyotsana and Berish, Diane and Valenti, Korijna G and Jao, Ying-Ling} } @article {11359, title = {Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults}, journal = {International Journal of Environmental Research and Public Health}, volume = {18}, year = {2021}, pages = {351}, abstract = {There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4\% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants{\textquoteright} symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95\% CI: 1.04{\textendash}1.06) and dementia (HR = 1.05; 95\% CI: 1.03{\textendash}1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.}, keywords = {cognitive impairment, Dementia, insomnia, Older Adults, Sleep, time-varying}, isbn = {1661-78271660-4601}, doi = {10.3390/ijerph18010351}, author = {Nicholas V Resciniti and Yelverton, Valerie and Kase, Bezawit E and Zhang, Jiajia and Matthew C. Lohman} } @article {11679, title = {Understanding how psychosocial factors relate to seeking medical care among older adults using a new model of care seeking}, journal = {Social Science \& Medicine}, volume = {281}, year = {2021}, pages = {114113}, abstract = {RationaleResearch has identified psychosocial factors related to the use of health services among the older population; however, the specific roles by which these factors drive behavior have not been identified and empirically tested.ObjectiveThis study tested whether previously identified psychosocial factors decrease or increase the motivational potential to seek care, the motivational sensitivity to perceived access, or the motivational sensitivity to perceived need.MethodsThe 2014 U.S. Health and Retirement Study was used. Analysis was based on 2589 older noninstitutionalized respondents (age greater than 64). The dependent variable was the number of healthcare provider visits in the preceding two years. Psychosocial factors included were life satisfaction, social network indicators, optimism, pessimism, positive social support, hopelessness, loneliness, self-efficacy, health efficacy, positive affect, negative affect, and purpose in life. Covariates included age and sex. Maximum likelihood estimation of an interpretable structural model was used.ResultsResults of the study provide evidence that psychosocial variables are related to health care seeking through both motivational potential and sensitivity parameters. Some psychosocial variables are related to multiple roles. For example, pessimism is related to a lower motivational potential and is more sensitive to access at higher levels of access, whereas hopelessness is related to a higher motivational potential and more sensitive to need and access at lower levels of each.ConclusionsFindings imply psychosocial characteristics are related to health care seeking and utilization of older adults via different roles that can countervail each other, and therefore the influence of interventions can be complex. To address this, complex interventions may be required.}, keywords = {Care seeking, Decision making, Older Adults, Psychosocial factors}, isbn = {0277-9536}, doi = {10.1016/j.socscimed.2021.114113}, author = {Veazie, Peter and Denham, Alina} } @article {10648, title = {Adherence to Mediterranean Diet Is Associated With Lung Function in Older Adults: Data From the Health and Retirement Study}, journal = {Journal of the American College of Nutrition}, volume = {40}, year = {2020}, pages = {119-124}, abstract = {Objective: The aim of this work was to examine the association between adherence to a Mediterranean diet (MD) and lung function in older adults.Design: This was an observational and cross-sectional study.Setting: This research was conducted among community-dwelling older adults from the 2014 Health and Retirement Study (HRS).Subjects: Subjects were 2108 adults aged 50 years or older, 1234 (58.5\%) of whom were female.Measures: Dietary intakes from respondents of the Health and Retirement Study (HRS) were used for the current analysis. Adherence to MD was evaluated using the MedDietScore, while lung function was evaluated through peak expiratory flow rate (PEF; l/min). Multiple linear regression and logistic regression were performed, adjusted for potential confounders, to examine the relation between adherence to MD and lung function.Results: Mean MedDietScore was 28.0 ({\textpm} 5.0), indicating a moderate adherence to MD. Multiple linear regression showed a significant association between the MedDietScore and lung function (β = 0.072, 95\% confidence interval [CI]: 0.039{\textendash}0.104) after adjusting for age, gender, body mass index, race, comorbidities, education, height, grip strength, smoking history, physical activity, and daily caloric intake. Specific food groups such as grains, dairy products, and fish consumption were also associated with PEF rate (p < 0.05). Logistic regression confirmed these findings, and high adherence to MD was associated with reduced risk of having PEF rate < 80\% of its peak predictive value (odds ratio: 0.65, 95\% CI: 0.48{\textendash}0.89).Conclusions: The results of this study indicate that adherence to MD is an independent predictor of lung function in older adults, and dietary interventions could be a possible preventive measure in adults with a high risk of developing lung function decline.}, keywords = {lung function, MedDietScore, Mediterranean diet, Older Adults, pulmonary}, doi = {10.1080/07315724.2020.1740114}, author = {Ionas Papassotiriou and Sheikh Mohammed Shariful Islam} } @article {10751, title = {Advance Care Planning Prior to Death in Older Adults with Hip Fracture}, journal = {Journal of General Internal Medicine}, year = {2020}, abstract = {Background Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. Objective To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and to identify factors associated with ACP. Design Retrospective cohort study using Health and Retirement Study (HRS) interviews linked to Medicare fee-for-service claims data. Participants Six hundred six decedent participants aged 65 or older who sustained a hip fracture during HRS enrollment and had a proxy participate in the exit HRS survey. Main Measures Survey responses by proxies were used to determine ACP, defined by either advance directive completion or surrogate designation, and to assess decision-making at the end of life. Multivariate logistic regression was used to analyze correlates of ACP. Key Results Prior to death, 54.9\% of all participants had an advance directive and 68.9\% had designated a surrogate decision-maker; however, 24.5\% had no ACP. Of the total cohort, 32.5\% required decisions to be made about treatment at the end of life and lacked capacity to make these decisions themselves. In this subset, 19.9\% had no ACP. In all participants, ACP was less likely in non-white individuals (adjusted odds ratio (aOR) 0.14, 95\% CI 0.06{\textendash}0.31), those with less than a high school education (aOR 0.58, 95\% CI 0.35{\textendash}0.97), and those with a net worth below the median of the cohort (aOR 0.49, 95\% CI 0.26{\textendash}0.72). No clinical factors were found to be associated with ACP completion prior to death. Conclusions A considerable number of older adults with hip fracture required surrogate decision-making at the end of life, of whom one fifth had no ACP prior to death. Clinicians providing care for these patients are uniquely poised to address ACP. }, keywords = {Advance care planning, advance directive, Hip fracture, Older Adults, surrogate decision-making}, isbn = {1525-1497}, doi = {10.1007/s11606-020-05644-1}, author = {Kata, Anna and Irena Cenzer and Rebecca L. Sudore and Kenneth E Covinsky and Victoria L. Tang} } @article {10696, title = {Disrespect at Work, Distress at Home: A Longitudinal Investigation of Incivility Spillover and Crossover Among Older Workers}, journal = {Working, Aging and Retirement}, year = {2020}, type = {Journal}, abstract = {The prevalence of workplace mistreatment toward older adults is well-documented, yet its effects are understudied. We applied the strength and vulnerability integration model (SAVI) to hypothesize that, despite its low intensity, workplace incivility has numerous deleterious outcomes for older employees over time. Specifically, we investigated whether and how incivility relates to well-being outside of work, among both targeted employees and their partners. We drew on affective events theory to examine how incivility {\textquotedblleft}spills over{\textquotedblright} to older targets{\textquoteright} personal lives. We also tested whether incivility is potent enough to {\textquotedblleft}crossover{\textquotedblright} to the well-being of older targets{\textquoteright} partners at home. Based on longitudinal data from a national study of older workers (N = 598; 299 couples), results demonstrate that workplace incivility related to decrements in targets{\textquoteright} affective well-being, which in turn, was associated with life dissatisfaction, interference with work, and lower overall health. Workplace incivility also predicted declines in partner well-being, although these crossover effects varied by gender: Men{\textquoteright}s postincivility affective well-being predicted their female partners{\textquoteright} life satisfaction but not vice versa. However, women{\textquoteright}s uncivil experiences directly related to the affective well-being of their male partners. These results suggest that for both older workers and their partners, the harms of incivility eventually extend beyond the organizations where they originate.}, keywords = {Older Adults, Workplace incivility}, doi = {10.1093/workar/waaa007}, author = {Lisa A Marchiondo and Gwenith G Fisher and Cortina, Lilia M. and Matthews, Russell A.} } @mastersthesis {11098, title = {The Effect of Income on Quality of Life and Survival Expectation Among Older Adults in America: Evidence from the Social Security Notch}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Georgia}, address = {Athens, GA}, abstract = {The Social Security retirement income program provides financial support for older adults in America and is the primary source of income for retirees. As the inflows into the Social Security Trust Fund become smaller than outflows, it is projected that the Social Security Trust Fund will become insolvent by 2035. A potential future reduction in retirement benefits may constitute a significant risk for quality of life of older adults. Previous studies examined the relationships between income, life satisfaction, well-being, and quality of life among older adults, but the causal pathways are not yet fully explained. The purpose of this study is to identify latent dimensions of the perceived quality of life of older Americans and to estimate the causal effect of Social Security retirement income on these aspects of life quality, as well as on a 10-year survival expectation. To overcome the problem of endogeneity of income, I adopt a two-stage estimation procedure which uses the Social Security {\textquotedblleft}notch{\textquotedblright} as an instrument for retirement income. The term {\textquotedblleft}notch{\textquotedblright} refers to variation in Social Security benefits paid to people born between 1917 and 1921 that resulted from the Social Security administration{\textquoteright}s unintended mistake in the formula for cost-of-living adjustment. The data is drawn upon the 1993 Asset and Health Dynamics Among the Oldest Old, a supplement to the Health and Retirement Study. I find positive and statistically significant relationship between the amount of Social Security retirement income received and the perceived quality of life as measured by items that correspond to feelings of living a fulfilled life and being in control of one{\textquoteright}s life. At the same time, income does not appear to be a determinant of being forward-looking or hopeful among older adults in America. Similarly, I do not find convincing evidence that income significantly affects optimism regarding survival as measured by reports of one{\textquoteright}s expected longevity. Overall, my findings suggest that a potential reduction in future Social Security benefits may inflict damage on some aspects of perceived quality of life among older adults.}, keywords = {Effect of income, Instrumental variable estimation, Older Adults, Quality of Life, Social Security Notch, Survival expectation}, isbn = {9798672123011}, author = {Chung, Sae Rom} } @mastersthesis {10844, title = {Examination of Social Exclusion as a Construct and Its Impact on Mortality and Survival Time among Older Adults}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Maryland}, type = {Dissertation}, address = {Baltimore}, abstract = {Although social exclusion may be an important predictor of mortality, there is a lack of empirical evidence on the impact of social exclusion on mortality/survival time among older adults in the U.S. The study reported in this dissertation examined the effects of social exclusion on mortality and survival time using a nationally representative sample of adults over 50 years of age. The primary goal was to better understand how social exclusion affects mortality and survival time among older adults. Data were drawn from the 2010 and 2014 Health and Retirement Study (core wave, exit wave, and psychosocial supplement) and focused on older adults aged 65 years or older (8,439 participants). Social exclusion indicators were based on previous conceptual and empirical frameworks, and a total of 21 possible indicators were measured. On the basis of correlation analyses, three indicators were excluded due to very low correlation coefficients or statistical nonsignificance. The remaining indicators nested in four social exclusion domains (material resources, social, health, and community). Average inter-item correlations supported the reliability of the remaining 18 indicators, and multiple regression models supported the validity of the four domains. The results of a Cox regression model revealed that the material resources domain had a higher influence on mortality than did the other three domains. Six individual indicators (wealth, car availability, social activity, social membership, self-rated health, and disability) were associated with mortality, adjusting for demographic variables. Kaplan{\textendash}Meier survival analyses based on each indicator showed that all social exclusion indicators were significantly associated with survival rate with the exception of social support, city/town satisfaction, and neighborhood safety. The findings from this dissertation indicate that social exclusion affected mortality and survival time among older adults in the U.S. However, not all indicators were associated with mortality and survival time. The results of the dissertation imply that policies can be modified to improve social participation and access to transportation and that multidimensional services or interventions focusing on the more influential social exclusion indicators are needed (e.g., connecting resources, facilitating social connections). Further, there is a need to reconcile the differences between conceptual and empirical domains/indicators. }, keywords = {Older Adults, social exclusion, Survival Rate}, url = {https://archive.hshsl.umaryland.edu/bitstream/handle/10713/13032/Lee_umaryland_0373D_11145.pdf?sequence=1\&isAllowed=y}, author = {Lee, Joonyup} } @article {BERGMANS2020113033, title = {Examining associations of food insecurity with major depression among older adults in the wake of the Great Recession}, journal = {Social Science \& Medicine}, volume = {258}, year = {2020}, abstract = {Abstract: As a psychosocial stressor, the degree to which food insecurity impacts depression may be dependent on macro-level context, which can be examined in the wake of the Great Recession. The objective of this study was to determine (1) whether food insecurity transition status (i.e. initially food insecure, becoming food insecure, and remaining food insecure vs. not food insecure) was associated with major depression in older adults, and; (2) whether this association was moderated by macrolevel context. Data came from the United States Health and Retirement Study, 2008-2016. Multivariable logistic regression across all years revealed that major depression was associated with any exposure to food insecurity, however; this association was moderated by time period. Remaining food insecure was associated with major depression during all time periods. In contrast, becoming food insecure was associated with major depression in the years during and immediately following the Recession, but not in later time periods. Findings suggest that associations of food insecurity with major depression among older adults are moderated by macro-level context, consistent with theories of social comparison and relative disadvantage. Food insecurity may represent an important risk factor for major depression and mental health disparities across socioeconomic strata among older adults. Thus, policies that increase access to food assistance programs or improve the quality of local food environments may buffer against the impact of food insecurity on depression and associated complications in old age.}, keywords = {depression, Food insecurity, Life transitions, Older Adults, Recession, relative disadvantage, social comparison, stress process}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2020.113033}, author = {Rachel S. Bergmans and Riley Wegryn-Jones} } @article {LEE2020, title = {Falls in community-dwelling older adults with heart failure: A retrospective cohort study}, journal = {Heart \& Lung}, year = {2020}, abstract = {Background While heart failure (HF) in older adults is associated with fall risk, little is known about this in the U.S. Objective To examine the independent effect of functional impairments related to HF on falls among community-dwelling older adults in the U.S. Methods A retrospective cohort study was conducted with 17,712 community-dwelling older adults aged 65 and above with (n = 1693) and without HF, using mixed-effects logistic regression to examine the association between HF and falls. Results HF patients had 14\% greater odds of falling than those without HF. Moreover, HF patients with functional difficulties in mobility, large muscle difficulty, instrumental activities of daily living difficulty, poor vision, and urinary incontinence demonstrated an increased likelihood of falling. Conclusion Community-dwelling older adults with HF and functional difficulties have a higher fall risk than those without HF, indicating that fall prevention programs should be developed, tested, and implemented for this population.}, keywords = {Aging, Falls, Heart Failure, Nursing, Older Adults}, issn = {0147-9563}, doi = {https://doi.org/10.1016/j.hrtlng.2019.12.005}, url = {http://www.sciencedirect.com/science/article/pii/S014795631930559X}, author = {Kayoung Lee and Matthew A. Davis and John E. Marcotte and Susan J Pressler and Jersey Liang and Nancy A. Gallagher and Marita G. Titler} } @article {CASANOVA2019100226, title = {Gender Differences in Cognitive Function among Older Mexican Immigrants}, journal = {The Journal of the Economics of Ageing}, volume = {16}, year = {2020}, abstract = {This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the {\textquotedblleft}risk factor hypothesis{\textquotedblright}); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the {\textquotedblleft}survival bias hypothesis{\textquotedblright}); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the {\textquotedblleft}differential selection hypothesis{\textquotedblright}); and whether male immigrants are better acculturated to life in the United States than female immigrants (the {\textquotedblleft}acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition.}, keywords = {Cognition, Gender Differences, MHAS, Older Adults}, issn = {2212-828X}, doi = {https://doi.org/10.1016/j.jeoa.2019.100226}, author = {Maria Casanova and Emma Aguila} } @article {LIU2019, title = {The impact of sleep medications on physical activity among diabetic older adults}, journal = {Geriatric Nursing}, volume = {41}, year = {2020}, pages = {400-405}, abstract = {The purpose of this study was to examine the impact of prescription sleep medications on physical activity (PA) participation among diabetic older adults. We analyzed cross-sectional data of 1,581 respondents >= 50 years from the 2006{\textendash}2014 waves of the Health and Retirement Study. The respondents self-reported frequency of their PA from light, moderate and vigorous activity and whether they regularly took prescription sleep medications. We found that 381 of 1,581 respondents (24\%) reported regular use of prescription medications for sleep. Hierarchical linear regression models revealed that use of prescription sleep medications significantly predicted less participation in PA after controlling for demographic variables, personality traits, social support, environmental factors, social integration, sensory functions, presence of pain, prescription pain medication use, body mass index, and health conditions. The finding highlights that use of prescription sleep medications may be an important risk factor of physical inactivity in diabetic older adults.}, keywords = {Diabetes, Older Adults, Physical activity, Prescription sleep medication}, issn = {0197-4572}, doi = {https://doi.org/10.1016/j.gerinurse.2019.12.003}, author = {Zhaoli Liu and Chenchen Yang} } @mastersthesis {11096, title = {The Influence of Mental, Physical, and Social Activity on Episodic Memory of Persons Aged 50 and Above in the United States}, volume = {Doctor of Philosophy}, year = {2020}, school = {Florida Atlantic University}, address = {Boca Raton, FL}, abstract = {The purpose of this study was to describe the relationship between mental, physical, and social activity, and episodic memory (EM) of cognitively intact older persons. The specific aims were (a) to describe the relationship between EM and mental, physical, and social activity, (b) to describe the role of gender, marital status, and race on EM, (c) to describe the moderating effects of each activity on the relationship between each of the remaining two activities and EM, and (d) to describe the moderating effects of gender, marital status, and race on the relationship between each activity and EM. Two theoretical frameworks: Cognitive Reserve Theory (Stern, 2002) and Theory of Nursing as Caring (Boykin \& Schoenhofer, 1993) guided the study. This study was designed as a correlational and retrospective secondary analysis of data sets from the Health and Retirement Study. The sample consisted of 3,903 cognitively intact persons who were 50 years and older and completed immediate and delayed recall tests in the 2016 HRS and the 2015 Consumptions and Activities Mail Survey. Descriptive statistics included the means for age: 67 (SD 9.54), education:13.85 (SD 5.89), and total cognition 16.86 (SD 3.11). The sample was predominantly Caucasian (78.3\%), female (59.8\%), and married (60.9\%). The regression model, including mental, physical, and social activity as the predictors, and EM as the criterion was non-significant. There was a significant relationship between gender and EM, indicating that women had higher EM scores than men had. Regression results also showed significant associations between marital status, race, and EM. Compared to the married group, EM scores significantly reduced in the divorced and widowed group. Compared to Whites/Caucasians, African Americans had significantly lower EM scores. The moderation analysis indicated that mental activity significantly moderated the relationship between physical activity and EM. There was a positive relationship between physical activity and EM in the low mental activity group. Gender moderated the relationship between mental activity and EM, indicating a negative relationship between mental activity and EM for women. Marital status also moderated the relationship between physical activity and EM, revealing a positive relationship between physical activity and EM for the widowed group. The study findings can guide primary care services and health-promoting interventions for cognitively intact adults to maintain and improve their episodic memory.}, keywords = {cognitive functioning, Episodic Memory, Mental activity, Older Adults, Physical activity, Social activity}, isbn = {9798664739381}, url = {https://search.proquest.com/openview/cef6bd54bc560188cb9262fbe73aa154/1?pq-origsite=gscholar\&cbl=18750\&diss=y}, author = {Malatyali, Ayse} } @article {11144, title = {A Latent Deprivation Perspective: Mechanisms Linking Volunteering to Mental Health in Later Life.}, journal = {International Journal of Aging and Human Development}, year = {2020}, month = {2020 Oct 13}, abstract = {

This study tests the hypothesis that the latent deprivation model (LDM) can be extended to volunteer work, by exploring the extent to which two potential latent benefits of volunteer work-purpose in life and perceived social status-mediate the negative relationship between volunteerism and mental health (measured as depressive symptoms). Structural equation modeling with the full-information maximum likelihood (FIML) was adopted to model a sample of 5887 respondents from the Health and Retirement Study (HRS). The outcome was depressive symptoms; the independent variable was volunteering; and the mediators were "purpose in life" and "perceived social status." Findings show that purpose in life and perceived social status partially mediated the relationship between volunteering and depressive symptoms, with purpose in life having a more substantial effect than perceived social status. Implications for future research and practice are also discussed.

}, keywords = {Depressive symptoms, mediation, Older Adults, Purpose in life, Social status}, issn = {1541-3535}, doi = {10.1177/0091415020959767}, author = {Jie Yang and Matz, Christina} } @article {10859, title = {Life After Death: Widowhood and Volunteering Gendered Pathways Among Older Adults}, journal = {Demographic Research}, volume = {43}, year = {2020}, pages = {581-616}, abstract = {Background: Spousal loss is one of the most traumatic events an individual can experience. Studies on behavioral changes before and after this event are scarce. Objective: This study investigates gender differences in pathways of volunteering before and after transition to widowhood among older adults in the United States. Methods: We use longitudinal data from the Health and Retirement Study and estimate fixed-effect models with lags and leads to identify pathways of volunteering on a sample of 1,982 adults aged 50 and over. Results: The results show a U-shape pattern with a decline in volunteering activities before the death of the partner and then a slight process of adaptation and recovery. The process is strongly gendered with women considerably more resilient than men. Whether death was expected or not influences the effect of partner death on volunteering likely due to the pre-death burden of caregiving. Looking at the role of pre-death partner{\textquoteright}s volunteering we found, for both genders, but especially for women, that the odds of volunteering increase (decrease) if the partner was (was not) volunteering (complementarity hypothesis). Contribution: Given the positive effects of volunteering both for the volunteer and the society as a whole, our findings contribute to the literature highlighting that critical family events may affect participation in society of older people and demonstrating the heterogeneity of the effects especially in terms of gender differences.}, keywords = {Gender Differences, Older Adults, trajectories of social activities, Volunteering, Widowhood}, doi = {10.4054/DemRes.2020.43.21}, author = {Bolano, Danilo and Bruno Arpino} } @article {11074, title = {Life Stressors: Elevations and Disparities Among Older Adults with Pain.}, journal = {Pain Medicine }, volume = {21}, year = {2020}, pages = {2123-2136}, abstract = {

OBJECTIVE: To examine stressor elevations among older adults with pain, and gender and race disparities in the dual burdens of late-life pain and stressors.

DESIGN: Cross-sectional.

SETTING: Community.

SUBJECTS: Participants in the Longitudinal Late-Life Health study (LLLH; N = 1,884) and the Health and Retirement Study (HRS; N = 7,704).

METHODS: Pain and stressor measures were harmonized across the LLLH and HRS samples. Analyses of covariance were conducted to determine the effects of older adults{\textquoteright} pain, gender, race, and interactions between these factors, on their stressors in nine separate life domains, and in stressors overall.

RESULTS: In both the LLLH and HRS samples, older adults with painful conditions (joint, back, headache, chest pain), more numerous painful conditions, more severe pain, and more pain interference had elevated stressors in all life domains, compared with older adults without or with less serious pain. Pain was more prevalent among women and nonwhites than men and whites. Stressor exposure was higher for men than women in most life domains; it was higher for nonwhites than whites in all life domains. For certain types of pain and life domains, pain and gender, as well as pain and race, interacted to predict stressor elevations.

CONCLUSIONS: Late-life pain is associated with elevations in stressors, and there are gender and race disparities in the dual burdens of heightened pain and elevated stressors in later life. Pain and stressors are not consistently more strongly linked among older women than older men, or among older nonwhite than older white persons.

}, keywords = {gender, Older Adults, Pain; Race, Stressors}, issn = {1526-4637}, doi = {10.1093/pm/pnaa189}, author = {Penny L. Brennan} } @article {10557, title = {Lifetime History of Traumatic Brain Injury is Associated with Increased Loneliness in Adults: A U.S. Nationally Representative Study}, journal = {International Journal of Geriatric Psychiatry}, volume = {35}, year = {2020}, pages = {553-563}, abstract = {Background/Objectives: An estimated 55 million individuals worldwide live with chronic disability associated with Traumatic Brain Injury (TBI) which may include cognitive, behavioral and social impairments. Reduced participation in social activities is common after TBI, however few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness, and to identify mediators of this association. Methods/Design: Retrospective cohort study. Nationally representative sample of N=724 adults over age 50 (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. Results: History of TBI was associated with a 1.28 point (95\% CI: 0.46, 2.11, p<0.05; Cohen{\textquoteright}s D=0.284) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms and comorbidity burden partially mediated the relationship between TBI and loneliness. All models were adjusted for United States (U.S.) population sampling weights. Conclusions: History of TBI was associated with greater loneliness compared to individuals without TBI in a representative sample of U.S. adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population. This article is protected by copyright. All rights reserved.}, keywords = {Loneliness, Older Adults, Traumatic Brain Injury}, doi = {10.1002/gps.5271}, author = {Raj G. Kumar and Katherine A Ornstein and Bollens-Lund, Evan and Watson, Eric M. and Claire K. Ankuda and Amy Kelley and Dams-O{\textquoteright}Connor, Kristen} } @article {2020-19126-00120200319, title = {Loneliness trajectories and correlates of social connections among older adult married couples.}, journal = {Journal of Family Psychology}, volume = {34}, year = {2020}, pages = {1014-1024}, abstract = {How loneliness manifests in older adult married couples is necessary to consider. Marriage partners may become more or less lonely based on shared circumstances with one another (i.e., the shared environment hypothesis). Moreover, individuals may pair off with a marriage partner who shares similar levels of loneliness (i.e., the homophily hypothesis; Cacioppo, Fowler, \& Christakis, 2009), which can potentially lead to higher or lower levels of loneliness. Therefore, examining couples dyadically is beneficial in order to understand how loneliness operates over time. Three waves of the Health and Retirement Study were used and participants included 1,389 older adult couples. The current study uses growth-mixture modeling to examine older adult couples{\textquoteright} joint loneliness trajectories. Multinomial logistic regressions were also used to examine social and demographic correlates of these trajectories. Three classes emerged, including classes characterized by high loneliness (N = 69), low lon}, keywords = {Aging, Couples, Loneliness, Marriage, Older Adults, Partners, person-centered modeling, Simulation, social connections, Social Interaction, Spouses}, issn = {0893-3200}, doi = {10.1037/fam0000652}, author = {Ashley E. Ermer and Dikla Segel-Karpas and Benson, Jacquelyn J.} } @article {11077, title = {A Measurement Model of Depressive Symptoms among Older, African American Women}, journal = {American International Journal of Social Science }, volume = {9}, year = {2020}, abstract = {For more than four decades, researchers have found depression to be a common mental illness among the elderly. Depression is a generalized mood disorder characterized by feelings of sadness and hopelessness, a sense of worthlessness, difficulty concentrating, loss of interest, and decrease in energy level. This definition is reflected in the Geriatric Depression Scale (GDS). The rates of depression among elderly residents of institutions are 67\% higher than among elderly adults residing at home. As in the United States, elderly women are twice as likely to be diagnosed with depressive symptoms as elderly men.. Time and again, research has revealed that depression is a significant problem for individuals later in life and may affect their psychological well-being. Using data from the Health and Retirement Study (HRS) 2010 wave, a secondary analysis was conducted to examine depression among community-dwelling, African American women, age 50 and over, as it relates to age, social support, religion, caregiving, and physical health. Intersectionality and social construction were used as theoretical frameworks for the study. Findings indicated significant relationships between depression and age, social support, and physical health. However, depression is treatable with pharmacotherapy, psychotherapy or combination of both.The overall purpose of this study was to explore the factors that may predict depression among older African American females, as well as identify gaps in the literature and add to the knowledge base about depression among this population of color, and develop a framework for future studies investigating mental health issues among diverse populations beyond African Americans.}, keywords = {African Americans, depressive symptoms and research, Older Adults, women}, issn = {2325-4149 }, doi = {doi:10.30845/aijss.v9n2p1}, author = {Baldwin-Clark, Tamika and de Carvalho, Jackson} } @article {10602, title = {Memory complaints and depressive symptoms over time: a construct-level replication analysis}, journal = {BMC Geriatrics}, volume = {20}, year = {2020}, pages = {57}, type = {Journal}, abstract = {Memory complaints and depressive symptoms are frequently associated in older adults and both serve as potential indicators of future cognitive decline. However, the temporal ordering of the development of these two symptoms remains unclear. The goal of the current study was to examine concurrent and temporal relationships between memory complaints and depressive symptoms in older adults.}, keywords = {Cognitive decline, Depressive symptoms, memory complaints, Older Adults, Replication analysis}, isbn = {1471-2318}, doi = {https://doi.org/10.1186/s12877-020-1451-1}, author = {Mogle, Jacqueline and Nikki L Hill and Bhargava, Sakshi and Tyler Reed Bell and Bhang, Iris} } @article {11064, title = {Optimism, pessimism, and health biomarkers in older couples.}, journal = {British Journal of Health Psychology}, year = {2020}, month = {2020 Sep 10}, abstract = {

OBJECTIVE: Studies have demonstrated the importance of optimism in predicting perceived general health. However, the handful of studies focusing on cardiovascular biomarkers show inconsistent effects. Additionally, no study examined whether spousal levels of optimism and pessimism affect an individual{\textquoteright}s biological markers of cardiovascular health. Thus, our objectives were to examine whether partners{\textquoteright} optimism and pessimism affect individual biological markers, differentiating between between-dyad associations and within-dyad predictive processes.

METHODS: Three waves of the Health and Retirement Study collected in 2006, 2010, and 2014 were used to test actor and partner effects of optimism and pessimism on C-reactive protein (CRP) and high-density lipoprotein. Multilevel longitudinal actor-partner models were used to examine the contribution of a partner{\textquoteright}s optimism and pessimism to each biomarker, adjusting for respondent{\textquoteright}s age, sex, depression, body mass index, daily activity levels, and a summary score of respondent{\textquoteright}s doctor-diagnosed chronic conditions.

RESULTS: Partners{\textquoteright} pessimism and optimism levels were moderately associated. Results for within-person effects were all non-significant, both within and across waves. Associations at the between-person level were also non-significant, with the exception of a positive association between husbands{\textquoteright} pessimism and their own CRP, and husbands{\textquoteright} optimism and their wives{\textquoteright} CRP.

CONCLUSIONS: Results suggest that optimism and pessimism may not play a pertinent role in within variability of biomarkers of cardiovascular diseases and have a minor role in predicting to between-person variability of biomarkers of cardiovascular diseases.

}, keywords = {Biomarkers, Couples, health, Older Adults, Optimism, pessimism}, issn = {2044-8287}, doi = {10.1111/bjhp.12466}, author = {Arbel, Reout and Dikla Segel-Karpas and William J. Chopik} } @article {11038, title = {Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach}, journal = {Health \& Place}, volume = {66}, year = {2020}, month = {2020/11/01/}, pages = {102420}, abstract = {Background Growing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion{\textquoteright}s {\textquotedblleft}dark side{\textquotedblright} and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes. Methods Data were from 12,998 participants in the Health and Retirement Study{\textemdash}a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing. Results Perceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.ConclusionsWith further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being.}, keywords = {Health and well-being, Older Adults, Outcome-wide epidemiology, Perceived neighborhood social cohesion, Public Health, social cohesion}, isbn = {1353-8292}, doi = {https://doi.org/10.1016/j.healthplace.2020.102420}, author = {Eric S Kim and Ying Chen and Ichiro Kawachi and Tyler J VanderWeele} } @article {VILLALONGAOLIVES2020108099, title = {Perceived social capital and binge drinking in older adults: the Health and Retirement Study, US data from 2006-2014}, journal = {Drug and Alcohol Dependence}, year = {2020}, pages = {108099}, abstract = {Objective Social capital has been described as having both positive influences as well as negative influences ({\textquotedblleft}the dark side{\textquotedblright}) on health behaviors. We sought to test the association of perceived social capital on the risk of binge drinking among older adults, using a longitudinal design. Methods We used HRS (Health and Retirement Study) data, a nationally representative sample of US adults aged >=50 years evaluated every two years (from 2006 to 2014). We investigated the relationship between perceived social capital (neighborhood social cohesion and neighborhood physical disorder, positive social support and negative social support) and binge drinking over time, with a multilevel structural equation modelling (MSEM) approach, modelling number of binge-drinking days as hurdle negative binomial. We used MSEM estimating the associations at person level (overall) and within waves. Results The sample included 19140 individuals (at baseline mean age 66.8 (SD 10.3). Over time, the number of binge drinking days decreased. Negative social support increased the average number of binge drinking days among those who drink, where one unit increase was associated with an increase of 37\% in the expected number of days binge drinking in the same wave. The association of positive social support on the number of binge drinking days was stronger for females (-0.59 (SE = 0.12)), while neighborhood social cohesion was significantly associated with binge drinking in females -0.05 (SE = 0.01), but not in males. Conclusions Negative social support favored binge drinking. Positive social support and neighborhood social cohesion are protective factors for binge drinking, especially for women.}, keywords = {Binge drinking, Older Adults, Social capital, social epidemiology}, issn = {0376-8716}, doi = {10.1016/j.drugalcdep.2020.108099}, author = {E. Villalonga-Olives and Josue Almansa and F. Shaya and Ichiro Kawachi} } @article {11081, title = {Reexamining the poverty cycle in middle and late adulthood: Evidence from the Health and Retirement Study 2002{\textendash}2014}, journal = {International Journal of Social WelfareInternational Journal of Social Welfare }, year = {2020}, abstract = {This study re-examined the poverty cycle among American middle-aged (45~64) and older (>=65) adults using contemporary data and has expanded the understanding of sociodemographic differences in the poverty cycle. Longitudinal data from the Health and Retirement Study (2002?2014) were used. Life tables examined age-specific and cumulative percentages of poverty. Mixed-effect logistic regression models examined the moderation role of sociodemographic characteristics in the relationship between age and poverty. The poverty proportion increased rapidly starting at age 75. The growth rate of poverty risk in late adulthood was found to be greater among women and those who did not receive public pensions. Gender divides in poverty risk in late adulthood could be attributed to the cumulative disadvantages of women?s social roles. The beneficial role of Social Security in late adulthood was supported. Policy advocacy efforts should address the needs of those who are financially vulnerable. Policy options such as financial education and retirement planning were recommended.}, keywords = {Life-course perspective, life-table approach, Older Adults, poverty cycle}, isbn = {1369-6866}, doi = {https://doi.org/10.1111/ijsw.12454}, author = {Lu, Peiyi and Shelley, Mack and Liu, Yi-Long} } @mastersthesis {11019, title = {RELATIONSHIPS BETWEEN NEIGHBORHOOD STRESSORS AND DEPRESSIVE SYMPTOMS: THE MODERATING EFFECTS OF SOCIAL SUPPORT AMONG OLDER ADULTS}, volume = {Doctor of Philosophy}, year = {2020}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {About 20\% of Americans have experienced depressive symptoms in their lives. Prior research has shown one{\textquoteright}s neighborhood of residence is an important determinant of one{\textquoteright}s mental health. However, major limitations in existing research are limited research on older adults, limited studies including both objective and subjective neighborhood stressors, and limited studies including social support as a possible moderator. The purpose of this dissertation was to increase knowledge about the relationships between neighborhood stressors and depressive symptoms among older adults. Applying social disorganization theory and stress process theory, this study investigated the associations between four neighborhood stressors (three objective indicators of neighborhood disadvantage {\textendash} neighborhood poverty, racial and ethnic composition, residential instability {\textendash} and one subjective characteristic {\textendash} perceived neighborhood disorder) and a count of depressive symptoms. This study also tested whether social support (from spouse, child, relatives, and friends) moderated the effects of the neighborhood stressors on depressive symptoms. This dissertation was based on secondary analysis of merged data from the Health and Retirement Study 2010, RAND HRS, U.S. Census 2010, and HRS restricted-use data. The final sample (N = 1,468) were all urban-dwelling; age 50 or older; married or partnered; having at least one child, relative, and friend. This study applied structural equation modeling with Full Information Maximum Likelihood estimation. Findings of this dissertation did not support the neighborhood effects hypotheses. Contrary to previous studies, this study found higher neighborhood poverty was associated with lower levels of depressive symptoms. No other neighborhood stressors were associated with depressive symptoms. Stress buffering effects of social support were not significant, for any neighborhood stressor. Not as a moderator but as a main effect, lower social support was significantly related to higher depressive symptoms. Lower income, female, lower education, and poorer health were also related to higher depressive symptoms. This dissertation contributes to social work practice by addressing older adults{\textquoteright} depressive symptomatology. Findings identified vulnerable older adults to target for interventions, based on individual characteristics. Focusing on social support should be a vital component of interventions. Social workers can help older adults to maintain and strengthen their social support, with beneficial effects for their depressive symptomatology.}, keywords = {Depressive symptoms, neighborhood stressors, Older Adults, Social Support}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=case1592324389134903}, author = {Cho, Seungjong} } @article {11274, title = {The role of Hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach}, journal = {Global Epidemiology }, volume = {2}, year = {2020}, pages = {100018}, abstract = {Hope is a topic widely discussed in the humanities and researched in the field of psychology. To explore the potential public health implications of hope for subsequent health and well-being outcomes, we prospectively examined the relation between baseline hope and a wide range of outcomes that included indicators of: physical health, health behaviors, and psychosocial well-being in older adults using an outcome-wide approach. Data from the Health and Retirement Study (N = 12,998, mean age = 66 years) were analyzed. Bonferroni correction was used to account for multiple testing. All models controlled for a wide array of factors including: sociodemographic characteristics, personality factors, and prior values of the exposure (hope) and all outcomes. A greater sense of hope was associated with: better physical health and health behavior outcomes on some indicators (e.g., reduced risk of all cause-mortality, fewer number of chronic conditions, lower risk of cancer, and fewer sleep problems), higher psychological well-being (e.g., increased positive affect, life satisfaction, and purpose in life), lower psychological distress, and better social well-being. A secondary analysis explored antecedents of hope. We identified several potentially modifiable factors that may lead to increased hope. These results may have important population-level implications for increasing hope and improving the physical, psychological, and social well-being of our growing older adult population.}, keywords = {Hope, hopelessness, Older Adults, outcome-wide analysis, Physical Health, Well-being}, doi = {https://doi.org/10.1016/j.gloepi.2020.100018}, author = {Long, Katelyn N.G. and Eric S Kim and Chen, Ying and Wilson, Matthew F. and Worthington Jr., Everett L. and Tyler J VanderWeele} } @mastersthesis {11097, title = {Sense of Control and Frailty among Older Adults}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Massachusetts Boston}, address = {Boston}, abstract = {While research on control beliefs and frailty as separate concepts is rapidly expanding, few studies have investigated the relationship between control beliefs and frailty. Frailty is an integrated clinical syndrome that is closely associated with adverse health outcomes and mortality. It is important to more fully understand the relationship between sense of control and frailty because the protective effects of sense of control may benefit older adults at risk of frailty. This research uses data from the Health and Retirement Study (HRS) and examines the relationship between sense of control and frailty of older adults by taking multilevel factors into account. Further, the impact of financial loss on the level of sense of control is examined. Logistic regression and cross-lagged model are used to examine sense of control and frailty at the individual level (n = 7,695). Multilevel multinomial regression model and Actor Partner Interdependence model are conducted to investigate sense of control and frailty at the couple level (n = 1,509). Difference-in-differences model and linear regression model are used to explore the impact of financial loss on change in sense of control (n = 16,936). The results suggest that sense of control is positively associated with lower risk of frailty among older individuals and older couples. Furthermore, there is a reciprocal relationship between sense of control and frailty. Additionally, actual financial loss, as well as perceived financial loss have a negative impact on sense of control. Programs or interventions to enhance sense of control should be developed and available. Intervention programs targeting married couples should emphasize the spousal effects of sense of control. Married couples, could be a source of social support and influence each other{\textquoteright}s level of frailty. Moreover, sense of control tends to decline over time, and financial loss may expedite this trajectory. Special attention should therefore be given to those who experience financial loss in an effort to minimize the associated detrimental effects.}, keywords = {Frailty, Older Adults, Sense of control}, isbn = {9798617020832}, url = {https://search.proquest.com/openview/12cbf898ad418515fe654c2b577a583a/1?pq-origsite=gscholar\&cbl=18750\&diss=y}, author = {Kim, Bon} } @article {10794, title = {Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans}, journal = {International Journal of Behavioral Medicine}, year = {2020}, abstract = {Background As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health. Method Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants >= 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span. Results Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression. Conclusion Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.}, keywords = {Aging, health, Loneliness, Older Adults, Sleep}, isbn = {1532-7558}, doi = {10.1007/s12529-020-09897-2}, author = {Sarah C. Griffin and Samantha N Mladen and Williams, Allison Baylor and Dautovich, Natalie D. and Lageman, Sarah K. and Joseph M. Dzierzewski and Paul B. Perrin and Bruce D. Rybarczyk} } @article {2020-13542-00120200221, title = {Social capital and health status: Longitudinal race and ethnicity differences in older adults from 2006 to 2014.}, journal = {International Journal of Public Health}, volume = {65}, year = {2020}, pages = {291-302}, abstract = {AbstractObjectivesWe examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults.MethodsWe used Health and Retirement Study, a nationally representative sample of US adults aged >= 50 years evaluated every 2 years (2006{\textendash}2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons.ResultsWe observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the corr}, keywords = {Health Status, longitudinal, Multilevel, No terms assigned, Older Adults, Racial differences, Social capital}, issn = {1661-8556}, doi = {10.1007/s00038-020-01341-2}, author = {Villalonga-Olives, Ester and Josue Almansa and Knott, Cheryl L. and Ransome, Yusuf} } @mastersthesis {10966, title = {Social determinants of health: Predictors of risk of substance use in older adults}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of the Cumberlands}, address = {Williamsburg, KY}, abstract = {Substance use in older adults is a public health concern, having both mental health and physical health impacts. The social determinants of health (SDOH) framework can aid in developing effective interventions to ensure healthy aging and coping in the older adult population. This study uses the SDOH framework to evaluate risk factors that contribute to substance use to cope with stress in older adults. A multiple regression analysis was used for secondary data analysis of the Health and Retirement Study to examine predictors of substance use to cope with stress in older adults. The main findings indicated predictors of substance use to cope with stress were social and community context, followed by the SDOH categories of health and healthcare, and neighborhood physical cohesion. The findings identify the importance of emphasizing access to equitable healthcare and healthy aging in communities. Implications for clinical practice include the implementation of policies and services that provide support to communities in which older adults reside. The social determinants of health framework may be an essential tool to develop policies and solutions addressing substance use, barriers to health, and community wellness. As the population ages, policy changes and community programs can counteract the stressors associated with aging to promote healthy aging and coping in communities.}, keywords = {coping, Older Adults, Social determinants of health, Stress, substance use}, author = {Young, Jennifer} } @article {2019-80770-00120191223, title = {Social isolation{\textquoteright}s influence on loneliness among older adults.}, journal = {Clinical Social Work Journal}, volume = {48}, year = {2020}, pages = {140-151}, abstract = {Social isolation and loneliness are significant risks to health among older adults. Previous studies have found a significant association between social isolation and loneliness; however, few studies examined the association between social isolation and loneliness in a multivariate context and how specific types of social isolation influence loneliness. This study fills this gap by examining social isolation{\textquoteright}s overall influence on loneliness and how specific social isolation indicators influence loneliness. Data comes from 2014 Wave of the Health and Retirement Study, a nationally representative study of adults aged 50 and older. Social isolation was operationalized using seven indicators as social isolation from: (1) adult{\textendash}children, (2) other family members, (3) friends, (4) living alone, (5) being unmarried, and (6) not participating in social groups or (7) religious activities. Loneliness was operationalized by the Hughes 3-item loneliness scale. Loneliness was regressed on social isolation and key socio-demographic factors. Results found when social isolation indicators were combined into an index, every unit increase in overall social isolation was associated with an increase in loneliness. Furthermore older adults who were isolated from other family members and from friends, lived alone, were single, and did not participate in social groups or religious activities reported greater loneliness. Study findings demonstrate that greater overall social isolation and specific social isolation indicators are associated with greater loneliness. Clinical practice with older adults can be enhanced by understanding the connections between social isolation and loneliness and which forms of social isolation are more meaningful for perceived loneliness.}, keywords = {Loneliness, No terms assigned, Older Adults, social isolation, Social networks}, issn = {0091-1674}, doi = {https://doi.org/10.1007/s10615-019-00737-9}, author = {Harry Owen Taylor} } @article {KALOUSOVA2020106127, title = {Tobacco control policy and smoking among older Americans: An analysis of a nationally-representative longitudinal sample (1992{\textendash}2014)}, journal = {Preventive Medicine}, volume = {137}, year = {2020}, abstract = {Smoking has decreased less rapidly among older adults than among the working age population in the United States. This study examines whether tobacco control policy, specifically smoke-free laws and increased cigarette prices, are associated with smoking cessation and lower smoking intensity among older adults. In addition, it considers whether the effect of smoke-free laws varied by labor force participation. Using geocoded longitudinal data from the Health and Retirement study collected from 1992 to 2014, I estimate survival models to evaluate the association between the implementation of city, county, and state smoke-free laws, changes in average state cigarette pack price, and smoking cessation among smokers. I then interact labor force status with smoke-free laws to assess whether the associations differ for retired versus employed respondents. Second, I estimate within-person fixed effects models to evaluate the association between the implementation of smoke-free laws, changes in average state cigarette pack price, and smoking intensity among smokers. Models were stratified by labor force status to assess whether the associations varied by labor force participation. All analyses were also stratified by age into younger (51{\textendash}64) and older (65+) respondents. Neither the implementation of smoke-free laws nor increases in cigarette prices were associated with greater smoking cessation or lower smoking intensity. There was no evidence that labor force participation was associated with greater responsiveness to smoke-free laws. The results suggest that two of the most popular tobacco control policy tools in the US, smoke-free laws and cigarette prices, may be less effective among older adults.}, keywords = {Older Adults, Smoke-free laws, Taxes, Tobacco, tobacco control, USA}, issn = {0091-7435}, doi = {https://doi.org/10.1016/j.ypmed.2020.106127}, url = {https://pubmed.ncbi.nlm.nih.gov/32417216/}, author = {Lucie Kalousova} } @article {11207, title = {TRENDS IN THE USE OF RESIDENTIAL SETTINGS AMONG OLDER ADULTS ISSUE BRIEF}, year = {2020}, institution = {U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy}, address = {Washington, D.C.}, abstract = {This brief presents data on the estimated change in the size of residential care population and characteristics of older adults within different settings.}, keywords = {Health Services, housing services, Older Adults}, url = {https://aspe.hhs.gov/basic-report/trends-use-residential-settings-among-older-adults-issue-brief}, author = {Toth, Matthew and Palmer, Lauren A. Martin and Lawren E. Bercaw and Voltmer, Helena and Sarita Karon} } @article {DAS2020100341, title = {Women{\textquoteright}s greater late-life depression: Traumatic experiences or GxE?}, journal = {Advances in Life Course Research}, volume = {45}, year = {2020}, pages = {100341}, abstract = {Objectives This study examined the role of traumatic life experiences, and their interaction with genetic risk, in explaining gender differences in late life depression. Methods Data were from the 2008-through-2014 waves of the Health and Retirement Study, nationally representative of U.S. adults over age 50. Analysis was restricted to white participants. Newly available polygenic risk scores indexed genetic propensity for depression. Linear growth models examined gender effects on depression, as well as their mediation by environmental and genetic risk. Results Across-person results suggested greater depression among older white women than men. No disparities were found in within-person change. Women also did not have more traumatic life experiences. Nor did the few factors they reported more than men influence depression, or mediate the gender difference in this outcome. The sole exception was childhood parental physical abuse. This early experience mediated about a quarter of the gender disparity{\textemdash}but only at mean or high genetic vulnerability. In contrast, adulthood traumas common among women interacted negatively with polygenic risk{\textemdash}such that they mediated the gender effect only at low levels of the latter. Discussion Traumatic life experiences and their genetic interactions appear to have minimal utility in explaining women{\textquoteright}s greater depression{\textemdash}at least among white older adults. Careful work is needed on the extent to which these factors underlie other social disparities in mental health.}, keywords = {depression, gender, Older Adults, polygenic risk, Trauma}, issn = {1040-2608}, doi = {10.1016/j.alcr.2020.100341}, author = {Aniruddha Das} } @article {9980, title = {Change in leisure participation among older adults after falling}, journal = {Leisure Sciences}, year = {2019}, type = {Journal}, abstract = {Falls among older adults can lead to severe physical and psychological consequences. However, whether leisure participation changes after falling is not clear. We investigated whether falls resulted in reduced leisure participation in terms of duration, number, and intensity among older adults. Secondary data from the Health and Retirement Study and the Consumption and Activities Mail Survey (n = 1163) were analyzed. The results showed falls did not predict future leisure participation. Female, white, higher education, fewer functional limitations, and good balance were significant predictors of leisure participation at follow-up. Being white also predicted a significant decline in total number of leisure activities from baseline to follow-up, whereas higher education protected older adults from a significant reduction in total intensity of leisure activity. Our findings suggest falls may not directly affect leisure participation, but its risk factors, such as demographics, functional limitations, and balance, have a direct impact on leisure participation.}, keywords = {Disabilities, Falls, Older Adults, Participation}, issn = {0149-0400}, doi = {10.1080/01490400.2018.1536568}, url = {https://www.tandfonline.com/doi/full/10.1080/01490400.2018.1536568?scroll=top\&needAccess=true}, author = {Tuo-Yu Chen and Megan C Janke} } @mastersthesis {10246, title = {Longitudinal associations between functional disability, depression, and suicide in middle-aged and older adults.}, volume = {Ph.D.}, year = {2019}, month = {2019}, pages = {88}, school = {West Virginia University}, address = {Morgantown, WV}, abstract = {Suicide is a significant public health problem among older adults in the United States and around the world. There has been little research to date on longitudinal change in functional disability and depressive symptoms, both of which have been posited to be associated with suicide risk among middle-aged and older adults, and their association with death by suicide. The aims of this study were to 1) characterize longitudinal change in functional disability and depressive symptoms separately; 2) characterize the directional associations between functional disability and depressive symptoms in bivariate models; and 3) determine how different patterns of change among these variables are associated with risk for death by suicide. The study used two larger population-based longitudinal datasets, the Health and Retirement Study (HRS) in the United States, and the Swedish Twin Registry (STR). Results from HRS indicated that change in functional disability and depressive symptoms is characterized by a complex system of effects, including both systematic, linear change effects and proportional change based on the level of each variable at each wave. Functional disability generally increased across time and depressive symptoms remained relatively stable, with some slight increases. A bivariate model where level of disability was associated with subsequent change in depressive symptoms was supported by the data, and latent class membership representing group differences in patterns of change within this model predicted risk for death by suicide. Cognitive impairment was significantly associated with lower risk for death by suicide, and appeared to have a suppressor effect on the association of class membership with death by suicide. In STR, functional disability did not predict risk for death by suicide. Further research is needed to characterize the complex longitudinal associations between disability and depression and their effects on suicide risk, taking into account cognitive status.}, keywords = {Depressive symptoms, functional disability, Middle age, Older Adults, suicide}, url = {https://researchrepository.wvu.edu/etd/4122/}, author = {Lutz, Julie Ann} } @article {11138, title = {Reciprocal Effects Between Loneliness and Sleep Disturbance in Older Americans.}, journal = {Journal of Aging and Health}, year = {2019}, abstract = {

To model the relationship between loneliness and sleep disturbance over time. : Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age >= 65 years; = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. : Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. : Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness.

}, keywords = {health, insomnia, Loneliness, Older Adults, Sleep}, issn = {1552-6887}, doi = {10.1177/0898264319894486}, author = {Sarah C. Griffin and Williams, Allison Baylor and Samantha N Mladen and Paul B. Perrin and Joseph M. Dzierzewski and Bruce D. Rybarczyk} } @mastersthesis {10366, title = {Social Relationships and Progression of Frailty: Exploring the Reciprocal Association of Social Ties and Physical Vulnerability in Later Life}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-10-03}, pages = {140}, school = {Michigan State University}, type = {phd}, abstract = {Frailty is described as a state of heightened vulnerability and functional impairment due to the cumulative declines across multiple physiological systems. When faced with stressor events, older adults with frailty are in higher risk of adverse health outcomes. While the prevalence of frailty generally increases with age, there are considerable heterogeneity in onset and progression of frailty among older population. Growing attention is given to identifying the psychosocial factors related to the development of frailty. Social relationships often serve as a vital context of health, where older adults experience multidimensional and dynamic exchange with close others as they age. In this dissertation, two studies are conducted to investigate complex and reciprocal nature of social relationships and frailty progression in older adulthood. The data are from the six waves (2006-2016) of the Health and Retirement Study (HRS), a nationally representative study of older adults in U.S. aged 50 and older. The first study utilized the convoy model of social relations to provide comprehensive investigation of how different aspects of social relations are associated with frailty progression over a decade. There were three distinctive subpopulations following a different frailty progression trajectory. When social network and relational quality with spouse, children, family, and friends were examined, higher frequency of contact with friends were associated with lesser frailty. Negative relationship quality with social ties were detrimental to frailty progression, such that strain with spouse and kin (children and extended family) had an additive effect on belonging to high frailty or steep increase frailty trajectory groups. The perceived loneliness partially explained the negative effect of spousal strain, but the negative effect of large family size and strain with kin were independent from loneliness. The second study explored the health contexts of older couple{\textquoteright}s marital quality, specifically focusing on the presence of frailty and depression within- and across-person in the marital relationship. Using three waves of dyadic data from HRS, I found that one{\textquoteright}s own and partner{\textquoteright}s higher frailty and higher depression all had independent associations with one{\textquoteright}s higher marital strain. For one{\textquoteright}s marital support, one{\textquoteright}s own higher frailty, higher depression, and partner{\textquoteright}s higher depression had negative effects. There was an across-person interaction effect of frailty, such that one{\textquoteright}s marital quality was affected by their partner{\textquoteright}s higher level of frailty only when their own health was good. Having a husband with higher frailty was associated with higher marital strain for wives. Most effects were stable over time. Overall, the findings illustrate the significance of social relationship context as a predictor for different trajectory of frailty progression. The size, frequency of contact, positive, and negative quality were linked to frailty differentially by relationship type, underscoring the benefits of comprehensive examination of social experiences. Further, the level of frailty and depression were linked to perceived marital quality of both members of the couple, especially in damaging manner when healthier spouse is faced with partner{\textquoteright}s health problems. Taken together, my dissertation demonstrated the importance of studying linked lives in context of health conditions prevalent in older adulthood. The findings can be useful to practitioners and policy makers in understanding the intricate link between social relations and frailty as well as in identifying modifiable factors for frailty prevention.}, keywords = {0344:Social research, 0351:Gerontology, 0621:Psychology, Aging, Frailty, Gerontology, Health and Retirement Study, Marriage, Older Adults, Psychology, Social Relationships, Social research}, isbn = {9781085749725}, url = {https://search.proquest.com/docview/2296357161?pq-origsite=gscholar}, author = {Ji Hyun Lee} } @mastersthesis {10262, title = {Socioeconomic Status, Dietary Patterns, and Cardiovascular Risk Factors in an Aging Population}, volume = {PhD}, year = {2019}, month = {10/2019}, pages = {149}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {As the leading cause of death in the United States (U.S.), cardiovascular disease (CVD) is responsible for 17\% of national health expenditures. The health and economic burden of CVD is especially high in older adults. As a consequence of population aging, it has been projected by the American Heart Association that by 2030, 40.5\% of the U.S. population will have some form of CVD, assuming no change to current prevention strategies. In order to address this rising public health issue with more effective prevention strategies, a better understanding of CVD risk factors and their interrelationship is needed. Obesity, type 2 diabetes (T2D), and hypertension (HTN) are each a leading and proximal CVD risk factor. In addition, they tend to coexist with each other and form multimorbidities, which are associated with substantially further elevated CVD risk. Using a life course approach, this dissertation examined the complex interrelationship among childhood socioeconomic status (SES), adulthood SES, adulthood dietary patterns, and the health outcomes of obesity, T2D, and HTN, individually and in the form of multimorbidities. Each of the three aims in this dissertation used a cross-sectional study design and was based on data from the Health and Retirement Study (HRS), a large nationally representative longitudinal study of U.S. adults aged over 50. Indicators of childhood SES included paternal education, maternal education and childhood financial strain. Indicators of adulthood SES included education and wealth. Two dietary patterns, prudent and Western, were initially identified using principal component analysis (PCA). The first aim examined the associations of childhood SES with adulthood dietary patterns using linear regression models. Results of this aim showed that, in selected sociodemographic groups, higher paternal education is associated with healthier dietary habits in adulthood, independent of adulthood SES. The second aim examined the associations of adulthood dietary patterns with obesity, T2D, and HTN, separately, accounting for potential confounding by childhood and adulthood SES and using logistic regression models. Under the potential influence of reverse causation and survival bias, results of this aim showed positive associations of both the prudent and Western dietary patterns with the health outcomes. SES, whether in childhood or in adulthood, did not appear to be a strong confounder to these associations. The third aim used multinomial logistic regression models to explore the associations of childhood SES, adulthood SES, and adulthood dietary patterns with the multimorbidity of obesity, T2D, and HTN. Results of this aim showed that the multimorbidity of obesity, T2D, and HTN is highly prevalent among older U.S. adults, and under the potential influence of reverse causation and survival bias, it is independently associated with lower paternal education, lower participant{\textquoteright}s education and wealth, and greater adherence to the prudent and Western dietary patterns. Overall, this dissertation provides further evidence that childhood environment and conditions may underlie adulthood dietary habits and proximal CVD risk factors (e.g. obesity, T2D, and HTN), individually and in the form of multimorbidity. More studies, especially prospective studies, are needed to further evaluate the potential impact of paternal education on later life CVD risk, as well as whether dietary behavior is an underlying pathway linking childhood SES to later life CVD risk.}, keywords = {Diabetes, diet, Hypertension, Obesity, Older Adults, socioeconomic status}, url = {https://deepblue.lib.umich.edu/handle/2027.42/151408?show=full}, author = {Li, Wenchao} } @article {9352, title = {Trajectories of Perceived Workplace Age Discrimination and Long-Term Associations With Mental, Self-Rated, and Occupational Health.}, journal = {Journals of Gerontology, Series B: Psychological Sciences \& Social Sciences}, volume = {74}, year = {2019}, pages = {655-663}, abstract = {

Objective: This study addresses older employees{\textquoteright} trajectories of perceived workplace age discrimination, and the long-term associations among perceived age discrimination and older workers{\textquoteright} mental and self-rated health, job satisfaction, and likelihood of working past retirement age. We evaluate the strength and vulnerability integration (SAVI) model.

Method: Three waves of data from employed participants were drawn from the Health and Retirement Study (N = 3,957). Latent growth modeling was used to assess relationships between the slopes and the intercepts of the variables, thereby assessing longitudinal and cross-sectional associations.

Results: Perceived workplace age discrimination tends to increase with age, although notable variance exists. The initial status of perceived age discrimination relates to the baseline statuses of depression, self-rated health, job satisfaction, and likelihood of working past retirement age in the expected directions. Over time, perceived age discrimination predicts lower job satisfaction and self-rated health, as well as elevated depressive symptoms, but not likelihood of working past retirement age.

Discussion: This study provides empirical support for the SAVI model and uncovers the "wear and tear" effects of perceived workplace age discrimination on older workers{\textquoteright} mental and overall health. We deliberate on social policies that may reduce age discrimination, thereby promoting older employees{\textquoteright} health and ability to work longer.

}, keywords = {Discrimination, Employment and Labor Force, Older Adults, Self-reported health}, issn = {1758-5368}, doi = {10.1093/geronb/gbx095}, author = {Lisa A Marchiondo and Guillermo Ernest Gonzales and Larry J Williams} } @mastersthesis {10290, title = {The Association between Depression and Social Isolation among Older Adults}, volume = {Master of Science in Gerontology }, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-05-08}, pages = {50}, school = {California State University}, type = {phd}, abstract = {The Health and Retirement Study (HRS) is a twenty-five-year longitudinal study that studies populations over the age of fifty. There is a lack of studies that examine depression and social isolation as comorbid conditions. The purpose of this study was to examine secondary data from the 2014 wave of the HRS regarding associations between depression, social isolation and demographic characteristics, including age (50{\textendash}104 years), gender, and marital status. Self-reported data from 18,289 participants (10,703 females and 7,586 males) suggested a positive association between depression and social isolation ( r = .365, p < .001) in that as levels of depression increase so do feelings of social isolation. Significantly more females than males reported having depression. Those who were married reported less depression and social isolation. Younger ages experienced depression and older ages social isolation. Further research should explore solutions to decreasing depression and social isolation among older adults in the United States.}, keywords = {depression, Health and environmental sciences, Health and Retirement Study, Mental Health, Older Adults, social isolation, Social Sciences}, isbn = {9780355650143}, url = {https://pqdtopen.proquest.com/doc/2015148276.html?FMT=ABS}, author = {Gelgur,Lauren A.} } @mastersthesis {10266, title = {Association Between Polypharmacy and Functional Status in Community-dwelling Older Adults}, volume = {PhD}, year = {2018}, month = {05/2018}, pages = {145}, school = {Virginia Commonwealth University}, address = {Richmond, VA}, abstract = {Background: Polypharmacy has no consensus definition in the literature. Previously used definitions include those based on the number of medications and those based on unnecessary or inappropriate medication use. Polypharmacy has been associated with increased risk of disability and functional limitations that impair a person{\textquoteright}s ability to live independently. Older adults are a population of interest as they are at increased risk for both polypharmacy and functional impairments. Understanding the relationship between polypharmacy and functional impairment in older adults could help health care providers and policy makers to target an at-risk population for interventions. Objectives: To assess the relationship between the number of medications taken and functional status in community-dwelling older adults using a nationally representative dataset. To assess the change in the relationship between the number of medications taken and functional status over time (2 years and 4 years). To study confounders of the relationship between polypharmacy and functional status. Methods: Data came from the Health and Retirement Study (HRS), collected in the following years: 2004, 2006 and 2008. The primary outcome was functional limitation as measured using the following validated tools: activities of daily living and instrumental activities of daily living (ADL and IADL). The exposure under study was polypharmacy status (no polypharmacy: < 5 prescribed medications, and polypharmacy: >=5 prescribed medications). Both cross-sectional and longitudinal models were used to examine different aspects of the relationship between polypharmacy and functional status. Results: A total sample size of 1,545 was included in our study. The prevalence of polypharmacy was 35.9\% at the beginning of the study. Polypharmacy status was significantly associated with functional decline in both the cross-sectional and longitudinal analyses after controlling for confounders. Self-reported health (SRH) and light exercise were associated with functional decline in all cross-sectional analyses. Age, arthritis, and SRH were also associated with functional decline in all longitudinal analyses. Other confounders were also associated with functional decline. Conclusion: Polypharmacy, defined as the use of more than five prescribed medications is a significant risk factor for functional decline in community-dwelling older adults.}, keywords = {Functional status, Older Adults, Pharmacy, Polypharmacy}, url = {https://scholarscompass.vcu.edu/etd/5356/}, author = {Bakhshwin, Duaa M.} } @mastersthesis {10242, title = {Does In-home Social Engagement Mitigate Depressive Symptoms after Driving Reduction or Cessation?}, volume = {Doctor of Philosophy}, year = {2018}, month = {2018}, pages = {101}, school = {Miami University}, address = {Oxford, OH}, abstract = {Driving offers people a sense of independence, the ability to connect with other people, and access to goods and services. Yet, many older Americans reduce or cease driving each year, with detrimental effects. Previous studies have shown associations between driving cessation, decreased social engagement, increased numbers of depressive symptoms, and mortality. Little information examines driving reduction and social engagement. Role theory and stressors occurring during life transitions may provide a theoretical understanding of these outcomes.This study uses four administrations of Health and Retirement Study survey data to determine whether driving reduction and/or cessation are associated with increased numbers of depressive symptoms or decreased levels of social engagement that takes place away from the home setting. Additionally, this study examines the effects of driving reduction and cessation on depressive symptoms when considering levels of social engagement that may occur within the home setting and aims to determine if in-home social engagement mitigates depressive symptoms after driving reduction or cessation. Finally, this study considers males and females separately to determine if gender differences occur.Results indicated that depressive symptoms increase and away from home social engagement decreases after driving reduction, but not cessation, for both men and women. When factoring in at-home social engagement, depressive symptoms still increase after driving reduction, but not cessation. Additionally, when considering the direct and interactive effects of in-home social engagement on depressive symptoms after driving reduction or cessation, mitigating effects of in-home social engagement were not evident.These results suggest that practitioners may wish to allocate resources to extend the safe driving careers of older adults and provide transportation to older adults who reduce or stop driving. Given these results, increasing in-home social engagement is, unfortunately, not a promising approach to mitigating depressive symptoms after driving reduction or cessation. Future research may include a wider variety of measures of social engagement, driving reduction, and cessation. Additionally, future research may enhance the understanding of factors that may mitigate depressive symptoms after driving reduction or cessation. Ultimately, such research may provide answers to enhance the quality of life for older adults who reduce or cease driving.}, keywords = {Depressive symptoms, driving cessation, driving reduction, Gender Differences, Older Adults, social engagement}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=miami1532348747212058}, author = {Brown, Karen M.} } @mastersthesis {10322, title = {Driving and Expectation to Age in Place for Older Adults along the Urbanicity Continuum}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-01-31}, pages = {108}, school = {University of Massachusetts Boston}, type = {phd}, abstract = {Many older adults would like to age in place. Expectations can be important and valid predictors of whether an older adult actually does remain in place. Along with health declines that may initiate unwanted relocation, additional factors influence expectation and ability to age in place. Driving is an important factor in aging in place. Many issues (e.g., unsafe driving, safety concerns, financial or physical burden of tending to a car, etc.) may lead to voluntary or involuntary driving cessation. Without access to public transit or access to adequate informal caregiver transportation (i.e., rides from family or friends) to reach target destinations, driving cessation may ultimately initiate unwanted relocation to a supportive housing environment or nursing home. An unwanted move may diminish quality of life among older adults and furthermore, aging in place is typically less expensive than moves to supportive housing. The purpose of this dissertation is to evaluate driving status as a factor in expectation to age in place. It also investigates how expectations to age in place as well as driving behaviors differ for older adults along the urbanicity continuum. Additionally, the impact of health status and physical mobility on the relationship between driving and expectation to age in place is examined. These relationships are evaluated using ordered logistic regression. The sample includes 8,046 older adults in the Health and Retirement Study database. Findings from the ordinal logistic regression indicate that non-drivers are significantly more likely to expect to age in place. The relationship between driving and expectation to age in place is not moderated by urbanicity status in the regression results. Driving represents a mediating factor in the link between health and expectation to age in place. Supplemental analyses mirror similar results to the ordinal logistic regression results. Relocation is a process triggered by a series of events and likely preceded by expectation to age in place. There are many factors related to driving and aging place. Though expectations may be a mainspring for planning, understanding what individuals anticipate regarding their future living situation is an important area of study.}, keywords = {0351:Gerontology, 0493:Aging, 0630:Public policy, Aging, Aging in place, Driving, Gerontology, Health and environmental sciences, Older Adults, Public Policy, Social Sciences, Urbanicity}, isbn = {9780438807549}, url = {https://scholarworks.umb.edu/doctoral_dissertations/434/}, author = {Richardson,Lorilei M.} } @article {9007, title = {An Exploration of Factors Associated With Ageist Stereotype Threat in a Medical Setting.}, journal = {Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, volume = {73}, year = {2018}, month = {2017 Mar 28}, pages = {1160-1165}, abstract = {

Objectives: Experiencing stereotype threat in a medical setting may be triggered by routine clinical activities, and may be detrimental to healthcare processes and outcomes. This study estimated the prevalence of, and identified factors associated with, reporting ageist stereotype threat in a medical setting using a nationally representative dataset.

Methods: Participants were community-dwelling adults aged 50 and older who had visited the doctor at least once in the past 2 years (n = 1,662). We analyzed data from the Health and Retirement Study using multivariate logistic regression.

Results: 8.31\% of participants felt worry or fear that they were judged by medical staff because of their age. Previous experiences of age discrimination (adjusted odds ratio [AOR] = 2.47, p < .01), poorer self-perceptions of aging (AOR = 1.34, p < .05), and having greater control over one{\textquoteright}s health (AOR = 0.84, p < .05) were associated with reporting stereotype threat because of age.

Discussion: Future research should investigate if measures to reduce age discrimination and to improve self-perceptions of aging and individual control over health protect against experiencing ageist stereotype threat in healthcare settings.

}, keywords = {Ageism, Medical setting, Older Adults, Stereotypes}, issn = {1758-5368}, doi = {10.1093/geronb/gbx034}, author = {Sandi Phibbs and Hooker, Karen} } @mastersthesis {10264, title = {Functional and Cognitive Status and Medication Complexity in Older Adults: The Health and Retirement Study}, volume = {PhD}, year = {2018}, month = {05/2018}, pages = {112}, school = {Virginia Commonwealth University}, address = {Richmond, VA}, abstract = {Introduction: Older adults have high prevalence of chronic illnesses that lead to have complex medication regimens. They are also more likely to have cognitive and functional impairments. Both cognitive/functional impairments and medication regimen complexity increase the risk of medication non-adherence. The objective of this study is to evaluate the association between prescription medication regimen complexity and cognitive/functional status at baseline and after two years, and to assess how changes in cognitive/functional status are associated with changes in medication regimen complexity. Methods: This study used nationally representative sample of community-dwelling older adults from the Health and Retirement Study, followed over a two-year period. The exposures examined were cognitive status, and two types of functional status (Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The association between cognitive/functional status and medication regimen complexity was examined at baseline and after two years. Similar models were used to examine the relationship between cognitive/functional impairment and sub-components of complexity, and to assess how changes in cognitive/functional impairment were associated with changes in medication complexity over two years. Results:Impairment in ADLs were associated with higher medication complexity at baseline (p=0.0029) and after two years (p=0.0243). Impairments in IADLs were associated with higher regimen complexity at baseline only (p=0.0130). Stratifying by depression status, IADL impairment was found to predict higher complexity at both time points, but only in participants without depression. Cognitive impairment was associated with lower medication regimen complexity at baseline (p Conclusion: ADL impairment was strongly associated with higher medication complexity. IADL impairment showed some association with higher medication complexity, but this relationship may vary according to depression status and requires further investigation. Recognition of these impairments may offer health care providers the opportunity to intervene by re-assessing medication regimens for patients with functional impairments. Cognitive impairment was associated with lower medication complexity. Changes in cognitive or functional were not associated with changes in complexity. Further study is needed to investigate this relationship over a longer period of time.}, keywords = {Cognition, Cognitive Status, Medication, Medication Complexity, Older Adults}, url = {https://scholarscompass.vcu.edu/etd/5355/}, author = {Duaa Bafail} } @article {9011, title = {Increased Engagement With Life: Differences in the Cognitive, Physical, Social, and Spiritual Activities of Older Adult Music Listeners.}, journal = {Gerontologist}, volume = {58}, year = {2018}, pages = {270-277}, abstract = {

Purpose of the Study: Clinical studies have demonstrated the health benefits of music listening, especially among older adults; however, this connection has not yet been examined in a nationally representative population based sample. The purpose of this study was to measure the connections between health, listening to music, and engagement with life activities among older Americans.

Design and Methods: We used data on 5,797 participants in both the 2012 Health and Retirement Study and 2013 Consumption and Activities Mail Survey. Participants reported their lifetime prevalence of health conditions, number of hours spent per week listening to music, as well as various cognitive, physical, social, and spiritual activities. We categorized participants as non-listeners (those reporting zero hours of music listening), average listeners (between >0 and 28.5 hr), and high listeners (>28.6 hr) and assessed associations between these music listening categories and life activities and the prevalence of health conditions.

Results: Approximately 20\% of the older Americans were non-listeners, a majority (75\%) reported average amounts, and 5\% reported high levels of music listening. Older Americans who were average or high music listeners reported a greater number of hours engaged in several cognitive, physical, social, and spiritual activities each week. Music listeners additionally reported fewer problematic health conditions than non-listeners.

Implications: Listening to music relates to increased life engagement and better health among older Americans. Given the wide-spread availability of music-based interventions for diverse populations, future studies may investigate the beneficial use of music as a public health initiative for older adults.

}, keywords = {Engagement, Older Adults}, issn = {1758-5341}, doi = {10.1093/geront/gnw192}, author = {Christopher N Kaufmann and Lori P Montross-Thomas and Griser, Sean} } @article {9004, title = {Later-Life Disability in Environmental Context: Why Living Arrangements Matter.}, journal = {Gerontologist}, volume = {58}, year = {2018}, month = {04/2018}, abstract = {

Background and Objectives: Household social and environmental context are key elements of the disablement process, yet few studies explicitly examine the relationship between household composition, housing type, and disability progression. This study investigates the risk of older adults{\textquoteright} disability progression by type of living arrangement (e.g., household composition, housing type) and whether the relationship varies by socioeconomic status.

Research Design and Methods: We used Health and Retirement Study data (waves 1998-2012; n = 41,467 total observations) and fit time-series logistic regression models to estimate increases in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) limitations. Because living arrangements are influenced by financial resources, we also stratified analyses by wealth.

Results: Disability rates were highest among those living alone or with nonfamily others and in self-described fair/poor quality housing. Overall, disability risk was more strongly associated with wealth than living arrangements. For more affluent older adults, living alone was associated with a decreased risk of IADL disability; for the least affluent older adults, living alone had the opposite association-increased risk of both ADL and IADL disability.

Discussion and Implications: Later-life disability progression should be understood in the context of both household environment and wealth. Household composition and housing characteristics were associated with disability progression and the risk of increasing disability was consistently higher for those in the lowest wealth quintile. These findings identify where older adults with disabilities live and that comprehensive interventions to reduce disability progression should consider household social and environmental context, as well as wealth.

}, keywords = {Disabilities, Living arrangements, Nursing homes, Older Adults}, issn = {1758-5341}, doi = {10.1093/geront/gnx019}, author = {Carrie Elizabeth Henning-Smith and Shippee, Tetyana and Benjamin D Capistrant} } @mastersthesis {10323, title = {Marital Biography and Well-Being in Later Life: The Role of Remarriage, Disruption Pathways, and Duration on Health, Parent-Child Contact, and Ambivalence Toward Children}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-09-06}, pages = {170}, school = {Bowling Green State University}, type = {phd}, abstract = {In 2015, nearly 30\% of individuals aged 50 and older had two or more marriages compared to 19\% in 1980, indicating that a growing share of older adults either divorced or were widowed during early or midlife and later remarried. Although widowhood remains a common exit from marriage in later life, divorce to people over 50 is also on the rise. Despite increasingly complex marital biographies of older adults, few researchers have examined differences between disruption pathways (i.e., one divorce, one widowhood, or multiple disruptions) and whether remarriage is associated with fewer costs of marital disruption. It is also unclear whether duration remarried or unmarried relates to better or worse health after different disruption pathways. Using the 1992{\textendash}2014 Health and Retirement Study, I investigate the associations of different disruption pathways, subsequent remarriage relative to being unmarried, and duration remarried or unmarried with older adults{\textquoteright} mental and physical health, contact with children, and ambivalence toward children. I also account for gender differences as the health and parent-child ties of men and women often differ in later life. This dissertation underscores the need to pay attention to older people with multiple disruptions, as they are often disadvantaged in health and parent-child relationships relative to older adults with one divorce or widowhood. The findings regarding the role of remarriage for each well-being outcome are mixed. Remarriage is beneficial for the mental health of men relative to being unmarried after any type of disruption, and for the physical health of divorced women. Although remarriage relates to more frequent parent-child contact for divorced men, remarriage relates to less contact among women after one widowhood or multiple disruptions. Remarriage also links to greater ambivalence among men after multiple disruptions. Duration also matters, but not uniformly across outcomes. Remarried men after multiple disruptions have worse mental health with more years remarried men after one divorce, indicating that duration remarried after multiple disruptions links to poorer mental health than duration remarried after one divorce. Although men with multiple disruptions have less contact with children than widowed men, additional years remarried yield more contact for men with multiple disruptions than for men with one widowhood. Moreover, women who remarry after widowhood have less contact with children than their unmarried counterparts, but each year remarried after widowhood is associated with more contact, suggesting these remarried women rebuild ties with children over time. In sum, my dissertation highlights the utility of employing different disruption pathways, subsequent remarriage, and duration remarried or unmarried to capture increasing complexity of marital biographies among older adults and to clarify its association with multiple dimensions of well-being.}, keywords = {0351:Gerontology, 0493:Aging, 0626:Sociology, 0628:Individual \& family studies, 0938:Demography, Aging, Demography, Families, Gerontology, Health and environmental sciences, Individual \& family studies, Marital disruption, Marital duration, Older Adults, Remarriage, Social Sciences, Sociology}, isbn = {9780438275652}, url = {https://etd.ohiolink.edu/pg_10?::NO:10:P10_ETD_SUBID:167588}, author = {Anna M Hammersmith} } @mastersthesis {10269, title = {Muscle Weakness in Older Americans: Examining the Measurement, Health Outcomes and Life Course Determinants.}, volume = {PhD}, year = {2018}, month = {10/2018}, pages = {170}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {Muscle weakness, as measured by hand grip strength, has been shown to be an important indicator of future disability, chronic disease status and early mortality. While muscle weakness is considered an important prognostic indicator, how best to measure weakness, the long term health outcomes associated with muscle weakness across different sub-populations and the life course determinants remain poorly understood. Indeed, there is little agreement on how best to measure muscle weakness across different groups and how to screen for muscle weakness in order to prevent disability and premature mortality. We begin by first deriving cutpoints for muscle weakness in a nationally representative sample of older adults from the Health and Retirement Study. After using Classification and Regression Tree (CART) models to identify cutpoints, we found that fifty-five percent of men (max grip strength < 39kg) and 47\% of women (< 22kg) were classified as weak. Higher cutpoints were identified for Black males (< 40kg) and females (< 31kg), and the prevalence of weakness (57\% and 88\%, respectively), was higher compared to Whites. As an extension to these results, we examine the validity of these cutpoints in a longitudinal setting to determine whether muscle weakness is associated with disability dynamics and premature mortality. We found that clinical muscle weakness, as identified by sex/race specific population-derived cutpoints from Aim 1, is strongly associated with the onset, progression and persistence of physical disability status. The odds of experiencing an onset of ADL disability were 54\% higher among weak individuals compared those who were not weak at baseline. We also found that weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals. Specifically, weak individuals were over 50\% more likely to die earlier than non-weak individuals. Lastly, the third aim of this dissertation seeks to quantify and understand whether experiencing stressful and traumatic events across the life course influences trajectories of grip strength in later life. We found that life course trauma and stress experienced during emerging/early adulthood was associated with both mean grip strength at age 50 and trajectories of grip strength over time. Among Black men, stress and trauma experienced during emerging/early adulthood was not only related to higher mean grip strength at age 50, but also associated with steeper declines as individuals aged over time compare to White men. Among Black women, traumatic events during emerging/early adulthood were associated with lower mean grip strength at age 50. Taken together, the results of this dissertation chart new territory in its overall goal to improve the measurement of muscle health across the diverse, older adult population and in identifying those most at risk for future disability and premature mortality. This dissertation also demonstrates the importance of investigating how life course social exposures drive differential vulnerability to muscle weakness among older adults. The results of this dissertation can be used to inform clinical practice in screening adults for muscle weakness while also seeking to shift the distribution of muscle weakness at the population level in order to intervene among those who are most vulnerable.}, keywords = {health outcomes, Muscle Weakness, Older Adults, social epidemiology}, url = {https://deepblue.lib.umich.edu/handle/2027.42/145837}, author = {Kate A Duchowny} } @article {9886, title = {Program Abstracts from the GSA 2018 Annual Scientific Meeting {\textquotedblleft}The Purposes of Longer Lives{\textquotedblright}}, journal = {Innovation in Aging}, volume = {2}, year = {2018}, pages = {1-877}, keywords = {Gerontology, Older Adults}, doi = {10.1093/geroni/igy023}, url = {https://academic.oup.com/innovateage/article/2/suppl_1/1/5180516http://academic.oup.com/innovateage/article-pdf/2/suppl_1/1/26545158/igy023.pdf} } @mastersthesis {10260, title = {Risk Factors for Falls in Community-Dwelling Older Adults with Heart Failure.}, volume = {PhD}, year = {2018}, month = {06/2018}, pages = {171}, school = {University of MIchigan}, address = {Ann Arbor, MI}, abstract = {Community-dwelling older adults with heat failure (HF) appear to have a greater risk of falling related to their symptoms, comorbid diseases, and/or adverse effect of HF management. The complexity of HF conditions and the growing number of HF patients pose new challenges for developing innovative fall prevention programs. To be successful, it is essential first to examine the independent effect of HF on falls, and to describe fall risk factors in the HF population. However, little is known about the effect of HF on falls in the U.S. population, and known risk factors have not been fully examined specific to HF patients. This study had two aims. Aim 1 examined the independent effect of HF on the likelihood of falling among community-dwelling older adults. Aim 2 explored functional impairment (i.e., physical, cognitive, sensory, and urinary impairment) in explaining falls among community-dwelling older adults with HF. This retrospective cohort study used data from Health and Retirement Study (HRS), a nationally-representative longitudinal study. The sample for Aim 1 included 17,712 community-dwelling older adults aged 65 or older, who participated in at least two consecutive HRS interview waves between 1998 and 2014. Among them, the sample for Aim 2 included 1,693 community-dwelling older adults with self-reported HF. This study found that HF patients had a 14\% higher likelihood of falling than those without HF, after controlling for socio-demographics, physical and psychological symptoms, health behaviors, functional factors, psychiatric medication use, and environmental factors (OR = 1.14, 95\% CI: 1.04, 1.26). This study of the sample of HF patients found that while a decline in sensory function was least associated with falls, three functional domains (declines in physical, cognitive, or urinary function) were associated with an approximately two-fold higher likelihood of falling, after controlling for socio-demographic factors (i.e., age, sex, race/ethnicity, and spouse/partner status). This study provides empirical evidence for developing fall prevention interventions specific to community-dwelling older adults with HF. Future prospective studies are needed to extend this research to elucidate the causal mechanism among HF, functional factors and falls. Also, future work is needed to understand the indirect effect of behavioral/environmental factors, and/or person-environment interactions, which have not been fully tested on falls in HF patients. In order to develop and test fall prevention interventions for this population, more attention needs to be paid to HF patients{\textquoteright} fall experiences in outpatient, primary or home care settings and their need for support from caregivers, health providers, and the social community.}, keywords = {Heart Failure, Older Adults, Risk Factors}, url = {https://deepblue.lib.umich.edu/handle/2027.42/144142?show=full}, author = {Kayoung Lee} } @article {8709, title = {Accelerated increase and relative decrease in subjective age and changes in attitudes toward own aging over a 4-year period: results from the Health and Retirement Study}, journal = {European Journal of Ageing}, volume = {14}, year = {2017}, pages = {17-27}, abstract = {The passage of time may force people to adjust their subjective age in response to changes in their attitudes toward own aging (ATOA). Although positive associations have been found between well-being and both positive ATOA and younger subjective age, the relationships between changes in these measures have not been examined yet. We expected (1) a decrease in positive ATOA to be associated with an accelerated increase in subjective age and (2) an increase in positive ATOA to be associated with a relative decrease in subjective age. Participants were individuals and their spouses, aged 50 and over, recruited by the Health and Retirement Study, who provided responses to a question concerning one{\textquoteright}s subjective age in 2008 and 2012 (n = 4174). A change in subjective age over the two waves was regarded as (1) an accelerated increase if it was greater than 5 years (36.2 \% of the sample); (2) a relative decrease (39.1 \%), if it was less than the 3 years; (3) no change if it did not comply with criteria 1 or 2 (24.7 \%). A decrease in positive ATOA over the two waves resulted in an accelerated increase in subjective age, and an increase resulted in a relative decrease in subjective age. Older age and more physical impairments and depressive symptoms in 2012 compared with 2008 were associated with an accelerated increase in subjective age. Our findings emphasize the consequences ATOA might have on subjective age experiences, and the need to improve them.}, keywords = {Aging, Cognitive Ability, Health Conditions and Status, Older Adults, Self-reported health}, issn = {1613-9372}, doi = {10.1007/s10433-016-0383-2}, url = {http://link.springer.com/10.1007/s10433-016-0383-2http://link.springer.com/content/pdf/10.1007/s10433-016-0383-2http://link.springer.com/content/pdf/10.1007/s10433-016-0383-2.pdfhttp://link.springer.com/article/10.1007/s10433-016-0383-2/fulltext.html}, author = {Ehud Bodner and Liat Ayalon and Sharon Avidor and Yuval Palgi} } @article {8860, title = {Accounting for the process of disablement and longitudinal outcomes among the near elderly and elderly}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {Jan-01-2017}, pages = {190 - 221}, abstract = {Using a new disability measure applicable to both the near elderly and elderly population, we track respondents aged 51{\textendash}61 in 1992 from the Health and Retirement Study and account for their status over 20 years. We demonstrate that to screen in as disabled and to screen out as nondisabled require different analytic strategies and use multiple indicators to establish three groups: disabled, nondisabled, and a residual category with ambiguous status. We use work-disability and Supplemental Security Income/Disability Insurance (SSI/DI) receipt for testing distributional outcomes and assessing face validity of our disability measure. Selective attrition due to death and institutionalization is substantial over 20 years. Persistent disability is the dominant adverse outcome of initial disability shock. Overtime exits due to death become progressively more important; 44\% disabled at baseline are dead by Wave 11 compared to 21\% for nondisabled. Disability status at baseline is associated with financial insecurity persisting to Wave 11 among survivors. {\textcopyright} 2016, {\textcopyright} The Author(s) 2016.}, keywords = {Disabilities, Financial security, Longitudinal data, Older Adults, Retirement Planning and Satisfaction}, issn = {0164-0275}, doi = {10.1177/0164027516656141}, url = {http://journals.sagepub.com/doi/10.1177/0164027516656141}, author = {Rupp, Kalman and Irena Dushi} } @article {8971, title = {Adaptive Quadrature for Maximum Likelihood Estimation of a Class of Dynamic Latent Variable Models}, journal = {Computational Economics}, volume = {49}, year = {2017}, month = {Jan-04-2017}, pages = {599 - 622}, abstract = {Maximum likelihood estimation of models based on continuous latent variables generally requires to solve integrals that are not analytically tractable. Numerical approximations represent a possible solution to this problem. We propose to use the adaptive Gaussian{\textendash}Hermite (AGH) numerical quadrature approximation for a particular class of continuous latent variable models for time-series and longitudinal data. These dynamic models are based on time-varying latent variables that follow an autoregressive process of order 1, AR(1). Two examples are the stochastic volatility models for the analysis of financial time series and the limited dependent variable models for the analysis of panel data. A comparison between the performance of AGH methods and alternative approximation methods proposed in the literature is carried out by simulation. Empirical examples are also used to illustrate the proposed approach.}, keywords = {Older Adults, Survey Methodology}, issn = {0927-7099}, doi = {10.1007/s10614-016-9573-4}, author = {Cagnone, Silvia and Francesco Bartolucci} } @article {8970, title = {Annuity Options in Public Pension Plans:The Curious Case of Social Security Leveling}, number = {No. 23262}, year = {2017}, month = {03/2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Social Security Leveling is an annuity option that allows participants to receive a level income before and after age 62. The retiree receives a larger pension benefit prior to age 62, but then the pension benefit is lowered at age 62 when the individual is expected to claim Social Security benefits. This option is not uncommon in public pension plans, yet little is known about how this option is used in practice and its impact on well-being in retirement. Our study uses a combination of administrative records and survey data from recent North Carolina public sector retirees. We find that one-third of all retirees selecting a single life annuity between 2009 and 2014 opted for Social Security Leveling. The evidence suggests that individuals are choosing this option in a way that is consistent with their stated preferences and a consumption smoothing motive. However, we also see higher rates of ex post {\textquotedblleft}regret{\textquotedblright} in the annuity choice among those choosing the level income option.}, keywords = {Annuitization, Older Adults, Pensions, Social Security}, doi = {10.3386/w23262}, url = {http://www.nber.org/papers/w23262.pdf}, author = {Robert Clark and Hammond, Robert and Morrill, Melinda and Vanderweide, David} } @article {8952, title = {Anticipated support from children and later-life health in the United States and China}, journal = {Social Science \& Medicine}, volume = {179}, year = {2017}, month = {Jan-04-2017}, pages = {201 - 209}, keywords = {Caregiving, China, Cross-National, Older Adults}, issn = {02779536}, doi = {10.1016/j.socscimed.2017.03.007}, url = {https://www.sciencedirect.com/science/article/pii/S0277953617301466}, author = {Cheng, Cheng} } @article {9009, title = {Arthritis and cognitive impairment in older adults.}, journal = {Rheumatology International}, volume = {37}, year = {2017}, pages = {955-961}, abstract = {Adults aged 65 or older with arthritis may be at increased risk for cognitive impairment [cognitive impairment but not dementia (CIND) or dementia]. Studies have found associations between arthritis and cognition impairments; however, none have examined whether persons with arthritis develop cognitive impairments at higher rates than those without arthritis. Using data from the Health and Retirement Study, we estimated the prevalence of cognitive impairments in older adults with and without arthritis, and examined associations between arthritis status and cognitive impairments. We calculated incidence density ratios (IDRs) using generalized estimating equations to estimate associations between arthritis and cognitive impairments adjusting for age, sex, race/ethnicity, marital status, education, income, depression, obesity, smoking, the number of chronic conditions, physical activity, and birth cohort. The prevalence of CIND and dementia did not significantly differ between those with and without arthritis (CIND: 20.8\%, 95\% CI 19.7-21.9 vs. 18.3\%, 95\% CI 16.8-19.8; dementia: 5.2\% 95\% CI 4.6-5.8 vs. 5.1\% 95\% CI 4.3-5.9). After covariate control, older adults with arthritis did not differ significantly from those without arthritis for either cognitive outcome (CIND IDR: 1.6, 95\% CI = 0.9-2.9; dementia IDR: 1.1, 95\% CI = 0.4-3.3) and developed cognitive impairments at a similar rate to those without arthritis. Older adults with arthritis were not significantly more at risk to develop cognitive impairments and developed cognitive impairments at a similar rate as older adults without arthritis over 6~years.}, keywords = {Arthritis, Cognitive Ability, Older Adults}, issn = {1437-160X}, doi = {10.1007/s00296-017-3698-1}, author = {Nancy A. Baker and Kamil E Barbour and Charles G Helmick and Matthew M. Zack and Soham Al Snih} } @article {8956, title = {Baby boomers in the United States: Factors associated with working longer and delaying retirement.}, journal = {American Journal of Industrial Medicine}, volume = {60}, year = {2017}, month = {2017 Apr}, pages = {315-328}, abstract = {

OBJECTIVES: This study estimated the self-reported probability of working full-time past age 62 (P62) or age 65 (P65) among four cohorts of Americans born between 1931 and 1959.

METHODS: Data from the Health and Retirement Study (HRS) were analyzed. Respondents in four age cohorts were selected for comparison. Multivariable linear regression models were used to assess cohort differences in P62 and P65 while adjusting for covariates.

RESULTS: P62 and P65 increased among boomers despite worsened self-rated health compared to the two preceding cohorts, with 37\% and 80\% increases among mid-boomers in construction trades. Cohort differences in P62 and P65 remained after controlling for covariates. Changes in pensions, income inequity, and education were significantly associated with work expectations, but SSA policy was not.

CONCLUSIONS: Baby boomers expect to work longer than their predecessors. Efforts to improve work quality and availability for older workers are urgently needed, particularly in physically demanding occupations. Am. J. Ind. Med. 60:315-328, 2017. {\textcopyright} 2017 Wiley Periodicals, Inc.

}, keywords = {Baby Boomers, Delaying retirement, Health Conditions and Status, Older Adults, Retirement Planning and Satisfaction}, issn = {1097-0274}, doi = {10.1002/ajim.22694}, author = {Xiuwen S Dong and Wang, Xuanwen and Ringen, Knut and Sokas, Rosemary} } @article {8999, title = {The best investment for retirement? Try marital counseling and a home miles away from your kids}, journal = {The Globe and Mail}, year = {2017}, chapter = {Globe Investor}, address = {Toronto}, keywords = {Counseling, Investing, Marriage, News, Older Adults, Retirement Planning and Satisfaction}, url = {http://www.theglobeandmail.com/globe-investor/retirement/retire-planning/in-retirement-money-doesnt-matter-as-much-as-you-think/article34623592/}, author = {Ian McGugan} } @article {8962, title = {Biopsychosocial Predictors of Fall Events Among Older African Americans.}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {04/2017}, pages = {501-525}, abstract = {This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed.}, keywords = {Falls, Health Shocks, Older Adults, Racial/ethnic differences, Women and Minorities}, issn = {1552-7573}, doi = {10.1177/0164027516651974}, author = {Emily J Nicklett and Taylor, Robert Joseph and Rostant, Ola and Kimson E Johnson and Evans, Linnea} } @article {8707, title = {Changes in positive and negative affect as predictors of change in felt age: Results from the Health and Retirement Study}, journal = {The Journal of Positive Psychology}, volume = {12}, year = {2017}, pages = {605-612}, abstract = {The present study aimed to examine how changes in positive and negative affect and their interaction predict changes in felt age in a longitudinal design of two waves drawn from the Health and Retirement Study (HRS). Participants (n = 4174) at an average age of 67.97 completed the 2008 and 2012 left behind questionnaire of the HRS. Our results showed that an increase in positive affect and a decrease in negative affect from Wave 1 to Wave 2 predicted an accelerated decrease in felt age. There was an interaction effect showing that for those with an increase in negative affect, a higher change in positive affect predicted reduced odds for accelerated increase in felt age. To conclude, improving favorable change in the combination between positive and negative affect might in turn relate to the individual{\textquoteright}s self-perceptions of aging, in the second half of life.}, keywords = {Aging, Mood, Older Adults, Perception, Self-reported health}, issn = {1743-9760}, doi = {10.1080/17439760.2016.1221121}, url = {https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221121}, author = {Yuval Palgi and Liat Ayalon and Sharon Avidor and Ehud Bodner} } @article {8936, title = {Clinical Trials Targeting Aging and Age-Related Multimorbidity}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {72}, year = {2017}, pages = {355-361}, abstract = {Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules.}, keywords = {Chronic disease, Clinical trials, Older Adults}, issn = {1079-5006}, doi = {10.1093/gerona/glw220}, url = {https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated}, author = {Mark A. Espeland and Eileen M. Crimmins and Brandon R. Grossardt and Jill P. Crandall and Jonathan A. L. Gelfond and Tamara B Harris and Stephen B Kritchevsky and JoAnn E Manson and Jennifer G Robinson and Walter A Rocca and Temprosa, Marinella and Thomas, Fridtjof and Robert B Wallace and Barzilai, Nir} } @article {8902, title = {Cut points for clinical muscle weakness among older Americans.}, journal = {American Journal of Preventative Medicine}, volume = {53}, year = {2017}, pages = {63-69}, abstract = {

INTRODUCTION: Muscle weakness is an important indicator of disability, chronic disease, and early mortality. Grip strength is a simple, cost-effective measure of overall muscle strength. The Foundation of the National Institutes of Health recently proposed sex-specific grip strength cut points for clinical muscle weakness. However, these criteria were established using non-nationally representative data. This study used nationally representative data on Americans aged >=65 years to identify race- and sex-specific cut points for clinical muscle weakness and quantify prevalence among older blacks and whites by sex.

METHODS: Classification and Regression Tree models were used to identify cut points based on individual-level grip strength associated with slow gait speed (<0.8 m/second) among 7,688 individuals (57\% female; 8\% black; mean age, 74.6 [SD=6.79] years) from the 2010/2012 Health and Retirement Study during January-April 2016. Identified cut points were then used to quantify the prevalence of weakness by race/sex subgroup.

RESULTS: Fifty-five percent of men (maximum grip strength <39 kg) and 47\% of women (maximum grip strength <22 kg) were classified as weak. Higher cut points were identified for black men (maximum grip strength <40 kg) and women (maximum grip strength <31 kg), and the prevalence of weakness (57\% and 88\%, respectively) was higher compared with whites. Fifty-five percent of individuals had slow gait speed (<0.8 m/second).

CONCLUSIONS: Prevalence of weakness was substantially higher than previous reports, underscoring the importance of using population-level data to identify individuals at greatest risk for adverse health outcomes. This is the first study to establish cut points for muscle weakness in a nationally representative sample by race and sex.

}, keywords = {Cut points, Gender Differences, Grip strength, Muscle Weakness, Older Adults, Racial/ethnic differences}, issn = {1873-2607}, doi = {10.1016/j.amepre.2016.12.022}, author = {Kate A Duchowny and Mark D Peterson and Philippa J Clarke} } @article {8895, title = {Death of family members as an overlooked source of racial disadvantage in the United States.}, journal = {Proceedings of the National Academy of Sciences of the United States of America}, volume = {114}, year = {2017}, month = {2017 Jan 31}, pages = {915-920}, abstract = {

Long-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.

}, keywords = {Bereavement, Death \& Dying, Disadvantage, Loss, Older Adults, Racial/ethnic differences}, issn = {1091-6490}, doi = {10.1073/pnas.1605599114}, author = {Debra Umberson and Olson, Julie Skalamera and Crosnoe, Robert and Hui Liu and Tetyana Pudrovska and Rachel Donnelly} } @article {8921, title = {The Decline in Earnings Prior to Application for Disability Insurance Benefits}, volume = {77}, year = {2017}, pages = {1-15}, publisher = {Social Security Bulletin}, edition = {1}, keywords = {Disabilities, Income, Medicare/Medicaid/Health Insurance, Older Adults, Social Security}, url = {https://www.ssa.gov/policy/docs/ssb/v77n1/v77n1p1.html}, author = {Costa, Jackson} } @article {8849, title = {Dementia rates are declining, and education could have a lot to do with it}, journal = {Stateside}, volume = {2017}, number = {01/10/2017}, year = {2017}, publisher = {Michigan Radio}, address = {Ann Arbor, MI}, keywords = {Dementia, Education, Health Conditions and Status, Interviews, Local news, Older Adults}, url = {http://michiganradio.org/post/dementia-rates-are-declining-and-education-could-have-lot-do-it}, author = {Stateside Staff} } @article {8963, title = {Depressive symptomatology and fall risk among community-dwelling older adults.}, journal = {Social Science \& Medicine}, volume = {178}, year = {2017}, month = {04/2017}, pages = {206-213}, abstract = {

RATIONALE: Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS.

OBJECTIVE: The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship.

METHODS: Using 2006-2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages >=65. Structural coefficients between falls and DS (in 2006{\textrightarrow}2008, 2008{\textrightarrow}2010) were estimated.

RESULTS: A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30\% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model.

CONCLUSION: Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies-highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.

}, keywords = {Community-dwelling, Depressive symptoms, Falls, Health Shocks, Older Adults, Restricted data}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.02.020}, author = {Geoffrey J Hoffman and Hays, Ron D and Steven P Wallace and Martin F Shapiro and Susan L Ettner} } @article {9005, title = {Difficulty managing medications and finances in older adults: A 10-year cohort study.}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1455-1461}, abstract = {

BACKGROUND: Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs.

OBJECTIVES: To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in older adults.

DESIGN: A prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of older adults.

PARTICIPANTS: 9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow-up assessments occurred every 2 years until 2012.

MEASUREMENTS: The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education.

RESULTS: The 10 years incidence of difficulty increased markedly with age, ranging from 10.3\% (95\% CI 9.3-11.6) for managing medications and 23.1\% (95\% CI 21.6-24.7) for managing finances in those aged 65-69, to 38.2\% (95\% CI 33.4-43.5) for medicines and 69\% (95\% CI 63.7-74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men.

CONCLUSION: This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.

}, keywords = {Financial literacy, Older Adults, Prescription Medication, Risk Factors}, issn = {1532-5415}, doi = {10.1111/jgs.14819}, author = {Bleijenberg, Nienke and Sei J. Lee and Irena Cenzer and W John Boscardin and Kenneth E Covinsky} } @article {8907, title = {Discrimination and Telomere Length Among Older Adults in the United States.}, journal = {Public Health Reports}, year = {2017}, month = {2017 Jan 01}, abstract = {

OBJECTIVES: Chronic stress from experiencing discrimination can lead to long-term changes in psychological and physiologic responses, including shorter leukocyte telomere length. We examined the association between leukocyte telomere length and variations in the association by race or type of discrimination.

METHODS: Our study consisted of 3868 US-born non-Hispanic black (hereinafter, black) and non-Hispanic white (hereinafter, white) adult participants from the 2008 Health and Retirement Study biomarker sample with complete sociodemographic and discrimination information. We examined major lifetime unfair treatment and everyday discrimination. Coarsened exact matching matched exposed and unexposed participants on several sociodemographic factors. Coarsened exact matching creates analytic weights for the matched data sets. We applied weighted linear regression to the matched data sets. We conducted 2 subanalyses in which we matched on potential mediators-physical activity, smoking status, and obesity-and examined if racism was associated with shorter telomere length compared with other attributes. All analyses were stratified by race.

RESULTS: We found no difference in telomere length for black and white participants reporting major lifetime unfair treatment (β = 0.09; 95\% CI, -0.33 to 0.15) or everyday discrimination (β = 0.04; 95\% CI, -0.12 to 0.40). Everyday discrimination was associated with shorter leukocyte telomere length among black people (β = -0.23; 95\% CI, -0.44 to -0.01) but not among white people (β = 0.05; 95\% CI, -0.01 to 0.10). Matching on potential mediators generally decreased the effect estimate among black people.

CONCLUSIONS: Experiencing everyday discrimination was associated with shortened telomere length among older black adults. Further research is needed to understand the adverse physiologic effects of discrimination to create effective interventions.

}, keywords = {Discrimination, Older Adults, Racial/ethnic differences, Telomeres}, issn = {1468-2877}, doi = {10.1177/0033354916689613}, author = {Sze Y Liu and Ichiro Kawachi} } @article {8899, title = {Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {International Dental Journal}, volume = {67}, year = {2017}, pages = {157-171}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.

METHOD: We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents >=51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.

RESULTS: In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.

CONCLUSIONS: European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.

}, keywords = {Cross-National, Dental Care, Older Adults, Out-of-pocket payments, SHARE}, issn = {1875-595X}, doi = {10.1111/idj.12284}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {9012, title = {Do multiple health events reduce resilience when compared with single events?}, journal = {Health Psychology}, volume = {36}, year = {2017}, pages = {721-728}, abstract = {

OBJECTIVE: The impact of multiple major life stressors is hypothesized to reduce the probability of resilience and increase rates of mortality. However, this hypothesis lacks strong empirical support because of the lack of prospective evidence. This study investigated whether experiencing multiple major health events diminishes rates of resilience and increases rates of mortality using a large population-based prospective cohort.

METHOD: There were n = 1,395 individuals sampled from the Health and Retirement Study (HRS) and examined prospectively from 2 years before 4 years after either single or multiple health events (lung disease, heart disease, stroke, or cancer). Distinct depression and resilience trajectories were identified using latent growth mixture modeling (LGMM). These trajectories were compared on rates of mortality 4 years after the health events.

RESULTS: Findings indicated that 4 trajectories best fit the data including resilience, emergent postevent depression, chronic pre-to-post depression, and depressed prior followed by improvement. Analyses demonstrate that multiple health events do not decrease rates of resilience but do increase the severity of symptoms among those on the emergent depression trajectory. Emergent depression increased mortality compared with all others but among those in this class, rates were not different in response to single versus multiple health events.

CONCLUSIONS: Multiple major stressors do not reduce rates of resilience. The emergence of depression after health events does significantly increase risk for mortality regardless of the number of events. (PsycINFO Database Record

}, keywords = {Health Shocks, Older Adults, Resilience}, issn = {1930-7810}, doi = {10.1037/hea0000481}, author = {Ruth T Morin and Isaac R Galatzer-Levy and Maccallum, Fiona and George A. Bonanno} } @article {9018, title = {Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study.}, journal = {The Gerontologist}, volume = {57}, year = {2017}, pages = {319}, abstract = {

PURPOSE OF THE STUDY: The purpose of this study is to expand our recent work, which showed that spousal dementia caregivers compared to spousal nondementia caregivers experience an accelerated rate of frailty over time, by exploring cognitive health outcomes between dementia and nondementia caregivers.

DESIGN AND METHODS: Using 8 biannual waves of the Health and Retirement Study data and performance on the modified Telephone Interview for Cognitive Status, we examined changes in cognitive health among surviving spousal caregivers (N = 1,255) of individuals with dementia (n = 192) and without dementia (n = 1,063), 2 waves prior and 2 waves following the death of the care recipient.

RESULTS: Controlling for baseline health and contextual factors (e.g., frailty status, age, education), results revealed that dementia caregivers had significantly greater cognitive decline (p < .01) compared to nondementia caregivers. Relative to 2 waves prior to the death of their spouse, dementia caregivers declined by 1.77 points relative to nondementia caregivers (0.87 points) at the time their spouses{\textquoteright} deaths were reported and 1.89 relative to the 1.18 points at the wave following these deaths, respectively.

IMPLICATIONS: The findings from this study show that spousal caregivers of persons with dementia experience accelerated cognitive decline themselves compared to nondementia caregivers. These results, along with our previous study findings, suggest that this vulnerable group could benefit from early cognitive screening and psychosocial interventions designed to help dementia caregivers better maintain their cognitive and physical health during and following their intensive caregiving responsibilities.

}, keywords = {Caregiving, Cognitive Ability, Dementia, Older Adults}, issn = {1758-5341}, doi = {10.1093/geront/gnv148}, author = {Kara B. Dassel and Dawn C Carr and Vitaliano, Peter} } @article {8923, title = {Effect of mortgage indebtedness on health of U.S. homeowners}, journal = {Review of Economics of the Household}, volume = {15}, year = {2017}, month = {Jan-03-2017}, pages = {239-264}, abstract = {This paper examines the effect of excessive mortgage indebtedness on health among homeowners using nine waves of the Health and Retirement Study from 1992 to 2008. Health status is measured by subjective well-being, number of depressive symptoms, and incidence of hypertension. Using average annual state-level home prices as an instrument, we attempt to identify the causal effect in an panel IV framework. Results from the panel IV estimations suggest that having a high mortgage loan to home value (LTV), defined as LTV at or above 80 \%, leads to more depressive symptoms and a higher incidence of hypertension, but has no effect on subjective well-being. Since the results from panel estimations did not show that debt affects health, whether the panel IV results demonstrate a causal relationship depends critically on the exclusion assumption.}, keywords = {Debt, Economics, Health Conditions and Status, Housing, Mortgages, Older Adults}, issn = {1569-5239}, doi = {10.1007/s11150-014-9250-0}, author = {Leigh Ann Leung and Lau, Catherine} } @article {8964, title = {Ethnic Differences in Advance Directive Completion and Care Preferences: What Has Changed in a Decade?}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1352-1357}, abstract = {Studies have documented ethnic differences in advance directive (AD) completion, with lower rates in minority groups. Of those with ADs, blacks are more likely than whites to prefer aggressive care, but little is known about how these differences in preferences have changed over time in ethnic groups. This nationally representative study aimed to investigate whether these differences in AD development persisted after adjusting for important confounding variables. Year of death was analyzed to see how AD completion changed over time within ethnic groups, and for those with an AD, the association between these factors and opting for aggressive care was investigated. Data from the 2000 to 2012 Health and Retirement Study (HRS) exit interviews from 7,177 decedents were used. Analyses included logistic regression to determine the relationship between ethnicity and AD completion and preferences for aggressive care and how it changed over time in ethnic groups. Forty-six percent of decedents had completed an AD (whites 51.7\%, Hispanics 18.0\%, blacks 15.0\%). Of blacks completing an AD, 23.8\% elected prolonged care, compared with 13.3\% of Hispanics and 3.3\% of whites. Logistic regression revealed that blacks 75\% lower odds of completing an AD and Hispanics had 70\% lower odds. Model covariates had a small influence on ethnic differences, although in examining the change in AD completion over time, the odds of having an AD increased with each subsequent death year for blacks and whites but not Hispanics. Additional research is needed to investigate the effect of cultural differences in AD completion rates of ethnic minority groups to ensure that preferences are honored in the clinical setting.}, keywords = {Older Adults, Racial/ethnic differences}, issn = {1532-5415}, doi = {10.1111/jgs.14800}, author = {Portanova, Jaclyn and Jennifer A Ailshire and Perez, Catherine and Rahman, Anna and Enguidanos, Susan} } @article {8897, title = {Exercising your brain could stave off dementia}, journal = {Ask the Doctors}, year = {2017}, publisher = {The Californian}, address = {Salinas, CA}, keywords = {Dementia, Exercise, News, Older Adults}, url = {http://www.thecalifornian.com/story/life/2017/01/11/ask-drs-exercising-brain-stave-dementia/96232212/}, author = {Ashley, Robert} } @article {9471, title = {Functional Impairment and Decline in Middle Age: A Cohort Study.}, journal = {Annals of Internal Medicine}, volume = {167}, year = {2017}, pages = {761-768}, abstract = {

Background: Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults.

Objective: To determine the epidemiology and clinical course of functional impairment and decline in middle age.

Design: Cohort study.

Setting: The Health and Retirement Study.

Participants: 6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment.

Measurements: Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes.

Results: Impairment in ADLs developed in 22\% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4\% (95\% CI, 3\% to 5\%) of participants had died, 9\% (CI, 8\% to 11\%) had further ADL decline, 50\% (CI, 48\% to 52\%) had persistent impairment, and 37\% (CI, 35\% to 39\%) had recovered independence. In the 10 years after the initial impairment, 16\% (CI, 14\% to 18\%) had 1 or more episodes of functional decline and 28\% (CI, 26\% to 30\%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs.

Limitation: Functional status was self-reported.

Conclusion: Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age.

Primary Funding Source: National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.

}, keywords = {Activities of Daily Living, Functional limitations, Memory, Older Adults}, issn = {1539-3704}, doi = {10.7326/M17-0496}, author = {Rebecca T Brown and L Grisell Diaz-Ramirez and W John Boscardin and Sei J. Lee and Michael A Steinman} } @article {8966, title = {Functional limitations and health care resource utilization for individuals with cognitive impairment without dementia: Findings from a United States population-based survey.}, journal = {Alzheimer{\textquoteright}s \& Dementia}, volume = {6}, year = {2017}, month = {2017}, pages = {65-74}, abstract = {

INTRODUCTION: Little is known about functional limitations and health care resource utilization of people with cognitive impairment with no dementia (CIND).

METHODS: Respondents with stable or progressive cognitive impairment (CI) after the first (index) indication of CIND in 2000-2010 were identified from the Health and Retirement Study (HRS). Respondents never exhibiting CI were identified as potential controls. Propensity score-based optimal matching was used to adjust for differences in demographics and history of stroke. Differences between cohorts were assessed accounting for HRS survey design.

RESULTS: After matching, CIND respondents had more functional limitations (difficulty with >=1 activities of daily living: 24\% vs. 15\%; >=1 instrumental activities of daily living: 20\% vs. 11\%) and hospital stays (37\% vs. 27\%) than respondents with no CI (all P~<~.001). Seventy five percent of CIND respondents developed dementia in the observable follow-up (median time: \~{}6~years).

DISCUSSION: Even before dementia onset, CI is associated with increased likelihood of functional limitations and greater health care resource use.

}, keywords = {CIND, Cognitive Ability, Functional limitations, Older Adults}, doi = {10.1016/j.dadm.2016.11.005}, author = {J. Scott Andrews and Desai, Urvi and Noam Y Kirson and Caroline J. Enloe and Ristovska, Ljubica and King, Sarah and Howard G. Birnbaum and Adam S. Fleisher and Ye, Wenyu and Kahle-Wrobleski, Kristin} } @article {8979, title = {Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1482-1489}, abstract = {Objective To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Design Nationally representative cohort study. Setting Health and Retirement Study. Participants 7,492 U.S. adults aged >=65 years. Measurements Grip strength was measured by a hand dynamometer and classified as normal (>=16 kg for female; >=26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (>=0.60 m/s for female; >=0.52 m/s for male) and slow. Results Over an average follow-up time of 6.0 years, 1,870 (25.0\%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (>=150 mmHg) and DBP (>=90 mmHg) was associated with a 24\% (95\% CI, 7{\textendash}43\%) and 25\% (95\% CI, 5{\textendash}49\%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6\% (95\% CI, 31 to -27\%) and a 16\% (95\% CI, 46 to -26\%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95\% CI, 0.56{\textendash}1.29) and 0.53 (95\% CI, 0.30{\textendash}0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed. Conclusion Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.}, keywords = {Blood pressure, Grip strength, Mortality, Older Adults}, doi = {10.1111/jgs.14816}, url = {http://doi.wiley.com/10.1111/jgs.14816http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.14816/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Fjgs.14816}, author = {Wu, Chenkai and Smit, Ellen and Peralta, Carmen A and Sarathy, Harini and Michelle C Odden} } @article {8960, title = {The "Good Times" Cohort in Later-Life.}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {2017 Apr}, pages = {526-548}, abstract = {Race differences in midlife circumstances explain much of the disability gap in older adulthood, but questions remain about whether early life selection processes are race invariant. To address this, we (1) isolate the 1930s cohort to explore potential race-specific life courses and (2) utilize a two-stage estimation procedure to examine the role of early-to-midlife selection in shaping later-life functional limitations. Using data on Black and White adults born 1931-1941 from the Health and Retirement Study (W2-W9), we estimate trajectories of later-life functional limitations after modeling midlife income and comorbidity as a function of early life factors. Fair/poor childhood health similarly impacts midlife morbidity for both races. Childhood disadvantage (poor family, father unemployed, and no father/deceased) had an adverse effect on midlife income for White but not for Black adults. An education gradient in functional limitations exists only for White adults. We interpret these findings in the sociohistorical context of this birth cohort.}, keywords = {Older Adults, Racial/ethnic differences}, issn = {1552-7573}, doi = {10.1177/0164027516655582}, author = {Jessica Kelley-Moore and Huang, Wenxuan} } @article {8948, title = {Health, Health Insurance, and Retirement: A Survey}, number = {17-03}, year = {2017}, month = {01/2017}, institution = {Federal Reserve Bank of Richmond}, address = {Richmond, Virginia}, abstract = {The degree to which retirement decisions are driven by health is a key concern for both academics and policymakers. In this paper we survey the economic literature on the health-retirement link in developed countries. We describe the mechanisms through which health affects labor supply and discuss how they interact with public pensions and public health insurance. The historical evidence suggests that health is not the primary source of variation in retirement across countries and over time. Furthermore, declining health with age can only explain a small share of the decline in employment near retirement age. Health considerations nonetheless play an important role, especially in explaining cross-sectional variation in employment and other outcomes within countries. We review the mechanisms through which health affects retirement and discuss recent empirical analyses.}, keywords = {Disabilities, Health Conditions and Status, Medicare/Medicaid/Health Insurance, Older Adults, Retirement Planning and Satisfaction}, url = {https://www.richmondfed.org/-/media/richmondfedorg/publications/research/working_papers/2017/pdf/wp17-03.pdf}, author = {Eric French and John Bailey Jones} } @article {8896, title = {Health Status, Health Shocks, and Asset Adequacy Over Retirement Years.}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {2017 Jan}, pages = {222-248}, abstract = {

This article uses data on a sample of retirees drawn from the Health and Retirement Study (HRS) to examine changes in health over the retirement years and to estimate the effects of health changes in retirement on wealth. Using the framework of item response theory, we develop a novel measure of health that makes use of multiple indicators of physical health that are available in the HRS. We find that large negative shocks to the health of male retirees and their spouses are frequent in retirement and that when such shocks do occur, recovery to the preshock level of health is rare. Using a dynamic panel data model, we then estimate short- and long-run effects of changes in health on wealth. While our estimated short-run effects are modest, long-run estimates of the impact of health shocks on wealth are large, ranging from a 12\% to 20\% reduction in wealth by the 10th year, following a permanent one standard deviation decrease in health.

}, keywords = {Health Conditions and Status, Health Shocks, Older Adults, Retirement Planning and Satisfaction}, issn = {1552-7573}, doi = {10.1177/0164027516669567}, author = {Geoffrey L Wallace and Haveman, Robert and Barbara Wolfe} } @article {8998, title = {Heavier patients less likely to receive hospice care at end of life}, year = {2017}, publisher = {Michigan Radio}, keywords = {BMI, Hospice, News, Older Adults}, url = {http://michiganradio.org/post/heavier-patients-less-likely-receive-hospice-care-end-life}, author = {Stateside Staff} } @article {8968, title = {High Hemoglobin A1c and Diabetes Predict Memory Decline in the Health and Retirement Study.}, journal = {Alzheimer Disease and Associated Disorders}, volume = {31}, year = {2017}, month = {2017 Jan-Mar}, pages = {48-54}, abstract = {

BACKGROUND: Type 2 diabetes (T2D) is an established risk factor for dementia, but evidence for T2D and memory decline is less consistent. Understanding how T2D and blood glucose relate to memory decline is crucial to elucidating the mechanisms linking T2D and dementia.

MATERIALS AND METHODS: For 8888 Health and Retirement Study participants aged 50+, glycosylated hemoglobin (HbA1c) was measured in either 2006 or 2008 and physician{\textquoteright}s diagnosis of diabetes was self-reported in the same year. Composite memory (z scored) was assessed biennially through 2012 using immediate and delayed word list recall or the Informant Questionnaire for Cognitive Decline. Marginal mean regression models for repeated outcomes were specified to predict memory decline as a function of diabetes or HbA1c, using age as the timescale and adjusting for health and social confounders.

RESULTS: Diabetes was associated with a 10\% faster rate of memory decline [β=-0.04 per decade; 95\% confidence interval (CI), -0.06 to -0.01). A 1 U increase in HbA1c corresponded with a 0.05 SD decrease in memory score per decade (95\% CI, -0.08 to -0.03). Even among individuals with HbA1c<6.5\% (threshold for diabetes), higher HbA1c was associated with memory decline (β=-0.05 per decade; 95\% CI, -0.08 to -0.03).

DISCUSSION: Diabetes accelerated memory loss and higher HbA1c predicted memory decline even in nondiabetics.

}, keywords = {Cognitive Ability, Diabetes, Memory, Older Adults}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000182}, author = {Jessica R Marden and Elizabeth R Mayeda and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and M. Maria Glymour} } @article {8922, title = {How Couples Approach Portfolio Allocation}, volume = {17}, year = {2017}, publisher = {Federal Reserve Bank of Richmond}, chapter = {Economic Brief}, abstract = {The classical theory of household portfolio allocation finds that the share of household wealth invested in risky assets is independent of the level of household wealth. However, this prediction is at odds with empirical observations. This Economic Brief presents findings that reconcile the two. A model in which a household{\textquoteright}s portfolio allocation reflects the preferences of both spouses, adjusted for the bargaining power of each spouse, predicts that the wealthier a household becomes, the greater the share of its wealth will be invested in risky assets. }, keywords = {Decision making, Marriage, Older Adults, Retirement Planning and Satisfaction, Risk Aversion}, url = {https://www.richmondfed.org/-/media/richmondfedorg/publications/research/economic_brief/2017/pdf/eb_17-02.pdf}, author = {Fessenden, Helen and Lazaryan, Nika and Neelakantan, Urvi} } @article {8957, title = {Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study.}, journal = {Journal of Epidemiology and Community Health}, volume = {71}, year = {2017}, pages = {750-757}, abstract = {

OBJECTIVES: Poor health is a recognised predictor of workforce exit, but little is known about the role of insomnia in workforce exit. We examined the association between insomnia symptoms and subsequent job exit among middle-aged and older adults from the Health and Retirement Study (HRS).

METHODS: The study sample consisted of 5746 respondents aged between 50 and 70 who were working for pay when interviewed in the HRS 2004 and were followed up in the HRS 2006. Multinomial logistic regression was used to determine the association between number of insomnia symptoms (0, 1-2, 3-4) and job exit (no exit, health-related exit or exit due to other reasons).

RESULTS: In models adjusting for demographic characteristics, baseline health status and baseline job characteristics, compared with respondents with no insomnia symptoms, those with 3-4 insomnia symptoms had approximately twice the odds of leaving the workforce due to poor health (adjusted relative risk ratio=1.93, 95\% CI 1.04 to 3.58, p=0.036). There was no association between insomnia and job exit due to non-health reasons.

CONCLUSIONS: An elevated number of insomnia symptoms is independently associated with leaving paid employment. Workplace screening for and treatment of insomnia symptoms may prolong labour force participation of middle-aged and older adults.

}, keywords = {Employment and Labor Force, Older Adults, Sleep}, issn = {1470-2738}, doi = {10.1136/jech-2016-208630}, author = {Dong, Liming and Agnew, Jacqueline and Ramin Mojtabai and Pamela J Surkan and Adam P Spira} } @article {8961, title = {Intraindividual Variability in Late-Life Functional Limitations Among White, Black, and Hispanic Older Adults.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {04/2017}, pages = {549-572}, abstract = {Consistent with the weathering hypothesis, many studies have captured racial/ethnic disparities in average functional health trajectories. The same mechanisms of social inequality that contribute to worse average health among minority adults may also contribute to greater fluctuations in their physical function at upper ages. Using panel data from the Health and Retirement Study, we examine patterns of intraindividual variability over time in trajectories of functional limitations for White, Black, and Hispanic older adults. Intraindividual variability increases with age for both Whites and Blacks and such increase is greater for Blacks. Hispanics have the greatest intraindividual variability but there is no age-based pattern. Socioeconomic status and comorbidity are associated with intraindividual variability for all race/ethnicity yet do not explain the age-based increase in intraindividual variability for Whites or Blacks. The findings suggest further nuances to the weathering hypothesis-social disadvantage can generate instability in physical function as minority adults age.}, keywords = {Functional limitations, Health Conditions and Status, Older Adults, Racial/ethnic differences}, issn = {1552-7573}, doi = {10.1177/0164027516655583}, author = {Lin, Jielu and Jessica Kelley-Moore} } @article {8861, title = {Late Career Job Loss and Retirement Behavior of Couples}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {Jan-01-2017}, pages = {7 - 28}, abstract = {This article argues that wealth uncertainty influences when couples choose to retire. Using data from the Health and Retirement Study, I show that wives delay retirement when their husbands retire following a job loss. This effect is stronger when husbands are the primary earners, and couples are relatively poorer. This provides evidence of intra-household insurance that mitigates the impact of an unexpected earnings shock. I find that wives tend to delay retirement only until they become eligible for social security. This suggests that social security benefits can relax households{\textquoteright} budget constraints and allow wives to join their husbands in retirement}, keywords = {Couples, Employment and Labor Force, Job loss, Marriage, Older Adults, Retirement Planning and Satisfaction}, issn = {0164-0275}, doi = {10.1177/0164027516656136}, url = {http://journals.sagepub.com/doi/10.1177/0164027516656136}, author = {Lee, Ajin} } @article {BEGLEY201737, title = {Legacies of homeownership: Housing wealth and bequests}, journal = {Journal of Housing Economics}, volume = {35}, year = {2017}, pages = {37 - 50}, abstract = {This paper examines the effect of housing price shocks during the recent housing boom and bust on the bequest behavior of older homeowners. Prior studies find that illiquid assets have a strong expected influence on bequests, which suggests volatile housing markets will alter household bequest expectations, particularly since housing is generally the largest share of household wealth. I calculate shocks to housing wealth as the deviation in values from their growth trend over the last three years, and I exploit the geographic variation in housing market volatility to explore the relationship between housing value shocks and bequest expectations over the housing boom and bust. I find that housing price shocks, and especially negative shocks, have a consistent influence on bequest expectations for homeowners, particularly for older homeowners, and for those without stocks. A complementary analysis of elasticities also reveals a larger influence of housing values on bequests than other forms of wealth.}, keywords = {Bequests, Homeownership, Housing markets, Older Adults, Wealth}, issn = {1051-1377}, doi = {https://doi.org/10.1016/j.jhe.2016.12.002}, url = {http://www.sciencedirect.com/science/article/pii/S1051137715300103}, author = {Jaclene Begley} } @article {9000, title = {Life Course Trajectories of Later-Life Cognitive Functions: Does Social Engagement in Old Age Matter?}, journal = {International Journal of Environmental Research and Public Health}, volume = {14}, year = {2017}, month = {2017 Apr 07}, abstract = {This study identified differential patterns of later-life cognitive function trajectories and examined to what extent life course factors and social engagement are associated with group trajectories. Data came from seven waves of the Health and Retirement Study (HRS 1998-2010; n = 7374; Observations = 41,051). Latent class growth analysis identified cognitive function trajectory groups, and multinomial logistic regression was used to examine the factors associated with group trajectories. Five heterogeneous trajectories were identified: stable high, stable moderate, stable low, high-to-moderate, and moderate-to-low. Findings suggest that, after adjusting for life course factors, individuals who became volunteers were more likely to belong to one of the two least vulnerable trajectories, stable high or high-to-moderate. Our findings suggest that, despite the cumulative life course factors evident in cognitive decline, social engagement in old age may serve as a potential protective resource.}, keywords = {Cognitive Ability, Older Adults, Social Relationships, Trajectories}, issn = {1660-4601}, doi = {10.3390/ijerph14040393}, author = {So Jung Park and Kwon, Eunsun and Lee, Hyunjoo} } @article {8892, title = {Lifecourse transitions, gender and drinking in later life}, journal = {Ageing and Society}, volume = {37}, year = {2017}, month = {Jan-03-2017}, pages = {462 - 494}, abstract = {Older people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult{\textquoteright}s alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol.}, keywords = {Alcohol Consumption, Gender Differences, Older Adults, Women and Minorities}, issn = {0144-686X}, doi = {10.1017/S0144686X15001178}, url = {https://www.cambridge.org/core/product/identifier/S0144686X15001178/type/journal_article}, author = {Holdsworth, Clare and Frisher, Martin and Mendoca, Marina and de Olivieria, Cesar and Pikhart, Hynek and Shelton, Nicola} } @article {9017, title = {The Long Reach of Education: Health, Wealth, and DI Participation}, number = {Working Paper No. 23307}, year = {2017}, month = {04/2017}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Education is strongly related to participation in the Social Security Disability Insurance (DI) program. To explore this relationship, we describe the correlation between education and DI participation, and then explore how four factors related to education - health, wealth, occupation, and employment - feature in this correlation. We label these four factors {\textquotedblleft}pathway{\textquotedblright} variables. We find that a large component of the relationship between education and DI participation - more than one-third for men, and over two-thirds for women - can be attributed to the correlation of education with health, and of health with DI receipt. We use data from the Health and Retirement Study for the 1992-2012 period to explore the corresponding roles for each of the pathway variables, and also to study how changes over time in these variables, such as the widening gap between the health status of those with high and low educational attainment, have affected DI participation.}, keywords = {Education, Health Conditions and Status, Older Adults, Wealth}, doi = {10.3386/w23307}, url = {http://www.nber.org/papers/w23307.pdf}, author = {James M. Poterba and Steven F Venti and David A Wise} } @article {8903, title = {Marital Biography, Social Security Receipt, and Poverty.}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {2017 Jan}, pages = {86-110}, abstract = {

Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. Partnereds are disproportionately likely to receive Social Security and they enjoy relatively high Social Security benefits and very low poverty levels. Among singles, economic well-being varies by marital biography and gender. Gray divorced and never-married women face considerable economic insecurity. Their Social Security benefits are relatively low, and their poverty rates are quite high (over 25\%), indicating Social Security alone is not sufficient to prevent these women from falling into poverty. By comparison, gray widoweds are the most advantaged singles.

}, keywords = {Gender Differences, Marriage, Older Adults, Poverty, Social Security}, issn = {1552-7573}, doi = {10.1177/0164027516656139}, author = {Lin, I-Fen and Susan L. Brown and Anna M Hammersmith} } @article {9013, title = {Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia.}, journal = {Inquiry}, volume = {54}, year = {2017}, month = {2017 Jan}, pages = {46958017696757}, abstract = {Understanding expenditure patterns for hospital and emergency department (ED) use among individuals with dementia is crucial to controlling Medicare spending. We analyzed Health and Retirement Study data and Medicare claims, stratified by beneficiaries{\textquoteright} residence and proximity to death, to estimate Medicare expenditures for all-cause and potentially avoidable hospitalizations and ED visits. Analysis was limited to the Medicare fee-for-service population age 65 and older. Compared with people without dementia, community residents with dementia had higher average expenditures for hospital and ED services; nursing home residents with dementia had lower average expenditures for all-cause hospitalizations. Decedents with dementia had lower expenditures than those without dementia in the last year of life. Medicare expenditures for individuals with and without dementia vary by residential setting and proximity to death. Results highlight the importance of addressing the needs specific to the population with dementia. There are many initiatives to reduce hospital admissions, but few focus on people with dementia.}, keywords = {Dementia, Emergency services, Medicare linkage, Older Adults}, issn = {1945-7243}, doi = {10.1177/0046958017696757}, author = {Daras, Laura Coots and Feng, Zhanlian and Joshua M Wiener and Kaganova, Yevgeniya} } @article {8900, title = {Mental retirement and health selection: Analyses from the U.S. Health and Retirement Study.}, journal = {Social Science \& Medicine}, volume = {178}, year = {2017}, month = {2017 Jan 22}, pages = {78-86}, abstract = {

BACKGROUND: Research has recently suggested that retirement may decrease cognitive engagement, resulting in cognitive aging. Few studies have systematically documented whether or how selectivity into retirement shapes the relationship between retirement and cognitive aging.

METHODS: We draw on data from the Health and Retirement Study (1998-2012) to examine the relationship between cognition and retirement for 18,575 labor force participants. Longitudinal regression discontinuity modeling was used to examine performance and decline in episodic memory. Models differentiated three forms of selection bias: indirect and direct selection as well as reverse causation. To further interrogate the disuse hypothesis, we adjust for confounding from health and socioeconomic sources.

RESULTS: Results revealed that individuals who retired over the course of the panel were substantially different in terms of health, wealth and cognition when compared to those who remained employed. However, accounting for observed selection biases, significant associations were found linking longer retirement with more rapid cognitive decline.

DISCUSSION: This study examined respondents who were in the labor force at baseline and transitioned into retirement. Analyses suggested that those who retired over the course of the panel had worse overall functioning, but also experienced more rapid declines after retirement that increased the rate of aging by two-fold, resulting in yearly losses of 3.7\% (95\% CI~=~[3.5, 4.0]) of one standard deviation in functioning attributable to retirement. Results are supportive of the view that retirement is associated with more rapid cognitive aging.

}, keywords = {Cognitive Ability, Memory, Older Adults, Retirement Planning and Satisfaction}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.01.019}, author = {Sean A. P. Clouston and Denier, Nicole} } @article {8955, title = {More Americans say they{\textquoteright}re in pain. It{\textquoteright}s a fascinating and disturbing medical mystery.}, volume = {2017}, number = {03/16/2017}, year = {2017}, publisher = {Vox Media}, keywords = {Chronic pain, Health Conditions and Status, News, Older Adults}, url = {http://www.vox.com/science-and-health/2017/3/15/14903130/more-americans-pain-opioids-disturbing-medical-mystery}, author = {Frostenson, Sarah} } @article {8887, title = {More Women in Their 60s and 70s Are Having {\textquoteleft}Way Too Much Fun{\textquoteright} to Retire}, journal = {The New York Times}, volume = {February 12, 2017}, number = {A1}, year = {2017}, month = {02/12/2017}, chapter = {A}, address = {New York City}, keywords = {News, Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, url = {https://www.nytimes.com/2017/02/11/upshot/more-women-in-their-60s-and-70s-are-having-way-too-much-fun-to-retire.html?_r=0}, author = {Claire Cain Miller} } @article {8967, title = {Neighborhood Differences in Post-Stroke Mortality.}, journal = {Circulaton. Cardiovascular quality and outcomes}, volume = {10}, year = {2017}, month = {02/2017}, abstract = {

BACKGROUND: Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke.

METHODS AND RESULTS: Health and Retirement Study participants aged >=50 years without stroke at baseline (n=15 560) were followed <=12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95\% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95\% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals.

CONCLUSIONS: Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

}, keywords = {Mortality, Neighborhoods, Older Adults, Stroke}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.116.002547}, author = {Theresa L Osypuk and Amy Ehntholt and J Robin Moon and Paola Gilsanz and M. Maria Glymour} } @article {8901, title = {Neighborhood Environment and Falls among Community-Dwelling Older Adults.}, journal = {International Journal of Environmental Research and Public Health}, volume = {14}, year = {2017}, month = {2017 Feb 10}, abstract = {

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006-2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit increase in neighborhood social cohesion was associated with 4\% lower odds of experiencing a single fall (odds ratio (OR): 0.96, 95\% confidence interval (CI): 0.93-0.99) and 6\% lower odds of experiencing multiple falls (OR: 0.94, 95\% CI: 0.90-0.98). A one-unit increase in the physical environment scale was associated with 4\% lower odds of experiencing a single fall (OR: 0.96, 95\% CI: 0.93-0.99) and with 5\% lower odds of experiencing multiple falls (OR: 0.95, 95\% CI: 0.91-1.00) in adjusted models. Conclusions: The physical and social neighborhood environment may affect fall risk among community-dwelling older adults. Findings support the ongoing need for evidence-based fall prevention programming in community and clinical settings.

}, keywords = {Community-dwelling, Health Shocks, Neighborhoods, Older Adults, Social Support}, issn = {1660-4601}, doi = {10.3390/ijerph14020175}, author = {Emily J Nicklett and Matthew C. Lohman and Matthew Lee Smith} } @article {8894, title = {Own Gender, Sibling{\textquoteright}s Gender, Parent{\textquoteright}s Gender: The Division of Elderly Parent Care among Adult Children}, journal = {American Sociological Review}, volume = {82}, year = {2017}, month = {Jan-02-2017}, pages = {116 - 146}, abstract = {Research on the gender division of family labor largely focuses on housework and childcare in spousal couples. This article advances scholarship by examining the gender division of elderly parent care in sibling groups. Using the Health and Retirement Study, a nationally representative survey of elderly Americans, I find that caregiving to elderly parents varies not only by an adult child{\textquoteright}s own gender, but also by the gender of the siblings with whom caregiving is shared and by the gender of the parent to whom care is provided. The salience of an adult child{\textquoteright}s gender manifests in two primary ways: not only do daughters provide more care than do sons to their elderly parents, but daughters{\textquoteright} caregiving is also more elastic with respect to their own and their parents{\textquoteright} attributes than is sons{\textquoteright} caregiving. With respect to the gender of the siblings, sons provide relatively less care if they have sisters, whereas daughters provide relatively more care if they have brothers. With respect to the gender of the parent, sons provide relatively more care to fathers, and daughters provide relatively more care to mothers. Finally, analyses did not reveal changes over time.}, keywords = {Caregiving, Gender Differences, Gender Identity, Older Adults, Siblings, Women and Minorities}, issn = {0003-1224}, doi = {10.1177/0003122416686521}, url = {http://journals.sagepub.com/doi/10.1177/0003122416686521}, author = {Grigoryeva, Angelina} } @article {8898, title = {Perceived Neighborhood Social Cohesion and Preventive Healthcare Use.}, journal = {American Journal of Preventative Medicine}, volume = {53}, year = {2017}, pages = {e35-e40}, abstract = {

INTRODUCTION: Neighborhood social cohesion has been linked with better health and health behaviors, but its association with patterns of preventive healthcare use remains understudied. The hypothesis was that people with higher perceived neighborhood social cohesion would display increased use of preventive healthcare services.

METHODS: Participants (N=7,168) were drawn from the 2006 wave of the Health and Retirement Study-a prospective and nationally representative panel study of American adults aged >50 years-and tracked for one wave (2 years). Analyses were conducted in 2016.

RESULTS: After adjusting for sociodemographic factors and baseline health, each SD increase in neighborhood social cohesion was associated with a higher likelihood that people would obtain influenza vaccinations (OR=1.09, 95\% CI=1.04, 1.15) or cholesterol tests (OR=1.10, 95\% CI=1.02, 1.19). Further, women were more likely to receive mammograms/x-rays (OR=1.10, 95\% CI=1.01, 1.19) or Pap tests (OR=1.08, 95\% CI=1.00, 1.17). However, men were not more likely to receive prostate exams (OR=1.06, 95\% CI=0.96, 1.17).

CONCLUSIONS: With additional research, findings from this study may inform the development of new strategies that increase the use of preventive healthcare services and enhance the quality of life among people moving through the ranks of this aging society.

}, keywords = {Medicare/Medicaid/Health Insurance, Older Adults, Perception, Preventative Care, Social Relationships}, issn = {1873-2607}, doi = {10.1016/j.amepre.2017.01.007}, author = {Eric S Kim and Ichiro Kawachi} } @article {8950, title = {Personality and Employment Transitions at Older Ages: Direct and Indirect Effects through Non-Monetary Job Characteristics}, journal = {Labour}, volume = {31}, year = {2017}, pages = {127-152}, abstract = {We study whether individuals with different personality traits systematically exhibit different retirement trajectories. We find weak direct associations between personality and employment transitions. On the other hand, personality does contribute indirectly to these transitions by moderating the effects of non-monetary job characteristics. Specifically, workers with different traits are observed to follow different retirement paths when faced with similar physical demands, computer skills requirements, job flexibility, and age discrimination in the workplace. Contrary with other economic domains, conscientiousness does not have the strongest association with retirement; the other components of the Big Five personality traits show more salient patterns.}, keywords = {Employment and Labor Force, Jobs, Older Adults, Personality}, doi = {10.1111/labr.12090}, url = {http://doi.wiley.com/10.1111/labr.12090http://onlinelibrary.wiley.com/wol1/doi/10.1111/labr.12090/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Flabr.12090}, author = {Marco Angrisani and Michael D Hurd and Erik Meijer and Andrew M Parker and Susann Rohwedder} } @article {8906, title = {Personality traits and risk of cognitive impairment and dementia.}, journal = {Journal of Psychiatric Research}, volume = {89}, year = {2017}, month = {2017 Jan 22}, pages = {22-27}, abstract = {

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N~>~10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample.

}, keywords = {Cognitive Ability, Dementia, Older Adults, Personality}, issn = {1879-1379}, doi = {10.1016/j.jpsychires.2017.01.011}, author = {Antonio Terracciano and Yannick Stephan and Martina Luchetti and Albanese, Emiliano and Angelina R Sutin} } @article {9002, title = {Physical activity, but not body mass index, predicts less disability before and after stroke.}, journal = {Neurology}, volume = {88}, year = {2017}, month = {05/2017}, pages = {1718-1726}, abstract = {

OBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free.

METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates.

RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke.

CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.

}, keywords = {BMI, Disabilities, Older Adults, Physical activity, Stroke}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000003888}, author = {Pamela M. Rist and Benjamin D Capistrant and Elizabeth R Mayeda and Sze Y Liu and M. Maria Glymour} } @article {9001, title = {Predictive validity of the Work Ability Index and its individual items in the general population.}, journal = {Scandinavian Journal of Public Health}, volume = {45}, year = {2017}, pages = {350-356}, abstract = {

AIM: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population.

METHODS: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25-75-year-olds living in Sweden in 2000 that received a postal questionnaire ( n = 6637, response rate = 53\%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed.

RESULTS: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95\% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI.

CONCLUSIONS: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

}, keywords = {Older Adults, Self-reported health}, issn = {1651-1905}, doi = {10.1177/1403494817702759}, author = {Lundin, Andreas and Leijon, Ola and Vaez, Marjan and Hallgren, Mats and Torg{\'e}n, Margareta} } @article {8981, title = {Pros and cons of retiring near children}, journal = {Chicago Tribune}, year = {2017}, chapter = {Business/Success/Kiplinger}, keywords = {Adult children, News, Older Adults}, url = {http://www.chicagotribune.com/business/success/kiplinger/tca-pros-and-cons-of-retiring-near-children-20170331-story.html}, author = {Clark, Jane Bennett} } @article {8918, title = {Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.}, journal = {International Journal of Geriatric Psychiatry}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {164-174}, abstract = {

OBJECTIVE: To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia.

METHODS: Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer).

RESULTS: Of 414 participants with dementia, 41.4\% were prescribed a psychotropic medication, including 84.0\% of nursing home residents and 28.6\% of community-dwellers. Of participants, 23.5\% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use.

CONCLUSIONS: In this nationally representative sample, 41.4\% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {ADAMS, Antidepressants, Dementia, Drug use, Older Adults, Psychiatry}, issn = {1099-1166}, doi = {10.1002/gps.4452}, author = {Donovan T Maust and Kenneth M. Langa and Frederic C. Blow and Helen C Kales} } @article {8859, title = {Quantifying the relationship between patient characteristics and involvement in developing and implementing a treatment plan}, journal = {Drug, Healthcare and Patient Safety}, volume = {Volume 9}, year = {2017}, month = {Jan-01-2017}, pages = {1 - 8}, abstract = {Objective: Improving the patient-physician relationship through patient involvement in the care may lead to improved patient safety and better health outcomes. There exists a gap in knowledge in identifying factors that affect self-reported patient involvement in individualized treatment plans. The objectives of this study were to 1) describe patients{\textquoteright} perceptions of their involvement in the creation and implementation of their treatment plans and 2) determine if patient involvement varied by medical condition or demographic characteristics. Methods: This study was a cross-sectional analysis of data from the {\textquotedblleft}Quality of Care{\textquotedblright} module of the 2008 Health and Retirement Study (HRS). The individuals of HRS surveys were older than 50 years. One-way analyses of variance were conducted to determine differences between patient characteristics and involvement in creating a treatment plan. A linear regression was conducted to determine predictors of the summed involvement score. Results: Average summed scores for each domain (shared decision-making, counseling, and follow-up) and overall involvement scores were ~50\%. Linear regression showed that being non-White, older age, and diagnosed with a psychiatric condition or diabetes were predictors of increased self-reported involvement in the development and communication of a patient{\textquoteright}s treatment plan. Conclusion: Age, race, and having diabetes or a psychiatric condition were the major predictors affecting patient involvement in care, although overall involvement in care was low for all groups. Practice implications: Patient involvement in care was lower than expected and should be further studied to determine the effects of involvement on health outcomes.}, keywords = {Health Conditions and Status, Older Adults, Patient-physician Relationship, Quality of care}, doi = {10.2147/DHPS10.2147/DHPS.S107065}, url = {https://www.dovepress.com/quantifying-the-relationship-between-patient-characteristics-and-invol-peer-reviewed-article-DHPS}, author = {Roy, Natalie T. and Ulrich, Erin E.} } @article {8904, title = {Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States.}, journal = {BMC Geriatrics}, volume = {17}, year = {2017}, month = {2017 Feb 08}, pages = {48}, abstract = {

BACKGROUND: Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US.

METHODS: We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers.

RESULTS: The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14\% after diabetes diagnosis to 32\% after cancer diagnosis; for black smokers, the percentage ranged from 15\% after lung disease diagnosis to 40\% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38\% quit. In logistic models, black (OR = 0.43, 95\% CI: 0.19-0.99) and Latino (OR = 0.26, 95\% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95\% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes.

CONCLUSIONS: A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.

}, keywords = {Chronic disease, Health Conditions and Status, Older Adults, Racial/ethnic differences, Smoking}, issn = {1471-2318}, doi = {10.1186/s12877-017-0438-z}, author = {Ana R Qui{\~n}ones and Corey L Nagel and Jason T Newsom and Nathalie Huguet and Sheridan, Paige and Stephen M Thielke} } @article {8893, title = {Relating Older Workers{\textquoteright} Injuries to the Mismatch Between Physical Ability and Job Demands.}, journal = {Journal of Occupational and Environmental Medicine}, volume = {59}, year = {2017}, month = {2017 Feb}, pages = {212-221}, abstract = {

OBJECTIVE: We examined the association between job demand and occupational injury among older workers.

METHODS: Participants were workers aged 50+ enrolled in the Health and Retirement Study, 2010 to 2014. Participants reported physical ability within three domains: physical effort, stooping/kneeling/crouching, and lifting. To measure subjective job demand, participants rated their job{\textquoteright}s demands within domains. We generated objective job demand measures through the Occupational Information Network (ONET). Using Poisson regression, we modeled the association between physical ability, job demand, and self-reported occupational injury. A second model explored interaction between job demand and physical ability.

RESULTS: The injury rate was 22/1000 worker-years. Higher job demand was associated with increased injury risk. Within high job demands, lower physical ability was associated with increased injury risk.

CONCLUSIONS: Older workers whose physical abilities do not meet job demands face increased injury risk.

}, keywords = {Disabilities, Employment and Labor Force, Health Shocks, Job loss, Older Adults, Retirement Planning and Satisfaction}, issn = {1536-5948}, doi = {10.1097/JOM.0000000000000941}, author = {Laura A Fraade-Blanar and Jeanne M Sears and Kwun Chuen G. Chan and Hilaire J Thompson and Paul K Crane and Beth E. Ebel} } @article {8905, title = {The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study.}, journal = {Annals of Internal Medicine}, year = {2017}, month = {2017 Feb 07}, abstract = {

Background: Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown.

Objective: To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life.

Design: Retrospective cohort.

Setting: The HRS (Health and Retirement Study).

Participants: 5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012.

Measurements: Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. BMI was modeled as a continuous variable with a quadratic functional form.

Results: For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3\% (95\% CI, 36.5\% to 40.2\%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3\% (CI, 59.4\% to 63.2\%), and total Medicare expenditures were $42~803 (CI, $41~085 to $44~521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI >=40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2.

Limitation: Baseline data were self-reported, and the interval between reported BMI and time of death varied.

Conclusion: Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.

Primary Funding Source: Robert Wood Johnson Foundation Clinical Scholars Program.

}, keywords = {Hospice, Medicare/Medicaid/Health Insurance, Obesity, Older Adults}, issn = {1539-3704}, doi = {10.7326/M16-0749}, author = {Tamara B Harris and Byhoff, Elena and Chithra R Perumalswami and Kenneth M. Langa and Alexi A Wright and Jennifer J Griggs} } @article {8949, title = {Resource and Strategic Mobilization Model (RSM) of Productive Aging: Examining Older Americans{\textquoteright} Participation in Various Productive Activities}, journal = {Ageing International}, volume = {42}, year = {2017}, month = {Jan-03-2017}, pages = {23 - 43}, abstract = {Older people involve themselves in productive activities for different reasons, and the theoretical frameworks examining their engagement are limited. This study introduces a new theoretical model, the Resource and Strategic Mobilization model (RSM), and empirically tests how personal resources and networks influence older persons{\textquoteright} participation in three major productive activities: employment, volunteering, and caregiving. Using nationally representative American data from the 2004 Health and Retirement Study, this study included 10,089 community-dwelling older adults aged 65+. Key predictor variables reflected aspects of personal resources (finances and physical health), and personal networks (family and social). Socio-demographic characteristics were controlled to obtain independent impacts from the above predictor variables. Three separate logistic regression models were utilized to test whether older people{\textquoteright}s personal resources and networks influenced their engagement in employment, volunteering and caregiving. Findings showed that older Americans with greater financial resources were more likely to work and volunteer. In general, those with better health were more likely to participate in all three activities. Family networks were associated with providing care, and greater social network involvement was linked to volunteering. As the RSM predicts, the diverse contexts of older persons matter, as indicated by personal resources and networks, for the activities older adults are involved in. Implications of using the RSM model to understand productive activities in which older people engage are discussed.}, keywords = {Caregiving, Employment and Labor Force, Older Adults, Volunteerism}, issn = {0163-5158}, doi = {10.1007/s12126-016-9259-1}, url = {http://link.springer.com/10.1007/s12126-016-9259-1}, author = {Shen, Huei-Wern} } @article {9016, title = {Rising Risks for Retirement Savers}, journal = {The New York Times}, number = {A26}, year = {2017}, month = {04/06/2017}, chapter = {Opinion}, address = {New York City, New York}, keywords = {News, Older Adults, Risk Factors}, url = {https://www.nytimes.com/2017/04/06/opinion/rising-risks-for-retirement-savers.html} } @article {8958, title = {Sensory functioning and personality development among older adults.}, journal = {Psychology and Aging}, volume = {32}, year = {2017}, month = {03/2017}, pages = {139-147}, abstract = {Deficits in sensory functioning, such as poor vision and hearing, take a significant toll on quality of life. Little is known, however, about their relation with personality development across adulthood. This study examined whether baseline and change in vision and hearing were associated with personality change over a 4-year period. Participants (N = 7,471; Mage = 66.89; 59\% women) were drawn from the Health and Retirement Study. They provided data on vision, hearing, and personality both at baseline and 4 years later. Poor vision and hearing at baseline and declines in vision and hearing over time were independently related to steeper declines in extraversion, agreeableness, openness, and conscientiousness, and less decline in neuroticism, controlling for demographic factors, disease burden, and depressive symptoms. Sensory functioning was generally a stronger predictor of personality change than disease burden or depressive symptoms. Consistent with evidence that poor and worsening sensory functions compromise individuals{\textquoteright} interactions with the social and physical environment, this study found deficits in hearing and vision were also associated with maladaptive personality trajectories in older adults. }, keywords = {Older Adults, Personality}, issn = {1939-1498}, doi = {10.1037/pag0000159}, author = {Yannick Stephan and Angelina R Sutin and Bosselut, Gr{\'e}goire and Antonio Terracciano} } @article {8945, title = {Social connectedness, perceived isolation, and dementia: Does the social environment moderate the relationship between genetic risk and cognitive well-being?}, journal = {Gerontologist}, volume = {57}, year = {2017}, pages = {1031-1040}, abstract = {Purpose of the Study: This study examined whether the social environment moderates the relationship between the APOE e4 allele and cognitive functioning. Design and Methods: The Aging, Demographics, and Memory Study (ADAMS) data and multinomial logistic regression models were used to investigate these relationships for a nationally representative sample of U.S. adults aged 70 and older (n = 779). Results: Living alone (relative risk ratio [RRR] = 5.814; p = .000) and self-reported loneliness (RRR = 1.928, p = .049) were associated with a greater risk of cognitive difficulty. Living arrangements, perceived social support, and loneliness were found to moderate the relationship between the APOE e4 allele and cognitive function. Implications: The results support the need to consider the social context when examining cognitive well-being in later life. These findings also indicate a need for the development of policies and services that promote a rich social environment.}, keywords = {Cognitive Ability, Dementia, Depressive symptoms, Genetics, Isolation, Older Adults, Social Support}, issn = {0016-9013}, doi = {10.1093/geront/gnw154}, url = {https://academic.oup.com/gerontologist/article/2951236/Social}, author = {Judith L Poey and Jeffrey A Burr and J Scott Roberts} } @article {8972, title = {Study Shows One Way to Extend Working Years}, journal = {Journal Reports: Wealth Management}, year = {2017}, publisher = {The Wall Street Journal}, address = {New York City, NY}, keywords = {Employment and Labor Force, News, Older Adults}, url = {https://www.wsj.com/articles/study-shows-one-way-to-extend-working-years-1490582352}, author = {Lisa Ward} } @article {8965, title = {Subjective and objective cognitive function among older adults with a history of traumatic brain injury: A population-based cohort study.}, journal = {PLoS Medicine}, volume = {14}, year = {2017}, month = {03/2017}, pages = {e1002246}, abstract = {

BACKGROUND: Traumatic brain injury (TBI) is extremely common across the lifespan and is an established risk factor for dementia. The cognitive profile of the large and growing population of older adults with prior TBI who do not have a diagnosis of dementia, however, has not been well described. Our aim was to describe the cognitive profile associated with prior TBI exposure among community-dwelling older adults without dementia-an understudied but potentially vulnerable population.

METHODS AND FINDINGS: In this population-based cohort study, we studied 984 community-dwelling older adults (age 51 y and older and their spouses) without dementia who had been randomly selected from respondents to the 2014 wave of the Health and Retirement Study to participate in a comprehensive TBI survey and who either reported no prior TBI (n = 737) or prior symptomatic TBI resulting in treatment in a hospital (n = 247). Mean time since first TBI was 38 {\textpm} 19 y. Outcomes assessed included measures of global cognitive function, verbal episodic memory, semantic fluency, and calculation as well as a measure of subjective memory ("How would you rate your memory at the present time?"). We compared outcomes between the two TBI groups using regression models adjusting for demographics, medical comorbidities, and depression. Sensitivity analyses were performed stratified by TBI severity (no TBI, TBI without loss of consciousness [LOC], and TBI with LOC). Respondents with TBI were younger (mean age 64 {\textpm} 10 y versus 68 {\textpm} 11 y), were less likely to be female, and had higher prevalence of medical comorbidities and depression than respondents without TBI. Respondents with TBI did not perform significantly differently from respondents without TBI on any measure of objective cognitive function in either raw or adjusted models (fully adjusted: global cognitive function score 15.4 versus 15.2, p = 0.68; verbal episodic memory score 4.4 versus 4.3, p = 0.79; semantic fluency score 15.7 versus 14.0, p = 0.21; calculation impairment 22\% versus 26\%, risk ratio [RR] [95\% CI] = 0.86 [0.67-1.11], p = 0.24). Sensitivity analyses stratified by TBI severity produced similar results. TBI was associated with significantly increased risk for subjective memory impairment in models adjusted for demographics and medical comorbidities (29\% versus 24\%; RR [95\% CI]: 1.26 [1.02-1.57], p = 0.036). After further adjustment for active depression, however, risk for subjective memory impairment was no longer significant (RR [95\% CI]: 1.18 [0.95-1.47], p = 0.13). Sensitivity analyses revealed that risk of subjective memory impairment was increased only among respondents with TBI with LOC and not among those with TBI without LOC. Furthermore, the risk of subjective memory impairment was significantly greater among those with TBI with LOC versus those without TBI even after adjustment for depression (RR [95\% CI]: partially adjusted, 1.38 [1.09-1.74], p = 0.008; fully adjusted, 1.28 [1.01-1.61], p = 0.039).

CONCLUSIONS: In this population-based study of community-dwelling older adults without dementia, those with prior TBI with LOC were more likely to report subjective memory impairment compared to those without TBI even after adjustment for demographics, medical comorbidities, and active depression. Lack of greater objective cognitive impairment among those with versus without TBI may be due to poor sensitivity of the cognitive battery or survival bias, or may suggest that post-TBI cognitive impairment primarily affects executive function and processing speed, which were not rigorously assessed in this study. Our findings show that among community-dwelling non-demented older adults, history of TBI is common but may not preferentially impact cognitive domains of episodic memory, attention, working memory, verbal semantic fluency, or calculation.

}, keywords = {Brain injury, Cognitive Ability, Older Adults}, issn = {1549-1676}, doi = {10.1371/journal.pmed.1002246}, author = {Raquel C Gardner and Kenneth M. Langa and Kristine Yaffe} } @article {9015, title = {To What Extent is Gradual Retirement a Product of Financial Necessity?}, journal = {Work, Aging and Retirement}, volume = {3}, year = {2017}, month = {Jul-01-2018}, pages = {25 - 54}, abstract = {Changes in the retirement income landscape over the past 30 years have left older Americans more exposed to market forces than prior generations, and more reliant on earnings to ensure their financial stability at older ages. These earnings come from a variety of nontraditional paths to retirement. Most older Americans reduce hours in career employment, change employers later in life, reenter the labor force after an initial retirement, or follow some combination of these 3 paths. The many pathways to retirement are undoubtedly the product of a flexible labor market and may be good news on balance; however, for some these job changes may reflect hardship, as vulnerable populations seek whatever employment they can find to prevent falling into poverty at older ages. We assess the magnitude of this segment of older workers using data from the Health and Retirement Study (HRS), a large, nationally-representative longitudinal survey of older Americans that began in 1992. We find that bridge job prevalence among those with little or no financial assets resembles that of individuals in the middle of the wealth distribution, implying that financial insecurity does not appear to be a main driver of gradual retirement transitions among career workers. Bridge employment among those with little or no financial assets is, however, more likely to consist of full-time wage-and-salary work. With the prospect of increased financial insecurity among older Americans, this analysis suggests that gradual retirements consisting of short-term, full-time wage-and-salary employment may become more prevalent in the years ahead.}, keywords = {Bridge employment, Financial literacy, Older Adults, Retirement Planning and Satisfaction}, issn = {2054-4642}, doi = {10.1093/workar/waw027}, url = {https://academic.oup.com/workar/article-lookup/doi/10.1093/workar/waw027https://academic.oup.com/workar/article/2623812/To-What-Extent-is-Gradual-Retirement-a-Product-of}, author = {Kevin E. Cahill and Michael D. Giandrea and Joseph F. Quinn} } @article {8599, title = {Validation of abridged mini-mental state examination scales using population-based data from Sweden and USA}, journal = {European Journal of Ageing}, volume = {14}, year = {2017}, month = {06/2017}, pages = {199-205}, abstract = {The objective of this study is to validate two abridged versions of the mini-mental state examination (MMSE): one intended for use in face-to-face interviews, and the other developed for telephonic interviews, using data from Sweden and the US to validate the abridged scales against dementia diagnoses as well as to compare their performance to that of the full MMSE scale. The abridged versions were based on eight domains from the original MMSE scale. The domains included in the MMSE-SF were registration, orientation, delayed recall, attention, and visual spatial ability. In the MMSE-SF-C, the visual spatial ability item was excluded, and instead, one additional orientation item was added. There were 794 participants from the Swedish HARMONY study [mean age 81.8 (4.8); the proportion of cognitively impaired was 51 \%] and 576 participants from the US ADAMS study [mean age 83.2 (5.7); the proportion of cognitively impaired was 65 \%] where it was possible to compare abridged MMSE scales to dementia diagnoses and to the full MMSE scale. We estimated the sensitivity and specificity levels of the abridged tests, using clinical diagnoses as reference. Analyses with both the HARMONY and the ADAMS data indicated comparable levels of sensitivity and specificity in detecting cognitive impairment for the two abridged scales relative to the full MMSE. Receiver operating characteristic curves indicated that the two abridged scales corresponded well to those of the full MMSE. The two abridged tests have adequate validity and correspond well with the full MMSE. The abridged versions could therefore be alternatives to consider in larger population studies where interview length is restricted, and the respondent burden is high.}, keywords = {Cognitive Ability, Cross-National, Older Adults}, issn = {1613-9372}, doi = {10.1007/s10433-016-0394-z}, url = {https://link.springer.com/article/10.1007/s10433-016-0394-z}, author = {Ericsson, Malin Christina and Margaret Gatz and K{\r a}reholt, Ingemar and Parker, Marti G. and Fors, Stefan} } @article {8935, title = {Your Genes May Predict How Wealthy You Are}, journal = {Forbes}, year = {2017}, publisher = {Forbes}, keywords = {Genetics, News, Older Adults, Wealth}, url = {http://fortune.com/2017/02/28/rich-gene-billionaire/}, author = {Annalyn Kurtz} } @article {8837, title = {The Affordable Care Act as Retiree Health Insurance: Implications for Retirement and Social Security Claiming}, number = {Working Paper 22815}, year = {2016}, month = {11/2016}, pages = {1-55}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Using data from the Health and Retirement Study, we examine the effects of the Affordable Care Act (ACA) on retirement. We first calculate retirements (and in related analyses changes in expected ages of retirement and/or Social Security claiming) between 2010, before ACA, and 2014, after ACA, for those with health insurance at work but not in retirement. This group experienced the sharpest change in retirement incentives from ACA. We then compare retirement measures for those with health insurance at work but not in retirement with retirement measures for two other groups, those who, before ACA, had employer provided health insurance both at work and in retirement, and those who had no health insurance either at work or in retirement. To complete a difference-in-difference analysis, we make the same calculations for members of an older cohort over the same age span. We find no evidence that ACA increases the propensity to retire or changes the retirement expectations of those who, before ACA, had coverage when working but not when retired.}, keywords = {Affordable Care Act, Health Insurance, Older Adults, Retirement Planning and Satisfaction, Social Security}, doi = {10.3386/w22815}, url = {http://www.nber.org/papers/w22815.pdf}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {8358, title = {Age differences in conscientiousness facets in the second half of life: Divergent associations with changes in physical health}, journal = {Personality and Individual Differences}, volume = {96}, year = {2016}, month = {07/2016}, pages = {202-211}, publisher = {96}, abstract = {The development of personality across the lifespan has captivated researchers for several years. However, lower order facets may show different developmental trends and divergent associations with outcomes compared to their higher order traits. In a sample of 12,762 older adults, age differences in conscientiousness and its facets were examined. Further, the degree to which conscientiousness and its facets differentially predicted physical health over a four-year period was also examined. Broader conscientiousness, orderliness, and industriousness were lowest in late life. Traditionalism and virtue were highest in late life. Responsibility was highest around age 70. Self-control did not show any significant age-related differences. Conscientiousness, orderliness, industriousness, and responsibility were most consistently related to physical health over time. The findings are discussed in the context of the mechanisms that give rise to personality development and divergent associations in outcomes among seemingly related facets.}, keywords = {Conscientiousness, Health Conditions and Status, Older Adults, Self-control}, doi = {10.1016/j.paid.2016.02.076}, url = {http://www.sciencedirect.com/science/article/pii/S0191886916301325}, author = {William J. Chopik} } @article {8838, title = {The Aggregate Implications of Gender and Marriage}, number = {Working Paper No. 22817}, year = {2016}, month = {11/2016}, pages = {1-54}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Wages and life expectancy, as well as labor market outcomes, savings, and consumption, differ by gender and marital status. In this paper we compare the aggregate implications of two dynamic structural models. The first model is a standard, quantitative, life-cycle economy, in which people are only heterogenous by age and realized earnings shocks, and is calibrated using data on men, as typically done. The second model is one in which people are also heterogeneous by gender, marital status, wages, and life expectancy, and is calibrated using data for married and single men and women. We show that the standard life-cycle economy misses important aspects of aggregate savings, labor supply, earnings, and consumption. In contrast, the model with richer heterogeneity by gender, marital status, wage, and life expectancy matches the observed data well. We also show that the effects of changing life expectancy and the gender wage gap depend on marital status and gender, and that it is essential to not only model couples, but also the labor supply response of both men and women in a couple.}, keywords = {Gender Differences, Marriage, Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.3386/w22817}, url = {http://www.nber.org/papers/w22817.pdf}, author = {Borella, Margherita and Mariacristina De Nardi and Yang, Fang} } @article {8708, title = {The Association Between Alcohol Consumption And Cognitive Function In The Middle-Aged And Older Population: A Study Using The Health And Retirement Study (Hrs) Data}, journal = {Value in Health}, volume = {19}, year = {2016}, month = {Jan-05-2016}, pages = {A190}, keywords = {Alcohol Consumption, Cognitive Ability, Health Conditions and Status, Older Adults}, issn = {10983015}, doi = {10.1016/j.jval.2016.03.1336}, author = {Chen, C. and Raisch, D. W.} } @article {8353, title = {Baseline Depressive Symptoms Predict Subsequent Heart Disease; A 20-Year Cohort}, journal = {International Cardiovascular Research Journal}, volume = {10}, year = {2016}, pages = {29-34}, publisher = {10}, abstract = {Background: Depression is common among patients with heart disease. Depression is also associated with worse outcomes among patients with heart disease. Fewer studies have shown whether or not baseline depressive symptoms predict subsequent heart disease in general population. Objectives: This study aimed to investigate whether depressive symptoms at baseline predict risk of developing heart disease during the next 20 years in the United States. Patients and Methods: The data were extracted from the Health and Retirement Study (HRS), 1992 - 2012. The study was conducted on 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline, and had data on heart disease over the next 20 years. High depressive symptoms (modified Center for Epidemiologic Studies Depression Scale CES-D ) were considered as the independent variable. Self-reported data on physician diagnosis of heart disease were measured on a biannual basis. Baseline demographic data (i.e., age and gender), socioeconomic status (i.e., race, marital status, and education level), health behaviors (i.e., drinking, smoking, and exercise), and body mass index were controlled. Cox proportional hazard model was used for data analysis. Results: Cox proportional hazard model revealed a link between high depressive symptoms at baseline and time to developing heart disease (Hazard ratio = 1.439, 95 CI = 1.253 1.652), suggesting that individuals with high depressive symptoms at baseline developed heart disease sooner than others. The association between baseline depressive symptoms and risk of heart disease was significant after controlling for all the covariates. Conclusions: Individuals with depressive symptomatology are at higher risk of development of heart disease over time. Thus, individuals with depressed mood may need more rigorous evaluation for heart disease.}, keywords = {Depressive symptoms, Health Conditions and Status, Heart disease, Older Adults}, doi = {10.17795/icrj-10(1)29}, url = {http://ircrj.com/?page=article\&article_id=25689}, author = {Maryam Moghani Lankarani and Shervin Assari} } @mastersthesis {8993, title = {Bridge Employment and Health}, volume = {Ph.D.}, year = {2016}, school = {University of Michigan}, type = {Dissertation}, address = {Ann Arbor, Michigan}, abstract = {Due to the increasing longevity, advancing yet skyrocketing health care costs, and the lack of funds for elderly welfare, post-retirement health among older adults has become a crucial issue both at the individual and societal level. Concurrently, with widespread implementation of pro-work policies and the notion of retirement as a gradual process rather than one-time transition, bridge employment rate in the US has increased continually for last few decades. However, little is known regarding how the two major societal trends are related. Determinants of bridge employment are not fully understood, and how bridge employment affects post-retirement health is largely unknown. In addition, there is little systematic information on gender difference in the precursors and consequences of bridge employment despite distinct occupational experiences and biological differences in men and women. This dissertation focuses on the complex relationship between bridge employment and post-retirement health. Using data from Health and Retirement Study, a nationally representative longitudinal survey of individuals over age 50, major determinants of bridge employment among men and women were identified. Then, the effects of bridge employment on physical and mental health were investigated. Statistical analyses accounted for time-dependent confounders and potential bidirectional association in the relationship between bridge employment and health outcomes. Via separate analyses for men and women, this study shows that men{\textquoteright}s bridge employment is often driven especially by his early-life socioeconomic status, rather than his high occupational ability or self-esteem in the work place, while women{\textquoteright}s bridge employment is significantly influenced by her marital status, which may partly be due to women{\textquoteright}s nonlinear career trajectories. Bridge employment was associated with fewer depressive symptoms, while it was found to have deteriorative effects on physical functioning. Both associations did not differ by potential modifiers such as gender, income, education, and pre-retirement occupation. By investigating the antecedents of bridge employment and examining its physical and mental health effects, this dissertation provides an insight on the mechanism of the non-traditional retirement process. Our findings may be useful for policy implications to improve well-being of a number of prospective retirees who may engage in bridge employment in the next few decades. Advisors/Committee Members: Mendes de Leon, Carlos (committee member), Elliott, Michael R (committee member), Liang, Jersey (committee member), Needham, Belinda L (committee member), Schoeni, Bob (committee member).}, keywords = {Bridge employment, Health Conditions and Status, Older Adults}, url = {http://hdl.handle.net/2027.42/135855}, author = {Cho, Jihyun} } @mastersthesis {8736, title = {Changing generations: The importance of understanding long-term care options}, volume = {M.S.}, year = {2016}, pages = {58}, school = {Utica College}, type = {Thesis}, abstract = {The act of retiring, and retirement itself, is different for each individual, especially for those from different generations. Generational differences, along with economic and health status, can affect how an individual may plan for retirement or whether they plan at all. Though this topic is timely it has yet to be approached from an all-encompassing perspective. Various types of retirement planning were reviewed in this capstone. Literature reviewed from 1992 to 2014 revealed that generational differences impact how individuals plan{\textemdash}or do not plan{\textemdash}for retirement as well as what services they seek. Literature obtained through Utica Online Library and Google Scholar yielded the most significant information when examining retirement in conjunction with the trends in generational differences. Researchers also focused on individuals{\textquoteright} knowledge of and preparation for the retirement process. Future research to provide long-term healthcare planning options to individuals reaching the age of retirement was also discussed.}, keywords = {Long-term Care, Nursing homes, Older Adults, Retirement Planning and Satisfaction}, isbn = {9781339649351}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1785777525?accountid=14667}, author = {Bracken, Krista} } @article {8749, title = {Characteristics of Decedents in Medicare Advantage and Traditional Medicare}, journal = {JAMA Internal Medicine}, volume = {176}, year = {2016}, month = {Jan-07-2016}, pages = {1020}, abstract = {Approximately 25\% of all Medicare expenditures are for care received in the last year of life.1 Much research has been done to understand cost and utilization patterns for Medicare beneficiaries at the end of life (EOL).2 However, when assessing EOL costs, most studies focus on decedents with traditional fee-for-service (FFS) Medicare owing to the lack of cost and utilization data for the 30\% of Medicare beneficiaries in Medicare Advantage (MA) plans.3 This gap is a cause for concern because utilization and quality of care may differ between MA and FFS beneficiaries.4- 6 We sought to examine differences in characteristics of decedents in MA and FFS Medicare based on detailed survey data. Methods The Health and Retirement Study (HRS) is a biennial longitudinal survey of a nationally representative cohort of US adults 51 years or older that measures a broad range of questions about health and aging. Between interview cycles, the HRS identifies participants who have died using information from family members and the National Death Index. We included decedents 65 years or older who died between the 1998 and 2012 survey waves and who authorized their HRS responses to be linked to Medicare data. We compared demographic, health, and functional and cognitive characteristics of all HRS decedents enrolled in Medicare FFS and MA plans using χ2 and t test. We performed multivariable ordinal regressions to determine if demographic differences between the Medicare groups explained differences in health, functional, and cognitive status. We used multiple imputation for missing data. The study was exempt from institutional review board approval because the data looked only at decedents. There were no significant differences in results of multivariable analyses using imputed or nonimputed variables (Table 1). Results Of the 9385 decedents included in our analysis, 2280 (24.3\%) were continuously enrolled in MA plans for the last 6 months of life and 7105 (75.7\%) were continuously enrolled in Medicare FFS. The FFS beneficiaries were significantly older than MA beneficiaries at the time of death, and the 2 groups differed with respect to marital status, race, net worth, and educational attainment (Table 1). The MA decedents were less likely to have supplemental insurance compared with FFS decedents, including Medicaid or private insurance. The MA decedents were more likely to be living in urban areas and in the Northeast or West, whereas FFS decedents resided commonly in the Midwest and South. The MA and FFS decedents did not differ in having an advance directive or having discussed their EOL treatment preferences with their health care proxy. At their last survey before death, FFS beneficiaries were more likely than MA beneficiaries to rate their health as {\textquotedblleft}poor,{\textquotedblright} to have limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), and to have dementia. After adjusting for demographic differences between FFS and MA decedents in our sample, differences between FFS and MA decedents in self-rated health, functional limitations, and cognitive status remained significant (Table 2). Discussion The FFS beneficiaries were sicker than MA beneficiaries during the last year of life, with worse functional status, higher rates of dementia, and poorer self-rated health. These are important considerations because policymakers and researchers consider patient-specific factors related to high EOL costs in the Medicare population. Because MA beneficiaries are, on average, younger and more independent at the EOL, their health care utilization and costs may differ from those enrolled in FFS. Prior research6 shows that MA beneficiaries have lower inpatient and Emergency Department utilization at the EOL, and increased hospice enrollment compared with FFS beneficiaries. This pattern may arise from improved EOL management by MA plans but could also reflect a less chronically impaired population, with fewer acute care needs at the EOL owing to better social support and functional and cognitive status.}, keywords = {Health Conditions and Status, Medicare/Medicaid/Health Insurance, Older Adults}, issn = {2168-6106}, doi = {10.1001/jamainternmed.2016.2266}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.2266}, author = {Byhoff, Elena and Tamara B Harris and John Z. Ayanian} } @article {8345, title = {Comorbidities Among Persons With Incident Psychiatric Condition}, journal = {Gerontology and Geriatric Medicine}, volume = {2}, year = {2016}, publisher = {2}, abstract = {Objective: I sought to determine how medical comorbidities co-exist with incident psychiatric condition. Method: I used data from all 11 available waves (1992-2012) of the Health and Retirement Study (HRS). I identified 4,358 index participants with self-reported incident psychiatric condition. I collected comorbidity data from participants preceding, including, and succeeding that incident wave. Comorbidities assessed included high blood pressure (HBP), diabetes mellitus, cancer, lung disease, heart disease, stroke, and arthritis. Modified Poisson regression combined with log-linked binomial regression was used to estimate relative risks (RRs) of reporting a comorbidity preceding and following the incident wave. Multiple comparison testing dictated significance of RRs with p .007. Results: For the waves preceding the index wave, the RRs of reporting all comorbidities except HBP and cancer were significantly (p .007) increased. For the waves following incident psychiatric condition, the risks of reporting heart disease, diabetes, and lung disease were significantly (p .007) increased. These results were adjusted for participant age, race, gender, other comorbidities listed, and the wave in which a comorbidity was reported. Conclusion: The bidirectional association between a psychiatric condition and medical illnesses could only be statistically confirmed for lung disease, diabetes, and heart disease. It is of interest to determine how reporting a psychiatric condition may affect the sequelae of health care use and treatment outcomes for patients with either of these comorbidities or a combination of them.}, keywords = {Comorbidity, Health Conditions and Status, Older Adults, Psychiatry}, doi = { 10.1177/2333721416635001}, url = {http://ggm.sagepub.com/content/2/2333721416635001.abstract}, author = {Fluegge, Kyle R.} } @article {8826, title = {Data Resource Profile: Cross-national and cross-study sociodemographic and health-related harmonized domains from SAGE plus ELSA, HRS and SHARE (SAGE+, Wave 1)}, journal = {International Journal of Epidemiology}, volume = {45}, year = {2016}, month = {Aug-10-2016}, pages = {1403 - 1403j}, abstract = {Four longitudinal studies were included in this rigorous harmonization process: the Study on global AGEing and adult health (SAGE); English Longitudinal Study on Ageing (ELSA); US Health and Retirement Study (HRS); and Survey of Health, Ageing and Retirement in Europe (SHARE). An ex-post harmonized process was applied to nine health-related thematic domains (socio-demographic and economic, health states, overall self-report of health and mental state, health examinations, physical and mental performance tests, risk factors, chronic conditions, social network and subjective well-being) for data from the 2004 wave of each study. Large samples of adults aged 50 years and older were available from each study: SAGE, n = 18 886; ELSA, n = 9181; HRS, n = 19 303; and SHARE, n = 29 917. The microdata, along with further details about the harmonization process and all metadata, are available through the World Health Organization (WHO) data archive at [http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog]. Further information and enquiries can be made to [sagesurvey@who.int] or the corresponding author. The data resource will continue to be updated with data across additional waves of these surveys and new waves.}, keywords = {Cross-National, ELSA, Older Adults, SAGE, SHARE}, issn = {0300-5771}, doi = {10.1093/ije/dyw181}, url = {http://ije.oxfordjournals.org/lookup/doi/10.1093/ije/dyw181}, author = {Minicuci, Nadia and Naidoo, Nirmala and Chatterji, Somnath and Kowal, Paul} } @article {8410, title = {Differences between Subjective and Predicted Survival Probabilities and Their Relation to Preventive Care Use}, journal = {B.E. Journal of Economic Analysis and Policy}, volume = {16}, year = {2016}, pages = {807-835}, publisher = {16}, abstract = {I analyse how differences between subjective and predicted survival probabilities are related to preventive healthcare use. Based on the Health and Retirement Study, I find that private information inherent in subjective survival probability affects the decisions on preventive care use: positive and negative deviations between the subjective and predicted survival probabilities both imply lower likelihood of use, the relations with negative deviations being stronger. These results are driven by perceptions verified by later survival and health outcomes. A theoretical model provides explanation for the empirical results, in which preventive care increases the chances of survival, but the benefits of preventive care also vary with the survival probability.}, keywords = {Mortality, Older Adults, Preventative Care}, issn = {1935-1682}, doi = {10.1515/bejeap-2015-0154}, url = {https://www.degruyter.com/view/j/bejeap.2016.16.issue-2/bejeap-2015-0154/bejeap-2015-0154.xml}, author = {Anik{\'o} Bir{\'o}} } @article {8413, title = {Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households}, journal = {EBRI Notes}, volume = {37}, year = {2016}, publisher = {37}, abstract = {This paper examines in detail the differences in out-of-pocket health care spending between couple and single older households. The data for this paper come from the Health and Retirement Study (HRS), a study of a nationally representative sample of U.S. households with individuals over age 50. Throughout the paper participants are classified into three different age groups: ages 65-74 (Age Group I), ages 75-84 (Age Group II), and ages 85 and above (Age Group III). All the numbers reported are for a two-year period between 2010 and 2012. This paper also includes total recurring and total non-recurring expenses for the households studied. It should be noted that health insurance premiums and spending on over-the-counter drugs are not included in this study. The average per-person out-of-pocket spending for households ages 65 and above during a two-year period on doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is roughly 2,500 for both single and couple households. This amount does not change with age. There are large differences in non-recurring health care spending (which includes overnight hospital stays, outpatient surgery, home health care, nursing home stays, and other services) between older singles and older couples, and these differences increase with age. For Age Group I, the average total non-recurring expenses were 2,790 for singles and 2,024 for couples, a difference of 766. For Age Group II, the average total non-recurring expenses went up to 5,502 and 3,930 for singles and couples, respectively, a difference of 1,572. For the oldest age group (those 85 and above), the difference went up to 4,825 ( 13,355 for singles and 8,530 for couples). Some of the largest differences in non-recurring health care spending between older singles and older couples are in home health care and nursing home expenses. This suggests that couples benefit from their spouses or partners acting as their caregivers.}, keywords = {Health Expenses, Healthcare, Medicare/Medicaid/Health Insurance, Older Adults, Prescription Medication}, url = {http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2723591}, author = {Sudipto Banerjee} } @inbook {5264, title = {Disability Insurance Incentives and the Retirement Decision: Evidence from the United States}, booktitle = {Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement}, year = {2016}, pages = {45-80}, publisher = {Chicago University Press}, organization = {Chicago University Press}, address = {Chicago}, abstract = {Public programs that benefit older individuals, such as Social Security and Medicare, may be changed in the future in ways that reflect an expectation of longer work lives. But do older Americans have the health capacity to work longer? This paper explores this question by asking how much older individuals could work if they worked as much as those with the same mortality rate in the past or as much as their younger counterparts in similar health. Using both methods, we estimate that there is significant additional capacity to work at older ages. We also explore whether there are differences in health capacity across education groups and whether health has improved more over time for the highly educated, using education quartiles to surmount the challenge of changing levels of education over time.}, keywords = {Employment and Labor Force, Insurance, Older Adults, Public Policy, Retirement Planning and Satisfaction}, author = {Courtney Coile}, editor = {David A Wise} } @article {8411, title = {Diverging Fortunes: Racial/Ethnic Inequality in Wealth Trajectories in Middle and Late Life}, journal = {Race and Social Problems}, volume = {8}, year = {2016}, pages = {29-41}, publisher = {8}, abstract = {The primary aim of this study is to examine whether racial/ethnic inequality in wealth dissipates or increases between middle and late life, and by how much. To address this aim, this study draws on critical race and life course perspectives as well as 10 waves of panel data from the Health and Retirement Study and growth curve models to understand racial/ethnic inequality in wealth trajectories among whites, blacks, and Mexican Americans (N = 8337). Findings show that, by midlife, significant inequalities in net worth emerge between whites and their black and Mexican American counterparts. On average, white households have amassed a net worth of 105k by midlife, compared to less than 5k and 39k among black and Mexican American families, respectively. Moreover, whites experience much more rapid rates of wealth accumulation during their 50s and 60s than their minority counterparts, resulting in increasing wealth disparities with age, consistent with a process of cumulative disadvantage. At the peak of their wealth trajectory (at age 66), whites have approximately 245k more than blacks and 219k more than Mexican Americans. A wide range of socioeconomic, behavioral, and health factors account for a portion, but not all, of racial/ethnic inequality in wealth, suggesting that unobserved factors such as parental wealth, segregation, and discrimination may play a role in the production and maintenance of wealth inequality.}, keywords = {Event History/Life Cycle, Health Conditions and Status, Inequality, Net Worth and Assets, Older Adults, Racial/ethnic differences}, doi = {10.1007/s12552-016-9160-2}, url = {http://dx.doi.org/10.1007/s12552-016-9160-2}, author = {Tyson H Brown} } @article {8710, title = {Does retirement mean more physical activity? A longitudinal study}, journal = {BMC Public Health}, volume = {16}, year = {2016}, month = {Jan-12-2016}, pages = {1-7}, abstract = {Background: Evidence on physical activity (PA) and transitions out of full-time employment in middle-to-older age is mainly cross-sectional and focused upon retirement. The purpose was to examine trajectories in PA before and after transitions out of full-time employment. Methods: Data were obtained for 5,754 people in full-time employment aged 50-75 from the US Health and Retirement Survey. Logistic regression was used to examine trajectories in twice-weekly participation in light, moderate and vigorous PA among those transitioning to part-time work, semi-retirement, full retirement, or economic inactivity due to disability, in comparison to those remaining in full-time employment. Results: Twice weekly participation in vigorous and light physical activity changed little for those who remained in full-time employment, while moderate physical activity decreased between baseline and follow-up (OR 0.95, 95 \% CI 0.91, 0.99). Differences in physical activity according to transitional categories at follow-up were evident. Baseline differences in physical activity across all intensities were greatest among participants transitioning from full-time to part-time employment compared to those who remained in full-time employment throughout the study period (vigorous OR 1.41 95 \% CI 1.23, 1.61; moderate OR 1.28 95 \% CI 1.12, 1.46; light OR 1.29 95 \% CI 1.12, 1.49). Those transitioning to unemployment were already among the least physically active at baseline, irrespective of intensity (albeit, with 95 \% CIs spanning unity). Those transitioning to full-time retirement were also among the least active (e.g. vigorous OR 0.71 95 \% CI 0.61, 0.81; moderate OR 0.80 95 \% CI 0.71, 0.90). Declines in physical activity were reported for those transitioning to economic inactivity due to a disability (vigorous OR 0.29 95 \% CI 0.14, 0.64; moderate OR 0.56 95 \% CI 0.33, 0.95; light OR 0.34 95 \% CI 0.19, 0.63). Physical activity increased regardless of intensity among participants transitioning to semi-retirement (p > 0.05) and full retirement (e.g. vigorous OR 1.28 95 \% CI 1.09, 1. 51; moderate OR 1.24 95 \% CI 1.07, 1.43). Light physical activity increased for those transitioning to unemployment (OR 1.40 95 \% CI 1.02, 1.93), though less change was evident in moderate or vigorous physical activity. Conclusions: The amount and intensity of PA varies by the type of transition out of full-time employment among people in middle-to-older age.}, keywords = {Aging, Health Conditions and Status, Older Adults, Physical activity, Retirement Planning and Satisfaction}, doi = {10.1186/s12889-016-3253-0}, url = {http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3253-0http://link.springer.com/content/pdf/10.1186/s12889-016-3253-0}, author = {Feng, Xiaoqi and Croteau, Karen and Kolt, Gregory S. and Astell-Burt, Thomas} } @article {8932, title = {Dynamic aspects of family transfers}, journal = {Journal of Public Economics}, volume = {137}, year = {2016}, month = {Jan-05-2016}, pages = {1 - 13}, abstract = {Parents transfer a great deal to their adult children, and we have rich theoretical models providing a framework for these transfers. However, both the models and existing empirical work typically examine behavior in the cross section. To date, we know little about the dynamic aspects of family transfers. Here I examine transfers over a span of 17 years and find substantial changes in recipiency over time and a strong negative correlation between transfers and transitory income. I also find that events such as job loss and divorce are strong predictors of parental transfers and, although rare, are typically associated with larger transfers than income alone might predict. Finally, transfers are distributed unequally across siblings, and perhaps surprisingly, the distribution of transfers becomes even more unequal when examined over an extended period of time than in any single year. The evidence presented here thus suggests that dynamic analyses can provide insights into behavior that are impossible to obtain in a static context.}, keywords = {Adult children, Divorce, Job loss, Marriage, Older Adults}, issn = {00472727}, doi = {10.1016/j.jpubeco.2016.03.008}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0047272716300147http://api.elsevier.com/content/article/PII:S0047272716300147?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0047272716300147?httpAccept=text/plain}, author = {Kathleen McGarry} } @article {8541, title = {Dynamic modelling of long-term care decisions}, journal = {Review of Economics of the Household}, volume = {14}, year = {2016}, month = {Jan-06-2016}, pages = {463 - 488}, abstract = {This paper describes and analyzes research on the dynamics of long-term care and the policy relevance of identifying the sources of persistence in caregiving arrangements (including the effect of dynamics on parameter estimates, implications for family welfare, parent welfare, child welfare, and cost of government programs). We discuss sources and causes of observed persistence in caregiving arrangements including inertia/state dependence (confounded by unobserved heterogeneity) and costs of changing caregivers. We comment on causes of dynamics including learning/human capital accumulation; burnout; and game-playing. We suggest how to deal with endogenous geography; dynamics in discrete and continuous choices; and equilibrium issues (multiple equilibria, dynamic equilibria). We also present an overview of commonly used longitudinal data sets and evaluate their relative advantages/disadvantages. We also discuss other data issues related to noisy measures of wealth and family structure. Finally, we suggest some methods to handle econometric problems such as endogeneous geography.}, keywords = {Caregiving, Economics, Healthcare, Older Adults}, issn = {1569-5239}, doi = {10.1007/s11150-013-9236-3}, url = {http://link.springer.com/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3http://link.springer.com/content/pdf/10.1007/s11150-013-9236-3.pdfhttp://link.springer.com/article/10.1007/s11150-013-9236-3/fulltext.html}, author = {Sovinsky, Michelle and Steven N. Stern} } @article {8937, title = {The effect of job loss on health: Evidence from biomarkers}, journal = {Labour Economics}, volume = {41}, year = {2016}, month = {Jan-08-2016}, pages = {194 - 203}, abstract = {We estimate the effect of job loss on objective measures of physiological dysregulation using biomarker measures collected by the Health and Retirement Study in 2006 and 2008 and longitudinal self-reports of work status. We distinguish between group or individual layoffs, and business closures. Workers who are laid off from their job have lower health as measured by biomarker, whereas workers laid off in the context of a business closure do not. Estimates matching respondents wave-by-wave on self-reported health conditions and subjective job loss expectations prior to job loss, suggest strong effects of layoffs on biomarkers, in particular for glycosylated hemoglobin (HbA1c). A layoff could increase annual mortality rates by 10.3\%, consistent with other evidence of the effect of group layoffs on mortality.}, keywords = {Biomarkers, Health Shocks, Job loss, Older Adults, Retirement Planning and Satisfaction}, issn = {09275371}, doi = {10.1016/j.labeco.2016.05.014}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0927537116300288http://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/plain}, author = {Pierre-Carl Michaud and Eileen M. Crimmins and Michael D Hurd} } @mastersthesis {8986, title = {The effect of lifetime socioeconomic status on cardiovascular health among adults 50-years and older: findings from the 2006-2012 health and retirement study.}, volume = {Ph.D.}, year = {2016}, school = {University of Georgia}, type = {Dissertation}, address = {Athens, Georgia}, abstract = {The relationship between wealth and health continues to have important implications for public health policy as well as for individual behavior. As a result, economists, sociologists, and epidemiologists, among other disciplines, persist in pursuing a plausible working model linking wealth and health. Previous research indicates that childhood socioeconomic status (SES) plays a significant role in late-life health outcomes, however the mechanism by which this effect occurs remains unclear. Four competing models have been developed to explain this association: the critical-period model, the accumulation of risks model, and the pathway model, and the social-mobility model. Using data from the Health and Retirement Study, we conducted three observational investigations in order to 1) establish the prevalence of cardiovascular diseases (CVD) during the baseline year of 2006, 2) determine if social-mobility best explains the relationship between total net worth and incident CVD during the study period 2006-2012, and 3) provide an alternative hypothesis to the social-mobility model. Key findings from our analyses showed an inverse association between total net worth quintiles and prevalent CVD. The odds of any CVD diagnosis were 32\% and 38\% less among respondents in the two highest quintiles compared to the bottom quintile. Respondents in the top quintile also had lower odds of CHF (OR=0.57; 0.40-0.81, p=0.002) and angina (OR=0.58; 0.43-0.79, p<0.0001). In terms of economic mobility, respondents born into affluence who subsequently fell to the lowest tertile of net worth still had 0.69 times the risk of incident CVD compared to lifetime economically poor respondents. Maintaining middle class status from childhood to adulthood yielded an incidence rate ratio of 0.53 (0.37-0.78, p = 0.001). In addition to social mobility, we investigated the critical-period model. Results from this analysis suggested an association between respondents who identified their childhood socioeconomic status as "about average" and incident CVD (RR=0.73; 0.57-0.93, p=0.01) compared to respondents who identified their childhood SES as "poor". Our results add to a growing body of research concerning the timing of SES circumstance and its effect on health later in life. Accurate early-life SES information will be needed in order to determine the appropriate model driving this association. Advisors/Committee Members: TONI MILES.}, keywords = {Cardiovascular health, Older Adults, Socioeconomic factors}, url = {http://purl.galileo.usg.edu/uga_etd/allegra_joseph_c_201608_phd}, author = {Joseph C. Allegra} } @mastersthesis {8725, title = {The Effects of Gender and Social Isolation on Depression among Older Americans}, volume = {M.A.}, year = {2016}, pages = {49}, school = {University of Central Oklahoma}, type = {Thesis}, abstract = {The number of older adults is expected to increase in the near future. Since women live longer than men, women tend to have more complex social networks than men, and women report higher rates of depression than men, it is important to determine whether gender and social isolation affect the rates of depressive symptoms reported by older adults. This thesis seeks to determine the relationship between gender and social isolation and the influence of these variables on depressive symptoms in older adults using selected data from two sections of the 2012 wave of the Health and Retirement Study (HRS). Ordinary least squares (OLS) regression was performed in SPSS in order to determine the main effects relationship between the dependent variable, depression, and independent variables, gender and social isolation. Two additional models were examined to test whether social isolation had a mediating and/or moderating effect on gender{\textquoteright}s relationship to depressive symptoms. As expected, women average more depressive symptoms than men; however, several aspects of social support, such as living with a spouse or partner, contact with children, contact with friends, and neighborhood cohesion, decreased depressive symptoms. Contact with children, contact with friends, and neighborhood cohesion moderated depressive symptoms. All five social isolation variables {\textemdash} living with a spouse or partner, contact with children, contact with family, contact with friends, and neighborhood cohesion {\textemdash} mediated depressive symptoms for gender. These results suggest that social isolation not only has a direct effect, but also moderates and mediates depressive symptoms for gender. This research supports the hypothesis that depressive symptoms are associated with gender and social isolation.}, keywords = {Depressive symptoms, Gender Differences, Isolation, Older Adults, Social Relationships, Women and Minorities}, isbn = {9781339938912}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1820912961?accountid=14667}, author = {Jennifer E. Darling} } @article {8589, title = {Elderly with no nearby family to help them need safety net, experts say}, journal = {Chicago Tribune}, year = {2016}, keywords = {Finances, Older Adults, Risk Factors, Safety Net}, url = {http://www.chicagotribune.com/lifestyles/sc-elder-orphans-family-0823-20160819-story.html}, author = {Nara Schoenberg} } @mastersthesis {8738, title = {Essays in defense economics}, volume = {Ph.D.}, year = {2016}, pages = {106}, school = {Michigan State University}, type = {Dissertation}, address = {East Lansing}, abstract = {This dissertation contains three independent chapters focusing on a common theme{\textemdash}the behavior of military retirees and veterans at middle and old age. Chapter one focuses on a retirement benefit for military retirees and how a change in enrollment policy affected enrollment behavior. Chapters two and three focus on health care access and usage among older veterans. (Abstract shortened by ProQuest.)}, keywords = {Income, Medicare/Medicaid/Health Insurance, Older Adults, Veterans}, isbn = {9781369093193}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1816977966?accountid=14667}, author = {Stype, Amanda C.} } @mastersthesis {8728, title = {Essays in Household Finance}, volume = {Ph.D.}, year = {2016}, pages = {167}, school = {New York University}, type = {Dissertation}, abstract = {In this dissertation I examine the causes of household financial decision making. The first two chapters use administrative data in Sweden to study how wealth effects financial risk taking. In the third chapter I study the interaction between saving and health in the Health and Retirement Study (HRS). The first two chapters use an administrative data set of Swedish lottery players that were randomly assigned 500M USD to estimate the causal effect of wealth on various measures of financial risk taking. From 1999-2007 the Swedish tax authorities collected detailed records of asset holdings for the entire Swedish population to implement a tax on pre-existing wealth. During this same period, I have gained access to records of over 300K lottery winners that won prizes in three distinct lottery subsamples. By linking these two data sets, I have developed an ideal laboratory to estimate the causal effect of wealth on outcomes. The first chapter of this dissertation estimates the causal effect of wealth on stock market participation. A $150,000 windfall gain increases stock ownership probability among pre-lottery non-participants by 12 percentage points, while pre-lottery stock holders are unaffected. The effect is immediate, seemingly permanent and heterogeneous in intuitive ways. Standard lifecycle models predict wealth effects far too large to match our causal estimates under common calibrations. Additional analyses suggest a limited role for explanations such as procrastination or real-estate investment. Overall, results suggest that "nonstandard" beliefs or preferences contribute to the nonparticipation of households across many demographic groups. In the second chapter of this dissertation I estimate the causal effect of wealth on the share of risky assets in a household{\textquoteright}s financial portfolio. We find that $150,000 causes a 9 percentage point decrease in the average household portfolio{\textquoteright}s equity share in their financial portfolio. The effect is immediate, not explained by passive investing, and negative in all subsamples considered. A decrease in risk taking could indicate increasing relative risk aversion. However, we show that a dynamic model with realistic income profile can replicate the estimated decrease in portfolio risk, and that caution should be used when inferring risk preference from portfolio shares. In the third chapter of this dissertation I explore the role of health on retirement savings. Using the HRS, I estimate preferences for wealth when older individuals are in poor health. I find a high marginal value of wealth in the poor health state, and show that it is an important channel that encourages saving late in life.}, keywords = {Finances, Income, Older Adults, Retirement Planning and Satisfaction, Savings}, isbn = {9781339951539}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1820908554?accountid=14667}, author = {Briggs, Joseph S.} } @mastersthesis {8982, title = {Essays in the economics of long-term care utilization.}, volume = {Ph.D.}, year = {2016}, school = {University of New Hampshire}, address = {Durham, NH}, abstract = { This research examines three factors {\textendash} macroeconomic conditions, the Deficit Reduction Act of 2005, and inter-vivos transfers {\textendash} that influence both the availability of long-term care services and the use of these services. The first essay explores how changes in the macroeconomy, specifically the 2007-2009 {\textquotedblleft}Great Recession,{\textquotedblright} affect the utilization of paid and unpaid long-term care services. It is theoretically unclear how long-term care use should be affected by such downturns, as an individual{\textquoteright}s health status, wealth, insurance coverage and access to care are all likely to change during a significant downturn such as the {\textquotedblleft}Great Recession.{\textquotedblright} Using data from the 1998-2012 waves of the Health and Retirement Study, a survey that follows Americans over the age of 50 as they begin to transition into retirement, we estimate the effects of changes in the unemployment rate at both the national and county levels on long-term care use. We find consistent evidence that overall care use declines significantly during downturns, with additional results suggesting that these results may be driven by reductions in individual wealth and improvements in individual health status. The second essay examines how the implementation of the Deficit Reduction Act of 2005, a policy that imposed stricter regulations about how individuals could {\textquotedblleft}spend down{\textquotedblright} their assets to become Medicaid eligible, impacts both asset transfers and long-term care use among the elderly. Using data from the 1998-2010 waves of the Health and Retirement Study, I estimate the effects of this policy using a difference-in-difference framework. Overall, individuals seem to substitute from making inter-vivos transfers to holding assets in trusts in response to the enactment of the Deficit Reduction Act. With regard to care use, individuals seem to substitute from in-home long-term care to more visits to both doctors and adult day care facilities following the DRA, an effect primarily driven by the wealthiest and youngest individuals. The third essay investigates the relationship between parent-to-child inter-vivos asset transfers and future informal care provision by that child. Using data from the 1998 {\textendash} 2010 waves of the Health and Retirement Study, I am able to use the timing of the transfers and the care use to describe this relationship. The results suggest that the receipt of an inter-vivos transfer during the previous two years is strongly positively correlated with that child{\textquoteright}s likelihood of providing care during the previous month. In addition, I confirm a previous finding in the literature that child{\textquoteright}s gender, relationship to the parent and geographical proximity to the parent all significantly influence the child{\textquoteright}s decision to provide care.}, keywords = {Economics, Inter Vivos Transfers, Older Adults, Retirement Planning and Satisfaction}, url = {http://pqdtopen.proquest.com/doc/1842643629.html?FMT=AI\&pubnum=10161840}, author = {Hurdelbrink, Jonathan R.} } @mastersthesis {8723, title = {Essays on aging-related disease in the U.S. population}, volume = {Ph.D.}, year = {2016}, pages = {188}, school = {University of Pennsylvania}, type = {Dissertation}, abstract = {I research three topics in adult morbidity in the United States, focusing on two increasingly prevalent chronic diseases, diabetes and dementia. In the first essay, I investigate changes in age-specific diabetes prevalence across cohorts born in the 20th century and use the cross-cohort comparisons to generate model age patterns of diabetes prevalence and incidence. I show that most of the increase in diabetes prevalence over time is attributable to increases in age-specific prevalence from one cohort to the next. Because the risk of diabetes is embodied in cohorts, diabetes prevalence is likely to increase in the future even if the prevalence of risk factors such as obesity plateau. In the second essay, I use multiple-decrement life tables to estimate age-specific lifetime risks of dementia for a dementia-free person. I estimate that about a quarter of dementia-free 70-year-old males and a third of females will develop dementia in their lifetimes. Although interventions that delay dementia onset could substantially reduce dementia risk, the results indicate a widespread need to prepare for a life stage with dementia. In the third essay, I use recent advances in propensity-score matching techniques to estimate the association between incidence diabetes and subsequent accumulation of mobility limitations. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 25\% more mobility limitations at study exit than those who did not develop diabetes. My estimates of this association are smaller than those found in most of the existing literature, but they are likely less biased.}, keywords = {Aging, Disease, Health Conditions and Status, Older Adults}, isbn = {9781339928586}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1802786679?accountid=14667}, author = {Ezra I. Fishman} } @mastersthesis {8991, title = {Essays on loss aversion and household portfolio choice.}, volume = {Ph.D.}, year = {2016}, school = {University of Illinois - Urbana-Champaign}, type = {Dissertation}, address = {Champaign, Illinois}, abstract = {This dissertation studies how loss-aversion, i.e., people{\textquoteright}s behavioral tendency to be more sensitive to potential losses than the same amount of potential gains, affects households{\textquoteright} insurance buying decisions and savings decisions. The first chapter, "Prospect Theory and Insurance Demand," tries to answer the question of why a substantial fraction of households remains uninsured even if classical expected utility theory predicts that it is beneficial to own insurance. This chapter posits that prospect theory{\textquoteright}s loss-aversion and reference point dependence can address the under-insurance puzzle and tests the theory. This chapter finds empirical evidence consistent with prospect theory using the American Life Panel (ALP) data: loss-averse individuals have a low ownership rate of long-term care insurance, supplemental disability insurance, and private health insurance; they express a low willingness to pay for health insurance; they are unwilling to purchase health insurance in a hypothetical insurance choice experiment. These results are consistent with prospect theory, which predicts that loss-aversion may decrease insurance demand if individuals{\textquoteright} reference points are {\textquoteright}the wealth level when they do not engage in insurance contracts.{\textquoteright} Under such reference points, individuals may regard insurance as a "risky investment" because they may lose premiums if a pre-specified bad event does not occur. Hence, those who are more sensitive to potential losses in premiums are unwilling to buy insurance. The second chapter investigates how loss-aversion affects individuals{\textquoteright} decisions about saving using the Health and Retirement Study (HRS) data. Specifically, this chapter empirically tests if prospect theory{\textquoteright}s loss aversion decreases insurance demands and increases savings demands. Loss-averse individuals may be unwilling to buy term-life insurance because term-life insurance can be regarded as a risky investment. Instead, they may choose a more safe option to prepare for uncertain future events by increasing precautionary saving. This chapter tests this prediction and finds empirical evidence consistent with it: loss-averse individuals are less likely to own term-life insurance and more likely to own whole-life insurance, which serves as a partial savings instrument. These individuals also hold a higher level of wealth than others, suggesting that they tend to save more (presumably for precautionary motives), all other things being equal. The third chapter explores the socially optimal level of insurance given that households are subject to behavioral biases, especially narrow framing and loss aversion. The central issue of this normative analysis is whether or not a social welfare function (SWF) should take into consideration the behavioral components of preferences. One school of thought claims that social planners should not consider behavioral components since they are anomalies or mistakes that are often self-destructive. Another school of thought argues that social planners should respect behavioral components because{\textellipsis} Advisors/Committee Members: Brown, Jeffrey R (advisor), Miller, Nolan H (advisor), Brown, Jeffrey R (Committee Chair), Miller, Nolan H (Committee Chair), Molitor, David (committee member), Weisbenner, Scott J (committee member).}, keywords = {Older Adults, Portfolios, Risk Aversion}, url = {http://hdl.handle.net/2142/92776}, author = {Hwang, In Do} } @mastersthesis {8720, title = {Essays on Risk and Insurance in the Extended Family}, volume = {Ph.D.}, year = {2016}, pages = {151}, school = {Yale University}, type = {Dissertation}, abstract = {This dissertation examines the role of extended family members as {\textquoteright}informal insurance{\textquoteright} against risk over the lifecycle. The three chapters contained in this dissertation focus on long-term care risk and income risk between parents and their adult children. The first chapter analyzes the role of informal care by family members in the demand for long-term care insurance. The second chapter quantifies the substitution between informal care and formal long-term care by exploiting variation in Medicaid eligibility rules across states over time. The third chapter presents a framework to quantify a network{\textquoteright}s ability to share risk and applies it to extended family networks with income risk. The first chapter demonstrates that informal care plays an important role in the demand for long-term care insurance. A key determinant of this result is the {\textquoteright}in-kind{\textquoteright} nature of insurance benefits that creates a lack of coverage of informal care. To quantify the effect of informal care on insurance demand and evaluate potential welfare-enhancing policies, I develop a dynamic model of long-term care decisions between an elderly parent and her adult child. I estimate the model using detailed data from the Health and Retirement Study from 1998-2010. The model replicates the low demand for insurance across the wealth distribution in addition to asset accumulation paths and informal care rates. I find that the availability of family care lowers the demand for insurance by 5 percentage points overall and by 25 percentage points for wealthy individuals. Counterfactual insurance policies that incorporate family care can generate large welfare gains to families. The second chapter examines the interaction between sources of long-term care more closely. Specifically, while most care in the United States is provided informally by family members, it is not obvious whether informal care acts as a substitute for formal care - such as nursing homes - or whether family and formal care service different health needs. I measure the extent to which family care responds to the price of formal long-term care services by exploiting panel variation in Medicaid {\textquoteright}spend-down{\textquoteright} provisions across states. Using data from the decennial Census, the American Community Survey and the Health and Retirement Study over the last 30 years, the analysis finds that Medicaid generosity decreases the use of family care by 1 to 4 percentage points for single individuals aged 80 and over, with a corresponding increase in the use of nursing home. These findings suggest that individuals substitute family care for nursing homes. The third chapter, which is joint with Orazio Attanasio and Costas Meghir, presents a framework to quantify a network{\textquoteright}s potential to share risk and the extent to which the network takes advantage of this opportunity. The standard life cycle model implies that a household will prefer smooth consumption to a variable one. However, the amount of smoothing a household can achieve depends on the instruments at its disposal, such as formal insurance, tax and transfer policies, or informal risk-sharing. The paper first develops a framework of partial insurance and group risk sharing that decomposes income shocks into idiosyncratic (i.e. insurable by the group) and group-aggregate (i.e. uninsurable by the group) components. This allows us to study the differential impact of these shocks on consumption. The second part of the paper applies this framework to extended family networks in the United States. The analysis uses data from the Panel Study of Income Dynamics, which provides longitudinal information on income and consumption of both parents and adult children. The estimates indicate that over 60\% of income shocks are idiosyncratic within extended family networks. We argue that this implies a large potential for the family risk sharing network to have a non-trivial impact on the transmission of income shocks into consumption. However, no such insurance occurs on average. Suggestive evidence shows that some insurance is provided by family networks in narrower geographic areas.}, keywords = {Adult children, Medicare/Medicaid/Health Insurance, Older Adults, Risk Factors}, isbn = {9781369126181}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1816296733?accountid=14667}, author = {Corina D Mommaerts} } @mastersthesis {8729, title = {Essays on the effects of social insurance for disability}, volume = {Ph.D.}, year = {2016}, pages = {233}, school = {University of Maryland, College Park}, type = {Dissertation}, abstract = {This dissertation examines how social insurance, family support and work capacity enhance individuals{\textquoteright} economic well-being following significant health and income shocks. I first examine the extent to which the liquidity-enhancing effects of Worker{\textquoteright}s Compensation (WC) benefits outweigh the moral hazard costs. Analyzing administrative data from Oregon, I estimate a hazard model exploiting variation in the timing and size of a retroactive lump-sum WC payment to decompose the elasticity of claim duration with respect to benefits into the elasticity with respect to an increase in cash on hand, and a decrease in the opportunity cost of missing work. I find that the liquidity effect accounts for 60 to 65 percent of the increase in claim duration among lower-wage workers, but less than half of the increase for higher earners. Using the framework from Chetty (2008), I conclude that the insurance value of WC exceeds the distortionary cost, and increasing the benefit level could increase social welfare. Next, I investigate how government-provided disability insurance (DI) interacts with private transfers to disabled individuals from their grown children. Using the Health and Retirement Study, I estimate a fixed effects, difference in differences regression to compare transfers between DI recipients and two control groups: rejected applicants and a reweighted sample of disabled non-applicants. I find that DI reduces the probability of receiving a transfer by no more than 3 percentage points, or 10 percent. Additional analysis reveals that DI could increase the probability of receiving a transfer in cases where children had limited prior information about the disability, suggesting that DI could send a welfare-improving information signal. Finally, Zachary Morris and I examine how a functional assessment could complement medical evaluations in determining eligibility for disability benefits and in targeting return to work interventions. We analyze claimants{\textquoteright} self-reported functional capacity in a survey of current DI beneficiaries to estimate the share of disability claimants able to do work-related activity. We estimate that 13 percent of current DI beneficiaries are capable of work-related activity. Furthermore, other characteristics of these higher-functioning beneficiaries are positively correlated with employment, making them an appropriate target for return to work interventions.}, keywords = {Disabilities, Health Shocks, Income shocks, Medicare/Medicaid/Health Insurance, Older Adults}, isbn = {9781339867335}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1799101132?accountid=14667}, author = {Stephanie Rennane} } @mastersthesis {8732, title = {Essays on the well-being of an aging population}, volume = {Ph.D.}, year = {2016}, pages = {151}, school = {City University of New York}, type = {Dissertation}, address = {New York City}, abstract = {This dissertation consists of three essays that examine health and labor issues among the middle aged and elderly. Chapter 1. A Delayed Retirement Policy and Male Labor Supply: Evidence from the Entire Dutch Population: This chapter examines the labor supply effects of a national delayed retirement policy introduced in the Netherlands in 2009. The policy offers a reduction in taxes on labor income for each year after the age of 62 in which a person worked. I estimate the average effect of the policy on male labor supply as well as its responsiveness to the size of the incentive. Comparing differentially affected birth cohorts suggests that labor force participation increased by about 3.8 to 5.5 percentage points in the three years after introduction for cohorts that were eligible before the normal retirement age. I also find that a higher bonus induces a greater increase in participation and in the number of hours supplied by those working. Chapter 2. Joint Delayed Retirement of Couples: In this chapter, I study the effect of husbands{\textquoteright} labor force participation on the participation decision of their wives. I exploit the fact that the introduction of the delayed retirement policy studied in chapter one provides a natural experiment allowing me to estimate the Local Average Treatment Effect (LATE) of husbands working on the probability that their wives work, for couples in which the husband was induced by the policy to remain in the labor force. I also study both the average effect of the policy on wives who were not eligible themselves, as well as the spillover effect of the policy through their husbands{\textquoteright} response to the policy. My results suggest that wives are 30 percentage points more likely to work if their husbands work among couples that were affected by the policy and I find a treatment effect on the labor force participation of wives associated with the policy of about 1.5-2 percentage points. Chapter 3. The Effect of Divorce on Health in Middle and Older Ages with Sanders D. Korenman: Both the prevalence and incidence of divorce at older ages have doubled since 1990. We use Health and Retirement Study data to describe associations between divorce and health in middle and later life, using models that follow individuals and couples through divorce (i.e., individual and couple fixed effects). Divorce in middle and older ages is associated with adverse physical health changes for women but not men, and greater mental health declines for women than men. Following individuals over time, women who divorce experience deteriorations in self-reported health and mental health, including depression. Following couples over time, divorce is associated with deterioration in self-reported health for wives but not their husbands. After divorce, a woman is more likely than her ex-husband to be diagnosed with mental health conditions. Differences in self-reported health associated with divorce appear linked to changes in mental rather than physical health.}, keywords = {Aging, Couples, Depressive symptoms, Divorce, Health Conditions and Status, Marriage, Older Adults}, isbn = {9781339746227}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1798833000?accountid=14667}, author = {Alice Zulkarnain} } @mastersthesis {8890, title = {Falls, Fall Injuries and the Aging Workforce}, volume = {Ph.D.}, year = {2016}, pages = {152}, school = {University of Colorado}, type = {Dissertation}, abstract = {Health is a resource that enables an individual to act more freely within the labor market. A person in good health can initiate and maintain gainful employment, even in a physically or cognitively demanding occupation. Poor health can limit an individual{\textquoteright}s functional abilities and job prospects, or the ability to work altogether. As individuals age, the likelihood of poor health increases as various health conditions and health events become more common. By informing which health conditions are likely to have significant economic consequences as the US population ages, epidemiologic research can help guide prevention strategies to reduce the economic burden of poor health and to maintain older adults{\textquoteright} quality of life through retirement. Falls and fall injuries become more common as people age. This is true for falls that occur in the workplace as well as falls that occur outside of work. Falls already have a significant effect on the economy {\textendash} a trend that will likely increase as the workforce ages. The projected lifetime costs of fall injuries occurring during 2010 in the US was over $152.9 billion. Falls also are a useful window through which researchers can see how work and health interact to influence retirement decisions. Like some other public health issues, such as heart attacks and strokes, falls have a dual nature. Falls are, on the one hand, discrete events and, on the other, indicators of ongoing changes in health and social status. An individual{\textquoteright}s labor force participation could, theoretically, be influenced by an injury subsequent to a fall, health changes that preceded and caused the fall or both. The dissertation research presented below is comprised of three research studies that explore how work and health, specifically the experience of falls, might influence older workers{\textquoteright} retirement decisions. The introductory chapter will begin by describing the epidemiology of falls and fall injuries. We present the unadjusted US rates of falls analyzed by age and other factors. We highlight epidemiologic research that has described fall injuries in the workplace and we compare the patterns of fall injuries to other types of occupational injuries, again focusing on age-related patterns. After summarizing the descriptive epidemiology, we highlight analytic research studies that have identified individual-level and environmental risk factors for fall injuries. The consequences of fall injuries are then described, including the types of injuries commonly caused by falls, as well as their effects on disability and retirement. Finally, we present several conceptual models that tie together research on falls and research on work disability. After the introductory chapter, each paper of the dissertation is presented as a chapter. The first paper examines the patterns of same-level fall injuries in US workplaces, exploring whether the relationship between age and fall injury incidence varies by industry. The second paper tests whether, among US workers 65 and older, falls - injurious and non-injurious {\textendash} are associated with a shorter time to first report of a health-related limitation in the work they can perform. The third paper then examines whether falling is associated with a shorter time to labor force exit among US workers 65 and older. A concluding section compares the findings from each study in relation to the research and broader context covered in the introductory chapter. }, keywords = {Falls, Health Shocks, Older Adults, Retirement Planning and Satisfaction}, author = {Kenneth A Scott} } @mastersthesis {8739, title = {Financial Literacy Continuing Professional Education Cognitive Needs Assessment for Florida Small Business Owners}, volume = {Ph.D.}, year = {2016}, pages = {449}, school = {University of South Florida}, type = {Dissertation}, abstract = {The purpose of this study was to assess the financial literacy continuing profession education cognitive needs of Florida small business owners through exploring their profile. To determine the financial literacy profile, an instrument containing 18 tested knowledge and 5 self-assessed knowledge questions was created. Using a panel of experts, the instrument was developed from previously tested financial literacy questions from several sources. Data were collected from clients of the West Central Region of the Florida Small Business Development Center at the University of South Florida. The online survey completed by participants included demographic questions to provide data to profile small business owners{\textquoteright} financial literacy by gender, age, education level, and small business classification. The results indicated small business owners have a high financial literacy. There were significant differences found between the financial literacy of men and women. Men{\textquoteright}s scores were higher for both tested knowledge and self-assessed knowledge. Younger small business owners scored lower than older small business owners. There were significant scoring differences between the highest and lowest levels of education. Tested scores and self-assessed scores increased with higher education levels. Pre-venture/start-up business owners scored lower than the small-medium enterprise owners. Implications included developing educational programs attentive to women small business owner{\textquoteright}s needs, as well as newer and/or younger small business owners.}, keywords = {Cognitive Ability, Education, Financial literacy, Gender Differences, Older Adults, Small business owners, Women and Minorities}, isbn = {9781339617862}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1781654615?accountid=14667}, author = {Dahmen, Pearl J.} } @article {8794, title = {Five Myths About Landing a Good Job Later in Life}, journal = {The Wall Street Journal}, year = {2016}, month = {11/29/2016}, address = {New York City}, abstract = {The conventional wisdom says it{\textquoteright}s impossible. The facts say otherwise.}, keywords = {Job loss, Jobs, Older Adults}, url = {http://www.wsj.com/articles/five-myths-about-landing-a-good-job-later-in-life-1480302842}, author = {Anne Tergesen} } @article {8845, title = {Gender, Illness-Related Diabetes Social Support, and Glycemic Control Among Middle-Aged and Older Adults}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {71}, year = {2016}, month = {May-11-2017}, pages = {1081 - 1088}, abstract = {This study examined whether the association between illness-related diabetes social support (IRDSS) and glycemic control among middle-aged and older adults is different for men and women. This cross-sectional analysis included 914 adults with diabetes who completed the Health and Retirement Study{\textquoteright}s 2003 Mail Survey on Diabetes. IRDSS is a composite score of 8 diabetes self-care measures. Hemoglobin A1c levels were obtained to measure good glycemic control (< 8.0\%). Gender-stratified multivariate log-binomial regression models were used to estimate prevalence ratios and examine the association between IRDSS and glycemic control after controlling for sociodemographic, lifestyle, and clinical characteristics. The prevalence of good glycemic control was 48.9\% among women and 51.1\% among men. Mean composite IRDSS scores did not differ by gender. Among women, composite IRDSS was associated with adequate glycemic control (prevalence ratio: 1.06; 95\% confidence interval: 1.02, 1.08), and all individual components of IRDSS, with the exception of keeping appointments, were positively associated with adequate glycemic control. No significant associations were observed in men for composite or individual components of IRDSS. Determining the gender-specific impact derived from IRDSS is a worthwhile approach to highlighting factors that differentially predict optimal glycemic control among middle-aged and older adults.}, keywords = {Diabetes, Gender Differences, Older Adults, Social Support, Women and Minorities}, issn = {1079-5014}, doi = {10.1093/geronb/gbv061}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbv061https://academic.oup.com/psychsocgerontology/article/71/6/1081/2194711/Gender-IllnessRelated-Diabetes-Social-Support-and}, author = {Mondesir, Favel L. and White, Kellee and Liese, Angela D. and Alexander C McLain} } @proceedings {8795, title = {Genetic approaches in studying work-family conflict and enrichment.}, journal = {Society for Industrial and Organizational Psychology}, year = {2016}, edition = {Novel methods to advance work-family research}, address = {Anaheim, CA}, keywords = {Conflict, Genetics, Older Adults}, author = {Yu, P. P. and Shockley, K. M.} } @mastersthesis {8715, title = {Genetic Moderators of Cognitive Decline in the Health and Retirement Study}, volume = {Ph.D.}, year = {2016}, month = {03/2016}, pages = {121}, school = {University of South Florida}, type = {Dissertation}, abstract = {The current dissertation used a gene x environment (G x E) approach to examine the independent and interactive effects of specific genetic variants and participation in physical and cognitive/social activities (PA and CSA) on cognitive performance in 4,764 participants of the Health and Retirement Study. Using three-wave data, three sets of multi-level growth models were conducted to examine baseline, longitudinal, and interactive effects of genotype (i.e., ApoE, COMT, and BDNF) and CSA/PA on performance across five cognitive measures: immediate, delayed and total word recall, and serial 7s and backwards counting. At baseline, the ApoE ϵ4 allele predicted worse performance in all measures except backwards counting, and the BDNF Met allele predicted better recall scores. The effect of COMT genotype was not significant. Higher CSA/PA predicted better performance on almost all measures. One significant G x E interaction was found between COMT x CSA for backwards counting. Longitudinally, participation in CSA moderated the effect of time on word recall in the ApoE and BDNF models. These results support the idea that genetic and environmental factors are mechanisms of cognitive aging, but also exemplify the variability seen in genetic association studies. Further research is needed to translate such findings into clinically relevant criteria that can be used to identify individual susceptibility to cognitive decline.}, keywords = {Aging, Cognitive Ability, Genetics, Health Conditions and Status, Older Adults}, isbn = {9781339757315}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1800553370?accountid=14667}, author = {Shannon K Runge} } @book {8924, title = {Handbook of Theories of Aging}, year = {2016}, pages = {752}, publisher = {Springer Publishing Company}, organization = {Springer Publishing Company}, edition = {Third}, address = {New York City, NY}, keywords = {Aging, Older Adults}, author = {Vern L. Bengtson and Richard A. Settersten Jr.}, editor = {Brian K. Kennedy and Morrow-Howell, Nancy and Jacqui Smith} } @article {8656, title = {Happy People Make Their Spouses Healthier}, journal = {TIME Magazine}, year = {2016}, keywords = {Happiness, Marriage, News, Older Adults}, url = {http://time.com/4506490/happy-people-make-their-spouses-healthier/}, author = {TIME} } @mastersthesis {8727, title = {Health and wellbeing of older adults in the United States and Japan: A comparative study}, volume = {M.P.H.}, year = {2016}, pages = {86}, school = {San Diego State University}, type = {Thesis}, abstract = {The global population is projected to reach 9.1 billion in 2050 due to an increase in the number of older adults. Older adults are living longer; however, life expectancy values vary by country. While a country{\textquoteright}s degree of economic development is a contributor to the health of its national population, life expectancy varies among economically developed countries as well. Social engagement has been studied as a factor contributing to longevity and the health of older adults. According to the convoy model of social relations, family members begin to play an increasingly integral role in the lives of older adults as they age. Literature has demonstrated preventive benefits of family engagement for the physical, psychological, and cognitive health of older adults. However, family engagement has also been linked to low health among older adults as a means of accommodating functional decline. Cultural values and attitudes have been shown to influence family engagement behaviors as well in both individualist and collectivist nations. This study examined the association of family engagement and self-rated health status (SHS) of older adults (ages 50 to 75 years) in the United State and Japan through a secondary cross-sectional analysis of the 2008 wave of the Health and Retirement Study and the 2007 Japanese Study of Aging and Retirement. Logistic regression found SHS, frequency of family engagement, and proximity of children{\textquoteright}s residence to be significantly associated with the survey country. In the combined sample, family contact of at least once a week (OR: 1.9, 95\% CI: 1.0-3.5), residence within 10 miles of their children (OR: 0.8, 95\% CI: 0.7-1.0), and residence with children (OR: 0.6, 95\% CI: 0.5-0.7) were significantly associated with SHS, even after controlling for age, gender, ethnicity, marital status, income, and comorbidities. Future research may consider a longitudinal analysis to observe whether family engagement demonstrates protective factors for maintaining high SHS over time. While these national surveys had been modeled after each other, increasing alignment of survey instruments for improved equivalence and comparability would strengthen the internal and external validity of findings.}, keywords = {Comorbidity, Cross-National, Health Conditions and Status, JSTAR, Older Adults, Racial/ethnic differences}, isbn = {9781339861340}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1809116978?accountid=14667}, author = {Suzuki, Yukari} } @mastersthesis {8716, title = {The Health Consequences of Negative Wealth Shock During Late Middle Age}, volume = {Ph.D.}, year = {2016}, pages = {143}, school = {University of Michigan}, type = {Dissertation}, address = {Ann Arbor}, abstract = {There is robust empirical evidence for a link between lower economic status and adverse health outcomes, but little is known about whether a sudden, unplanned loss of assets {\textendash} a negative wealth shock {\textendash} has long-term health consequences. Previous research has shown associations between negative wealth shocks and short-term health declines, primarily from losses of housing and investment wealth, with macroeconomic recession presumed to have triggered these shocks. Even during better economic times, however, negative wealth shocks arise frequently from more individualized circumstances, such as high medical expenses, but causal mechanisms linking subsequent health outcomes to these endogenous shocks can be difficult to establish due to the potential for reverse causality and residual confounding. Using data from the Health and Retirement Study, a nationally representative study of US adults aged 50 and older, this dissertation examined markers of short-term changes in stress and health care consumption after negative wealth shock in late middle age, a time of particular vulnerability. Then, differences by whether an individual experienced negative wealth shock in late middle age were assessed for three long-term aging-related trajectories {\textendash} cognitive decline, physical function limitation accumulation, and all-cause mortality. Design and analytic methods addressed bidirectional and time-dependent causation in the relationship between negative wealth shock and health outcomes. Over 15 percent of late middle-aged adults with existing assets experienced negative wealth shock. The main findings indicated that experiencing a negative wealth shock during late middle age was associated with a higher risk of elevated depressive symptoms, a marker of increased stress, as well as long-term risk of mortality and cognitive decline. However, there was no significant association between negative wealth shock and risk of cost-related medication non-adherence {\textendash} a marker of reduced health-related consumption, nor accelerated physical function limitation accumulation. With a substantial proportion of the late middle-aged population experiencing negative wealth shock, targeted interventions to prevent of the occurrence of these shocks and the health consequences thereafter may have a large impact on the health of older Americans}, keywords = {Health Conditions and Status, Health Shocks, Income, Medicare/Medicaid/Health Insurance, Older Adults, Wealth Shocks}, isbn = {9781369082029}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1817658414?accountid=14667}, author = {Lindsay R Pool} } @article {8940, title = {Health Literacy and Access to Care.}, journal = {Journal of Health Communication}, volume = {21 Suppl 1}, year = {2016}, month = {2016}, pages = {43-50}, abstract = {

Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forgo needed care or to report difficulty finding a provider, even after we controlled for other factors, including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after we controlled for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way.

}, keywords = {Aging, Health Literacy, Healthcare, Older Adults}, issn = {1087-0415}, doi = {10.1080/10810730.2015.1131776}, author = {Helen G Levy and Alexander T Janke} } @article {8783, title = {Health sensitivity: Age differences in the within-person coupling of individuals{\textquoteright} physical health and well-being.}, journal = {Developmental Psychology}, volume = {52}, year = {2016}, month = {Jan-01-2016}, pages = {1944 - 1953}, abstract = {Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals{\textquoteright} well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50{\textendash}109 year olds; 55\% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity{\textemdash}on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect{\textemdash}and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record (c) 2016 APA, all rights reserved)}, keywords = {Age differences, Health Conditions and Status, Marriage, Mortality, Older Adults}, issn = {0012-1649}, doi = {10.1037/dev0000171}, url = {http://doi.apa.org/getdoi.cfm?doi=10.1037/dev0000171}, author = {Sch{\"o}llgen, Ina and Morack, Jennifer and Frank J Infurna and Ram, Nilam and Denis Gerstorf} } @article {8835, title = {Here{\textquoteright}s why dementia rates are falling across U.S.}, journal = {The Los Angeles Times}, volume = {27 Nov 2016}, year = {2016}, month = {27 Nov 2016}, address = {Los Angeles}, abstract = {The decline in dementia rates translates to about one million fewer Americans suffering from the condition, said John Haaga, director of behavioral and social research at the National Institute on Aging, part of the National Institutes of Health, which funded the new study.}, keywords = {Dementia, Health Conditions and Status, News, Older Adults}, url = {http://www.dailynews.com/health/20161127/heres-why-dementia-rates-are-falling-across-us}, author = {Szabo, Liz} } @article {8561, title = {How Family Status and Social Security Claiming Options Shape Optimal Life Cycle Portfolios}, journal = {Review of Financial Studies}, volume = {29}, year = {2016}, month = {Jul-04-2016}, pages = {937 - 978}, abstract = {We show how optimal household decisions regarding work, retirement, saving, portfolio allocations, and life insurance are shaped by the complex financial options embedded in U.S. Social Security rules and uncertain family transitions. Our life cycle model predicts sharp consumption drops on retirement, an age-62 peak in claiming rates, and earlier claiming by wives versus husbands and single women. Moreover, life insurance is mainly purchased on men{\textquoteright}s lives. Our model, which takes Social Security rules seriously, generates wealth and retirement outcomes that are more consistent with the data, in contrast to earlier and less realistic models}, keywords = {Gender Differences, Older Adults, Retirement Planning and Satisfaction, Social Security}, issn = {0893-9454}, doi = {10.1093/rfs/hhv070}, url = {http://rfs.oxfordjournals.org/lookup/doi/10.1093/rfs/hhv070}, author = {Hubener, Andreas and Maurer, Raimond and Olivia S. Mitchell} } @article {8689, title = {How medical marijuana could help boomers get the most out of retirement}, journal = {The Washington Post}, year = {2016}, month = {10/04/2016}, keywords = {Baby Boomers, Cannabis, Older Adults, Prescription Medication, Retirement Planning and Satisfaction}, url = {https://www.washingtonpost.com/news/wonk/wp/2016/10/04/how-medical-marijuana-could-help-boomers-get-the-most-out-of-retirement/}, author = {Christopher Ingraham} } @article {8711, title = {Immigrant-native differences in stockholding {\textendash} The role of cognitive and non-cognitive skills}, journal = {Journal of Empirical Finance}, volume = {38}, year = {2016}, month = {Jan-09-2016}, pages = {103 - 119}, abstract = {This paper provides new evidence on immigrant-native differences in financial behavior. We use data from the Health and Retirement Study (HRS). Although looking at long-term immigrants, we find a substantial gap in stockholding between immigrant and native households. Estimates from a probit model suggest that cognitive and non-cognitive skills are important drivers and explain part of the difference between natives and immigrants. These findings are supported by results from a Blinder-Oaxaca decomposition analysis. Our paper delivers first evidence that differences in non-cognitive and cognitive skills contribute to the explanation of the financial market participation gap between natives and immigrants. (C) 2016 Elsevier B.V. All rights reserved.}, keywords = {Cognitive Ability, Health Behavior, Immigrants, Investing, Older Adults}, issn = {09275398}, doi = {10.1016/j.jempfin.2016.05.008}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0927539816300573http://api.elsevier.com/content/article/PII:S0927539816300573?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0927539816300573?httpAccept=text/plain}, author = {Luik, Marc-Andr{\'e} and Steinhardt, Max Friedrich} } @article {8543, title = {The Impact of Late-Career Job Loss and Genotype on Body Mass Index}, number = {Working Paper 22348}, year = {2016}, month = {06/2016}, pages = {1-44}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This study examines whether the effect of job loss on body mass index (BMI) at older ages is moderated by genotype using twenty years of socio-demographic and genome-wide data from the Health and Retirement Study (HRS). To avoid any potential confounding we interact layoffs due to a plant or business closure{\textemdash}a plausibly exogenous environmental exposure{\textemdash}with a polygenic risk score for BMI in a regression-adjusted semiparametric differences-in-differences matching framework that compares the BMI of those before and after an involuntary job loss with a control group that has not been laid off. Results indicate genetically-at-risk workers who lost their job before they were eligible for Social Security benefits, or before age 62, were more likely to gain weight. Further analysis reveals heterogeneous treatment effects by demographic, health, and socioeconomic characteristics. In particular, we find high risk individuals who gained weight after a job loss were more likely to be male, in worse health, single, and at the bottom half of the wealth distribution. Across the board, effects are concentrated among high-risk individuals who were not overweight prior to job loss, indicating unemployment at older ages may trigger weight gain in otherwise healthy or normal weight populations. }, keywords = {BMI, Genome, Job loss, Older Adults}, doi = {10.3386/w22348}, url = {http://www.nber.org/papers/w22348.pdf}, author = {Lauren L Schmitz and Dalton C Conley} } @mastersthesis {8722, title = {The impact of social network and neighborhood characteristics on the driving status of older adults: The moderating role of gender}, volume = {Ph.D.}, year = {2016}, month = {05/2016}, pages = {189}, school = {University of Massachusetts Boston}, type = {Dissertation}, address = {Boston}, abstract = {Due to the automobile-dependent nature of the U.S., the rapidly growing population of older adults, and the association of several age-related impairments and unsafe driving, understanding the factors that impact changes in older adults{\textquoteright} driving behavior has important implications for policy and practice. Previous research has demonstrated the effect of sociodemographic characteristics and health factors on the driving status of older adults, however, the impact of broader social and environmental factors in decisions about driving is less established. The purpose of the current study is to advance understanding of the impact of the quality of social relationships as well as neighborhood social factors and physical attributes, controlling for sociodemographic and health characteristics, on the driving status of older adults. A second aim of this study is to assess the moderating role of gender in the investigated associations. Guided by the socioecological theoretical model, multinomial logistic regression analyses were conducted, using the large, nationally representative Health and Retirement Study dataset (waves 2006-2008 and 2008-2010) to investigate the predictors of changes in driving status. Results suggest that social relationship quality, particularly relationship strain, and both components of neighborhood context, social cohesion and physical disorder, impact changes in driving status among older adults. Findings also suggest that gender moderates the relationship between social and environmental context factors and older adults{\textquoteright} decisions about driving. Implications for policy and practice are discussed.}, keywords = {Cognitive Ability, Driving, Functional limitations, Gender Differences, Older Adults, Social media, Social Relationships, Women and Minorities}, isbn = {9781339798707}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1803936508?accountid=14667}, author = {Kelli N. Barton} } @mastersthesis {8990, title = {The Influence of Mental Health on Portfolio Choice of Older Households.}, volume = {Ph.D.}, year = {2016}, school = {The Ohio State University}, type = {Dissertation}, address = {Columbus, Ohio}, abstract = {With an aging population, an increasing number of people including the baby boomers are entering their retirement age. The need for appropriate financial planning for the elderly is an important issue as most of them will need to depend on their retirement savings for expenditures in their retirement. The elderly people{\textquoteright}s well-being will hinge on how well they manage their personal finances. Yet there are many challenges facing the older population with respect to personal financial management. One of the most important challenges is that many elderly people have mental health conditions which may affect their ability to manage their household portfolios. This study examines the influences of different kinds of mental health conditions including depression, memory problems, sleep problems and psychiatric problems on household portfolio choice. This study specifically examines two potential significant mechanisms by which mental health conditions might affect household portfolio choice, namely direct influence of mental health on portfolio choice and indirect influence of mental health on portfolio choice through affecting cognitive ability. Based on the theoretical background on the relationship among mental health conditions, cognitive ability and portfolio choice, a model concerning these factors is established. Empirical specifications are built based on health and personal financial management literature. Several research hypotheses are developed to test the direct and indirect influences of mental health conditions on household portfolio choice. Panel regression analyses with fixed effects and mediation models are used to test the hypotheses concerning portfolio decisions in older households in various empirical specifications.Using data from the Health and Retirement Study, this study finds that elderly persons suffering from mental health conditions, including memory problems and depression, have significantly lower cognitive ability than those without these conditions. Fixed effects regressions and mediation models show that memory problems and depression are indirectly associated with a decrease in ownership of risky assets mediated by cognitive ability. Sleep problems, however, are indirectly associated with increase in ownership of risky assets mediated by cognitive ability. On the other hand, sleep problems, memory problems, depression and psychiatric problems are not significantly associated with the proportion of risky assets in the investment portfolios of older households.The results of this study have important policy implications in the area of personal financial management of the elderly. This study establishes the possible mechanism by which mental health conditions influence household portfolio choice. Policy makers may wish to suggest laws to protect elderly people suffering from mental health conditions while they make important investment decisions on their portfolios. One example is to make it mandatory for financial institutions to provide the mentally ill with adequate access to certified{\textellipsis} Advisors/Committee Members: Yilmazer, Tansel (Advisor).}, keywords = {Decision making, Mental Health, Older Adults, Portfolios}, url = {http://rave.ohiolink.edu/etdc/view?acc_num=osu1460215976}, author = {Cheung, Cheuk Hee} } @conference { ISI:000388585000170, title = {Internet Usage Among Older Adults: Findings from the Health and Retirement Study 2002-2014}, booktitle = {Gerontological Society of America}, year = {2016}, month = {NOV}, publisher = {Oxford}, organization = {Oxford}, keywords = {Internet usage, Older Adults, Societal changes}, issn = {0016-9013}, author = {Gwenith G Fisher and Wallace, L. E. and Lindsay H Ryan and Ryan J McCammon and John J McArdle} } @article {8657, title = {Job Lock, Work, and Psychological Well-being in the United States}, journal = {Work, Aging and Retirement}, volume = {2}, year = {2016}, month = {May-07-2017}, pages = {345 - 358}, abstract = {The purpose of the present study was to examine job lock in relation to well-being among workers in the United States. Job lock refers to a circumstance in which a worker would like to retire or stop working altogether, but perceives that they cannot due to needing the income, and/or health insurance. Prior to examining job lock as a potential predictor of life satisfaction we first investigated the construct validity of job lock. Results from a sample of N = 308 workers obtained via MTurk indicated that job lock due to financial need was more strongly associated with continuance and affective organizational commitment and job satisfaction compared to health insurance job lock. Job lock due to health insurance needs was related to a dimension of career entrenchment. We then tested hypotheses regarding the relation between job lock at T1 and life satisfaction at T2, 2 years later. Specifically, we hypothesized that perceptions of job lock would be negatively related to life satisfaction. Using 2 independent samples from the Health and Retirement Study (HRS), we found that both types of job lock were highly prevalent among workers aged 62{\textendash}65. Job lock due to money was significantly associated with lower life satisfaction 2 years later. The findings for job lock due to health insurance were mixed across the 2 samples. This study was an important first step toward examining the relation between job lock, an economic concept, in relation to workers{\textquoteright} job attitudes and well-being.}, keywords = {Depressive symptoms, Employment and Labor Force, Financial Health, Older Adults, Psychosocial}, issn = {2054-4642}, doi = {10.1093/workar/waw004}, url = {http://workar.oxfordjournals.org/lookup/doi/10.1093/workar/waw004}, author = {Gwenith G Fisher and Lindsay H Ryan and Amanda Sonnega and Naud{\'e}, Megan N.} } @mastersthesis {8734, title = {Labor Force Participation and Retirement}, volume = {Ph.D.}, year = {2016}, pages = {181}, school = {New York University}, type = {Dissertation}, address = {New York City}, abstract = {This dissertation contains two different papers on retirement. The two studies share two objectives. The first one is to understand retirement better, and to think about how retirement decisions are related to other decisions that people make during their lives, including decisions about labor supply, savings, and consumption. The second objective is to think about why Americans are retiring later (the labor force participation of older U.S. residents has been going up in the past 25 years, reverting a previous trend towards earlier retirement). The first chapter studies how marriage can affect retirement decisions. In particular, it shows that, when there is some complementarity in couples{\textquoteright} preferences regarding leisure, the increasing labor force participation of older women can help to explain the recent increase in retirement ages of married men. The second chapter studies how different private pension plans can have different effects on retirement. More specifically, it investigates whether the shift from defined benefit to defined contribution pension plans can help to explain recent retirement trends in the United States.}, keywords = {Employment and Labor Force, Financial literacy, Marriage, Older Adults, Retirement Planning and Satisfaction}, isbn = {9781339951010}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1820071383?accountid=14667}, author = {Noronha, Gilberto} } @article {8839, title = {Late-in-Life Risks and the Under-Insurance Puzzle}, number = {Working Paper No. 22726}, year = {2016}, month = {10/2016}, pages = {1-62}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Individuals face significant late-in-life risks, including needing long-term care (LTC). Yet, they hold little long-term care insurance (LTCI). Using both "strategic survey questions," which identify preferences, and stated demand questions, this paper investigates the degree to which a fundamental lack of interest and poor product features determine low LTCI holdings. It estimates a rich set of individual-level preferences and uses a life-cycle model to predict insurance demand, finding that better insurance would be far more widely held than are products in the market. Comparing stated and model-predicted demand shows that flaws in existing products provide a significant, but partial, explanation for this under-insurance puzzle.}, keywords = {Affordable Care Act, Health Insurance, Health Shocks, Medicare/Medicaid/Health Insurance, Older Adults, Risk Factors, Social Security}, doi = {10.3386/w22726}, url = {http://www.nber.org/papers/w22726.pdf}, author = {Ameriks, John and Briggs, Joseph S. and Caplin, Andrew and Matthew D. Shapiro and Tonetti, Christopher} } @article {8978, title = {Late-Life Bereavement: Association Between Familial Death and Weight Loss Among Elderly in the United States}, journal = {OMEGA - Journal of Death and Dying}, year = {2016}, month = {Sep-05-2016}, pages = {0030222816649082}, abstract = {Healthy aging is critical for the elderly to be independent and enjoy at least a satisfactory quality of life. However, late-life bereavement threatens healthy aging, as it may lead to adverse health effects. Using data from the Health and Retirement Survey, this study investigates the relationship between weight{\textemdash}specifically, body mass index (BMI){\textemdash}and the loss of a parent, sibling, or spouse at an older age. It is the first attempt to investigate this relationship among the elderly population in the United States and makes the following notable contributions to the literature: (a) use of a large longitudinal dataset, (b) estimation of the effects of a familial death on a person{\textquoteright}s BMI, and (c) investigation of the consequences of the bereavement for older people. Our results suggest that losing a family member at an older age results in a decrease in BMI.}, keywords = {Bereavement, BMI, Death \& Dying, Older Adults}, issn = {0030-2228}, doi = {10.1177/0030222816649082}, url = {http://ome.sagepub.com/lookup/doi/10.1177/0030222816649082}, author = {Murat Anil Mercan and Barlin, Hande and Cebeci, Ali F.} } @article {8836, title = {Leaving Big Money on the Table: Arbitrage Opportunities in Delaying Social Security}, number = {Working Paper No. 22853}, year = {2016}, month = {11/2016}, pages = {1-34}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Recent research has documented that delaying the commencement of Social Security benefits increases the expected present value of retirement income for most people. Despite this research, the vast majority of individuals claim Social Security at or before full retirement age. Claiming Social Security early is not necessarily a mistake, as delaying Social Security commencement requires forgoing current income in exchange for future income. The decision to claim early could therefore rationally be driven by liquidity constraints, mortality concerns, bequest motives, a high time discount rate, or a variety of other preference related factors. However, for some individuals, delaying Social Security offers a significant arbitrage opportunity because they can defer Social Security and have higher income in all future years. Arbitrage exists for most primary earners who either purchase a retail-priced annuity or opt for a defined benefit annuity when a lump sum payout is offered, while forgoing the opportunity to defer Social Security. These individuals are essentially buying an expensive annuity when a cheaper one is available, and their decision to claim Social Security early is almost certainly a mistake. The magnitude of the mistake can reach up to approximately $250,000.}, keywords = {Older Adults, Retirement Planning and Satisfaction, Social Security}, doi = {10.3386/w22853}, url = {http://www.nber.org/papers/w22853.pdf}, author = {Bronshtein, Gila and Jason S Scott and John B. Shoven and Sita Nataraj Slavov} } @article {8524, title = {Life Spans of the Rich Leave the Poor Behind}, journal = {The New York Times}, number = {A1}, year = {2016}, edition = {February 13, 2016}, chapter = {A}, keywords = {Income, Life Expectancy, Older Adults, Wage gap}, url = {http://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html}, author = {Tavernise, Sabrina} } @mastersthesis {8731, title = {Living alone and subsequent living arrangement transitions among older Americans}, volume = {Ph.D.}, year = {2016}, pages = {262}, school = {University of Massachusetts Boston}, type = {Dissertation}, address = {Boston}, abstract = {Past research often considers living alone as a risk factor for older persons. In fact, adverse health outcomes are associated with living arrangement transitions, suggesting a need to consider the dynamic process of living arrangements. Using eight waves of the Health and Retirement Study (1998{\textendash}2012), this study examines three research questions: (1) Do older Americans{\textquoteright} living arrangements exhibit a pattern of sequence? (2) What are implications of living arrangements at particular older ages on life expectancy? (3) What factors predict transitions out of a living alone arrangement? The first analysis displays and classifies ordered patterns of living arrangements over time. Baseline living arrangements have a substantial influence on subsequent transitions. Major patterns of women{\textquoteright}s living arrangement sequences are more diverse than those for men. In particular, living alone is both the major living arrangements at baseline or intermediately after baseline. These results suggest the importance of the living arrangement status at old ages in relation to subsequent living arrangements over time. Next, multistate life tables are estimated for calculating life expectancy in total and among distinct living arrangements. While the expected percentage of time spent living alone for men increases with age, about half of women{\textquoteright}s total life expectancy at any ages is spent living alone. Older persons living alone do not have shorter life expectancies than those in co-residential living arrangements, particularly among women. This suggests a selection process in which less robust older persons tend to transition to other living arrangements or die at younger ages. Lastly, discrete-time event history models are used to examine factors associated with transitioning from living alone. Sentinel health events and poorer functional status are associated with an increased risk of death, and, to a lesser extent, a subsequent transition to co-residence or institutionalization. Analyses of transitions from living alone measured concurrently with changes in functional status suggest that many transitions may be immediate reactions to a recent health decline rather than adjustments following a progressive health decline. In either case, subsequent co-residence does not appear to be a common adaptation for many older adults who live alone with increased needs for care.}, keywords = {Adult children, Living arrangements, Older Adults}, isbn = {9781339797564}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1804048288?accountid=14667}, author = {Shih, Yao-Chi} } @mastersthesis {8987, title = {Loneliness, Cynical Hostility, and Cognitive Decline in Americans above Age 50}, volume = {Master of Science}, year = {2016}, school = {Virginia Commonwealth University}, type = {Thesis}, address = {Richmond, Virginia}, abstract = {Background. Research identifies isolation (being alone) as a risk factor for cognitive decline{\textemdash} yet it is possible that subjective dimensions of isolation are more critical. Potential risk factors are loneliness (the distress stemming from feeling alone) and cynical hostility (an attitude of distrust and cynicism). The present study examined the relationship between these factors and cognitive functioning and decline. Methods. Data came from the Health and Retirement Study, a nationally representative longitudinal study of US adults over 50. Loneliness was measured using the Hughes Loneliness Scale; cynical hostility was measured using items from the Cook-Medley Hostility Inventory. Cognitive functioning was indexed by the Telephone Interview for Cognitive Status. Regressions were conducted to examine loneliness and cynical hostility as predictors of cognitive function at baseline as well as cognitive decline over four and six-year periods. Models were adjusted for demographic characteristics, health behaviors, and isolation. Results. Loneliness, [f2=.003, t(52)=-3.75; p<.001] and cynical hostility, [f2=.002, t(52)=-2.98, p=.004] predicted cognitive function at baseline. Loneliness and cynical hostility each predicted cognitive decline over four [f2=.001, t(52)=-2.29; p=.026 f2=.003, t(52)=-3.98; p<.001 respectively] but not six years [t(52)= -.78; p=.439; t(52)= -1.29; p=.203 respectively]. Discussion. Loneliness and cynical hostility are correlates of lower cognitive function and risk factors for cognitive decline over four years. The absence of significant effects of loneliness and cynical hostility over six years could be attributed to low statistical power in these analyses. The effect sizes in this study are small, yet meaningful in the context of the personal and social costs associated with cognitive decline. Advisors/Committee Members: Bruce Rybarczyk, Briana Mezuk, Paul Perrin.}, keywords = {Cognitive Ability, Depressive symptoms, Loneliness, Older Adults}, url = {http://scholarscompass.vcu.edu/etd/4192}, author = {Sarah C. Griffin} } @mastersthesis {8717, title = {Low-Intensity Physical Activity and Cardiometabolic Risk Factors among Older Adults with Multiple Chronic Conditions}, volume = {M.S.}, year = {2016}, month = {2016}, pages = {73}, school = {University of South Carolina}, type = {Thesis}, abstract = {Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. Methods Data from the Health and Retirement Study (HRS) were used for this study. We ascertained 2006 and 2008 HRS data from the Public Use Dataset, the RAND HRS Data File (Version N), and the HRS Biomarker Dataset. There were11890 participants aged 50 or older for cross-sectional analysis. Physical activity was converted to metabolic equivalent of tasks (METS) and outcome variables (systolic and diastolic blood pressure and HbA1c) were measured objectively. Mean levels of blood pressure and HbA1c were compared across physical activity intensity groups. Separate linear regression models were used to examine the association between LIPA and cardiometabolic risks adjusting for potential sociodemographic, behavioral, and clinical confounders. Results In the final study sample, 28.75\% were sedentary, 9.46\% regularly engaged in LIPA, 34.68\% engaged in MIPA, and 27.12\% engaged in VIPA. We did not find significant associations between LIPA and systolic blood pressure (B 0.235; 95\% confidence interval (CI), -1.127, 1.597), diastolic blood pressure (B = -0.167; 95\% CI, -0.954, 0.621), or HbA1c levels (B -0.009; 95\% CI, -0.049, 0.066). The average HbA1c was significantly lower only among individuals who engaged in MIPA (B -0.097; 95\% CI, -0.174, -0.020) and MIPA ( B -0.140; 95\% CI, -0.218, -0.063) in comparison to individuals who were categorized as in sedentary group Conclusion The findings from our study do not suggest that LIPA is independently associated with lower cardiometabolic risk factors among older adults. Associations between physical activity intensity and cardiometabolic risk factors among older adults with multiple chronic conditions need to be verified in studies using more objective measurement of physical activity.}, keywords = {Comorbidity, Health Conditions and Status, Heart disease, Older Adults, Physical activity, Risk Factors}, isbn = {9781339456591}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1780691559?accountid=14667}, author = {Yueyao Li} } @mastersthesis {8733, title = {Marital biography and chronic disease progression in mid- and late life}, volume = {Ph.D.}, year = {2016}, pages = {126}, school = {Michigan State University}, type = {Dissertation}, address = {East Lansing}, abstract = {In light of lengthening life expectancy with chronic disease and increasingly diverse marital experiences over the life course among older adults in the US, this dissertation investigates how marital biography is linked to chronic disease progression among older adults aged 50 years old and over in the US. I use three papers to address this overarching research question. The data are from the Health and Retirement Study (HRS), 1994{\textendash}2012, a national panel sample representative of noninstitutionalized civilian adults aged at least 50 years old in the US. My first paper evaluates how current marital status and current marriage duration are associated with the development of functional limitations among older adults diagnosed with diabetes, using multilevel growth curve models. The findings show that remarried, cohabiting and divorced/separated older adults with diabetes report significantly more functional limitations at age 50 than their peers who stay in their first marriage. Although widowed older adults with diabetes report significantly fewer functional limitations than the first-time married at age 50, they show a faster decline in their functional health over time. The never-married show a similar functional health trajectory as the first-time married. The second paper assesses the link between marital quality and functional limitations among older adults diagnosed with cardiovascular disease. Multilevel models are used to estimate the associations between marital quality and functional health and control for household-level clustering effects. My analyses show that while negative dimensions of marital quality are significantly associated with worse functional health subsequently in two years for both older men and women with cardiovascular disease, positive dimensions of marital quality are significantly linked to better functional health only for men. Additionally, improvements in positive marital quality over a four-year period are significantly associated with better functional health four years later. The third paper examines differential mortality risk by marital trajectories among older adults with cardiovascular disease, focusing on their lifetime exposure to marital losses with Cox regression models. The analyses show that among the remarried, only those who are one-time widowed exhibit a significantly higher mortality risk than the first-time married. Both the currently divorced/separated and widowed experience significant mortality disadvantage compared to their peers in their first marriage. Additionally, older cohabitors with cardiovascular disease also show a heightened mortality risk. The never-married, however, show comparable mortality risk to that of the first-time married. Overall, the findings from this dissertation point to the significance of marriage for maintaining physical functioning for older adults while they manage major chronic illnesses such as diabetes and cardiovascular disease. However, the benefits of marriage for chronic disease management are also contingent upon past marital experience and relationship quality. I expect the findings to have important implications for healthcare professionals working with chronic disease patients and public policies regarding chronic disease management.}, keywords = {Chronic disease, Divorce, Longevity, Marriage, Mortality, Older Adults}, isbn = {9781339966724}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1822210624?accountid=14667}, author = {Yu, Yan-Liang} } @mastersthesis {8985, title = {Measuring the Impact of Volunteering on Physical Activity Using Data from the Health and Retirement Study}, volume = {Ph.D.}, year = {2016}, school = {University of Illinois at Chicago}, type = {Dissertation}, address = {Chicago, Illinois}, abstract = {BACKGROUND: This study measures the impact of volunteering type and intensity on different aspects of physical activity including meeting recommended activity guidelines and level of intensity. METHODS: Four waves and eight years of longitudinal data on a nationally representative sample of Americans, 50 and older were used. RESULTS: As predicted, volunteering was associated with increased physical activity with respect to likelihood to meet guidelines and higher intensity of physical activity after adjusting for baseline age, gender, education, self-rated health and comorbidities and physical activity. Volunteers were more likely to meet physical activity guidelines and to maintain a higher likelihood of meeting guidelines than non-volunteers. In addition, volunteers were less likely to exhibit depressive symptoms, report decreases in functional limitation or decreases in self-rated health than those who did not volunteer. Number of hours of volunteering was significantly and positively associated with increased likelihood to meet guidelines. Finally, analyses found that older adults who volunteered with children had lower likelihood of depression and improvements in several psychosocial variables including social network and social support scores compared to older adults who volunteered but did not volunteer with children. CONCLUSIONS: Results suggest that volunteering could be a mechanism to help older adults meet and maintain the meeting of physical activity guidelines over time. Volunteering also appears to be associated with reduction of depressive symptoms, functional limitations and decreases in self-rated health over time. Finally, volunteering with children could act as a buffer to mediate lower social support and reports of negative familial support. The amount of volunteering required to confer maximum health benefits should be further explored. Future studies should also further examine the casual relationship between volunteering and physical activity.}, keywords = {Older Adults, Volunteerism}, url = {http://indigo.uic.edu/handle/10027/21292}, author = {Clark, Julia R.} } @article {8539, title = {Medicare Part D and Portfolio Choice {\textdagger}}, journal = {American Economic Review}, volume = {106}, year = {2016}, month = {Jan-05-2016}, pages = {339 - 342}, abstract = {Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk due to the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort.}, keywords = {Healthcare, Investing, Medicare/Medicaid/Health Insurance, Older Adults}, issn = {0002-8282}, doi = {10.1257/aer.p20161125}, url = {http://pubs.aeaweb.org/doi/10.1257/aer.p20161125}, author = {Padmaja Ayyagari and Daifeng He} } @inbook {8550, title = {Military Service in Lives: Where Do We Go From Here?}, booktitle = {Handbook of the Life Course}, year = {2016}, pages = {277-300}, publisher = {Springer}, organization = {Springer}, abstract = {Although the military has enduring effects on the lives of service members and their families, it is often overlooked as an institutional force that shapes the life course. This chapter aims to bring military service to the attention of life-course scholars by: providing a conceptual model for understanding the impact of military service on lives that builds on the core principles of the life-course perspective; reviewing empirical evidence regarding how military service is related to childhood and adolescence, influences the transition to adulthood, and has long-term consequences for various outcomes in mid-to-late life; and identifying methodological challenges and relatively unexplored questions that should be the focus of future inquiry. In doing so, this chapter facilitates an understanding of military service in lives while also underscoring the role of social institutions in shaping the life course.}, keywords = {Military service, Older Adults, Veterans}, author = {Andrew S London and Janet M Wilmoth} } @mastersthesis {8737, title = {A mindfulness-based stress reduction program for lesbian, gay, bisexual, transgender older adults: A grant proposal}, volume = {M.S.W.}, year = {2016}, pages = {71}, school = {California State University, Long Beach}, type = {Thesis}, abstract = {As the population of those aged 65 and older increases, it is important to support programs designed to improve the well-being and quality of life for this population. The lesbian, gay, bisexual, and transgender (LGBT) community has a history of oppression, discrimination, and social isolation, and many older adults are significantly at risk for poorer health outcomes. The purpose of this project was to develop a Mindfulness Based Stress Reduction (MBSR) program for LGBT older adults currently receiving services at the LGBT Center in Long Beach, California. The proposed program will be an 8-week mindfulness based program focused on stress management in order to improve their overall well-being and quality of life. After a comprehensive search of funding agencies, the best fit of a funder for this program was the David Bohnett Foundation. The actual submission or funding of this grant was not required for the successful completion of this grant proposal.}, keywords = {Grant proposal, LGBTQ, Older Adults, Stress}, isbn = {9781339638171}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1783572946?accountid=14667}, author = {Alicia Flores} } @mastersthesis {8721, title = {Modeling longitudinal mediation of within-person changes}, volume = {M.A.}, year = {2016}, pages = {75}, school = {The University of North Carolina at Chapel Hill}, type = {Thesis}, address = {Chapel Hill}, abstract = {Mediation analysis concerns the discovery of mechanisms that transmit an effect from one variable to another. At times, social scientists propose hypotheses involving mediation of within-person changes (e.g., do within-person changes in cognitive ability mediate the relation between changes in depression and changes in disability?) The current manuscript introduces an approach within the latent change score (LCS) modeling framework to test such hypotheses. This approach is compared to existing methods, including the cross-lagged panel model (CLPM; Cole \& Maxwell, 2003) and the LCS mediation model (Selig \& Preacher, 2009). Results from (1) a single-replication simulation and (2) an empirical example utilizing data from the Health and Retirement study are presented.}, keywords = {Latent change score, Meta-analyses, Older Adults, Psychosocial, Self-reported health}, isbn = {9781369014662}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1829616915?accountid=14667}, author = {Henk, Corinne M.} } @article {8834, title = {The New Lifecycle of Women{\textquoteright}s Employment: Disappearing Humps, Sagging Middles, Expanding Tops}, number = {Working Paper 22913}, year = {2016}, month = {12/2016}, pages = {1-39}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {A new lifecycle of women{\textquoteright}s employment emerged with cohorts born in the 1950s. For prior cohorts, lifecycle employment had a hump shape; it increased from the twenties to the forties, hit a peak and then declined starting in the fifties. The new lifecycle of employment is initially high and flat, there is a dip in the middle and a phasing out that is more prolonged than for previous cohorts. The hump is gone, the middle is a bit sagging and the top has greatly expanded. We explore the increase in cumulative work experience for women from the 1930s to the 1970s birth cohorts using the SIPP and the HRS. We investigate the changing labor force impact of a birth event across cohorts and by education and also the impact of taking leave or quitting. We find greatly increased labor force experience across cohorts, far less time out after a birth and greater labor force recovery for those who take paid or unpaid leave. Increased employment of women in their older ages is related to more continuous work experience across the lifecycle.}, keywords = {Employment and Labor Force, Lifecycles, Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.3386/w22913}, url = {http://www.nber.org/papers/w22913.pdf}, author = {Goldin, Claudia and Mitchell, Joshua} } @article {8997, title = {Occupational Transitions at Older Ages: What Moves are People Making?}, number = {WP 2016-352}, year = {2016}, month = {09/2016}, institution = {Michigan Retirement Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Given the clear benefit for both public and private finances of extending work lives, many policymakers are interested in finding and promoting ways to accomplish this objective while balancing concerns for work ability at older ages. At the same time, retirement itself is transforming from a simple transition from full-time work to full and permanent retirement to more of a process, potentially occurring in several stages over a number of years. We consider a set of work transitions at ages when the largest numbers of people are retiring and potentially pursuing different paths to full and permanent retirement. Among workers who transition between occupations, the most common transitions are between those that are closely related. However, even within closely related occupations, there are no large pipelines between any two. By age 62, 57 percent of workers are no longer in the labor force, 26 percent are still in their {\textquotedblleft}career{\textquotedblright} occupation, and 17 percent have changed from their career occupation to another occupation. Beginning at age 66, however, the percentages in different occupations, which may be bridge employment or unretirement, are very similar to the percentages remaining in career occupations. Occupational changes later in life tend to be accompanied by decreases in hourly earnings, suggesting that if workers are seeking flexible or part-time bridge employment, it may come at a cost. }, keywords = {Employment and Labor Force, Older Adults, Transitions}, url = {http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp352.pdf}, author = {Amanda Sonnega and McFall, Brooke Helppie and Robert J. Willis} } @article {8833, title = {Older Peoples{\textquoteright} Willingness to Delay Social Security Claiming}, number = {Working Paper No. 22942}, year = {2016}, month = {12/2016}, pages = {1-27}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {We have designed and fielded an experimental module in the 2014 HRS which seeks to measure older persons{\textquoteright} willingness to voluntarily defer claiming of Social Security benefits. In addition, we evaluate the stated willingness of older individuals to work longer, depending on the Social Security incentives offered to delay claiming their benefits. Our project extends previous work by analyzing the results from our HRS module and comparing findings from other data sources which included very much smaller samples of older persons. We show that half of the respondents would delay claiming if no work requirement were in place under the status quo, and only slightly fewer, 46\%, with a work requirement. We also asked respondents how large a lump sum they would need with or without a work requirement. In the former case, the average amount needed to induce delayed claiming was about $60,400, while when part-time work was required, the average was $66,700. This implies a low utility value of leisure foregone of only $6,300, or under 20\% of average household income.}, keywords = {Employment and Labor Force, Health Shocks, Older Adults, Retirement Planning and Satisfaction, Social Security}, doi = {10.3386/w22942}, url = {http://www.nber.org/papers/w22942.pdf}, author = {Maurer, Raimond and Olivia S. Mitchell} } @article {8888, title = {Older Women{\textquoteright}s Labor Market Attachment, Retirement Planning, and Household Debt}, number = {Working Paper No. 22606}, year = {2016}, month = {09/2016}, pages = {1-38}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The goal of this paper is to ascertain whether older women{\textquoteright}s current and anticipated future labor force patterns have changed over time, and if so, to evaluate the factors associated with longer work lives and plans to continue work at older ages. Using data from both the Health and Retirement Study (HRS) and the National Financial Capability Study (NFCS), we show that older women{\textquoteright}s current and intended future labor force attachment patterns are changing over time. Specifically, compared to our 1992 HRS baseline, more recent cohorts of women in their 50{\textquoteright}s and 60s{\textquoteright}s are more likely to plan to work longer. When we explore the reasons for delayed retirement among older women, factors include education, more marital disruption, and fewer children than prior cohorts. But household finances also play a key role, in that older women today have more debt than previously and are more financially fragile than in the past. The NFCS data show that factors associated with retirement planning include having more education and greater financial literacy. Those who report excessive amounts of debt and are financially fragile are the least financially literate, had more dependent children, and experienced income shocks. Thus shocks do play a role in older women{\textquoteright}s debt status, but it is not enough to have resources: people also need the capacity to manage those resources if they are to stay out of debt as they head into retirement.}, keywords = {Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.3386/w22606}, url = {http://www.nber.org/papers/w22606.pdf}, author = {Annamaria Lusardi and Olivia S. Mitchell} } @article {8528, title = {Opportunity or Necessity? Disaggregating Self-Employment and Entry at Older Ages}, journal = {Social Forces}, volume = {94}, year = {2016}, month = {Jun-06-2016}, pages = {1539 - 1566}, abstract = {Bridging the literatures on entrepreneurship and the aging workforce, we study the factors, particularly job loss, wealth, education, and risk aversion, associated with entry into self-employment at older ages using a multinomial logit hazard model. Using the Health and Retirement Study, we disaggregate self-employment by defining four types through an interaction along two scopes: one that divides along those with supervisory responsibilities or business asset ownership and the other divided into so-called {\textquotedblleft}knowledge{\textquotedblright} and {\textquotedblleft}non-knowledge{\textquotedblright} occupations. We find that job loss shows a strong association with entry into self-employment, particularly with less desirable forms of self-employment. In addition, we show that there are large differences between individuals in these alternative measures of self-employment and that there are distinctive factors that influence entry into these types. Additionally, we show that there are some differences in the factors affecting men{\textquoteright}s and women{\textquoteright}s entry into self-employment.}, keywords = {Entrepeneurship, Gender Differences, Older Adults, Risk Taking, Unemployment}, issn = {0037-7732}, doi = {10.1093/sf/sow026}, url = {http://sf.oxfordjournals.org/lookup/doi/10.1093/sf/sow026}, author = {Jeremy G. Moulton and John C. Scott} } @article {8406, title = {Ownership of a bank account and health of older Hispanics}, journal = {Economics Letters}, volume = {144}, year = {2016}, pages = {41-44}, publisher = {144}, abstract = {We study health effects of financial inclusion, particularly ownership of a bank account of older minorities, with focus on Hispanics. Using data from the Health and Retirement Study from 2000 to 2012, we find that, for Hispanics, being banked has a positive effect on mental health but is not associated with effects on physical health. Mental health benefits are likely to be larger for those who face greater hurdles to access formal financial institutions. Hispanics in less well-off neighborhoods and with below-median wealth appear to experience the greatest mental-health benefits associated with ownership of a bank account.}, keywords = {Cross-National, Finances, Healthcare, Older Adults, Women and Minorities}, doi = {10.1016/j.econlet.2016.04.013}, url = {http://www.sciencedirect.com/science/article/pii/S0165176516301239}, author = {Emma Aguila and Marco Angrisani and Blanco, Luisa R.} } @article {8526, title = {Predicting End-of-Career Transitions for Baby Boomers Nearing Retirement Age}, journal = {The Career Development Quarterly}, volume = {64}, year = {2016}, month = {Jan-06-2016}, pages = {153 - 168}, abstract = {Retirement has traditionally been conceptualized as a point-in-time decision to physically and psychologically withdraw from the workforce on reaching a certain age. However, the expectations of older workers demonstrate a new retirement paradigm, with many more retirement trajectories. The purpose of this study was to examine actual career decisions being made by older workers and to understand sociodemographic factors that might differentiate their career trajectories. Data from the Health and Retirement Study (Juster \& Suzman, 1995) were analyzed using multinomial logistic regression to compare 4 retirement trajectories (i.e., no retirement, full retirement, bridge employment, and encore career). Gender, age, education, marital status, health, and wealth differentially predicted the odds of pursuing each of the 4 retirement decisions. Career practitioners may use these results to help baby boomers make retirement decisions and provide them with appropriate education, guidance, and resources. Additional research is needed to examine other factors salient to each of the retirement trajectories. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (journal abstract)}, keywords = {Baby Boomers, Bridge employment, Older Adults, Retirement Planning and Satisfaction}, doi = {10.1002/cdq.2016.64.issue-210.1002/cdq.12048}, url = {http://doi.org/10.1002/cdq.12048}, author = {Boveda, Ingrid and Metz, A. J.} } @mastersthesis {8726, title = {Racial differences in the manifestation of mental illness among older adults}, volume = {Ph.D.}, year = {2016}, pages = {99}, school = {The Florida State University}, type = {Dissertation}, abstract = {This dissertation seeks to increase understanding about why older African Americans have equal or lower rates of mental illness than whites; despite the general tendency that disadvantaged individuals have worse mental health than advantaged individuals. To explain the unexpected finding from a methodological standpoint, this study uses the 2008 and 2012 Waves of the Health and Retirement Study and examines racial differences in the factor structures of mental illness focusing on symptoms included in the CES-D (Center for Epidemiologic Studies Depression) and the BAI (Beck Anxiety Inventory). To understand the implications of these racial differences in the stress process, this study also examines how discrimination, as a type of stressor, manifests into different mental health outcomes (somatic or mood-based symptoms) between older African Americans and whites. The analysis employs structural equation modeling and finds that modeling CES-D and BAI items as mood-based and somatic constructs of general distress has better model fit than modeling these items than as separate constructs of depression and anxiety (Chapter 2). In regard to racial differences in the factor structure of these models, the analysis finds that the factor structure of the somatic model differs between the racial groups whereas the factor structure of the mood-based model does not differ. When examining how discrimination manifests into different mental health outcomes, the analysis shows that discrimination is related to increased mood-based symptoms among whites and unrelated to mood-based symptoms among African Americans (Chapter 3). Additionally, everyday discrimination and lifetime discrimination are related to increased somatic symptoms among whites. Among African Americans, physical disability and financial status based discrimination are related to increased somatic symptoms, and lifetime discrimination and ancestry-based discrimination are related to decreased somatic symptoms. The findings from this dissertation suggest that current measures of mental illness (e.g., CES-D, BAI, etc.) may not measure the same constructs across racial groups and that modeling mental illness as mood-based and somatic constructs may give better insights into the prevalence of mental illness among older adults. Further, this study sheds light on the potential effects of discrimination on an alternative and more culturally specific expression of mental illness symptoms (somatic symptoms). This study also extends the literature on discrimination and mental health by illustrating how different forms of discrimination impact different mental health outcomes.}, keywords = {Depressive symptoms, Mental Illness, Older Adults, Racial/ethnic differences}, isbn = {9781339818276}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1806940543?accountid=14667}, author = {Preeti Vaghela} } @article {8691, title = {Real-life prosocial attitudes in North America: A genome-wide association approach.}, year = {2016}, keywords = {Genetics, Genome, Genome-Wide Association Study, Older Adults}, url = {http://www.ashg.org/2016meeting/}, author = {Georg Primes and Martin Fieder} } @mastersthesis {8719, title = {The relationship between retirement decisions and health care expenditures in the United States}, volume = {M.P.P.}, year = {2016}, month = {04/2016}, pages = {35}, school = {Georgetown University}, type = {Thesis}, address = {Washington, DC}, abstract = {A substantial literature analyzes the relationship in the U.S. between retirement decisions and health outcomes; however, the relationship between health care costs and retirement has not yet been adequately studied. This paper investigates the association between retirement choices and health care expenditures using data from the U.S. Health and Retirement Study. My analysis shows that retirement status is not predictive of healthcare expenditures. However, I find statistically significant evidence that the overall relationship between healthcare expenditures and retirement status is masked by the fact that this relationship is negative for women but positive for men.}, keywords = {Decision making, Income, Medicare/Medicaid/Health Insurance, Older Adults, Retirement Planning and Satisfaction}, isbn = {9781339689579}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1787149479?accountid=14667}, author = {Boyacioglu, Serife Nur} } @article {8659, title = {Retirement Timing: A Review and Recommendations for Future Research}, journal = {Work, Aging and Retirement}, volume = {2}, year = {2016}, month = {02/2016}, pages = {230 - 261}, abstract = {Although there have been many reviews of the retirement literature in recent years, the issue of retirement timing has received less attention, neglecting some large and important issues. Further, a significant number of empirical articles about retirement timing have been published across multiple disciplines since these review articles were written. The purpose of our study is to review and integrate prior research regarding retirement timing. We define retirement timing as the age or relative point at which workers exit from their position or career path (e.g., early, on time, and later). We propose a model to serve as an organizing framework for understanding retirement timing. Our model includes antecedents and consequences that are each grouped in terms of individual, family, work, and sociocultural factors related to the timing of the retirement process. We identify and discuss key factors that serve to moderate the relation between retirement timing and consequences. Finally, we identify gaps in the current literature and provide recommendations for future research.}, keywords = {Future, Older Adults, Retirement Planning and Satisfaction}, issn = {2054-4642}, doi = {10.1093/workar/waw001}, url = {http://workar.oxfordjournals.org/lookup/doi/10.1093/workar/waw001}, author = {Gwenith G Fisher and Chaffee, Dorey S. and Amanda Sonnega} } @article {8841, title = {The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Care - A Selected Literature Review}, number = {Working Paper No. 22521}, year = {2016}, month = {08/2016}, pages = {1-31}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The objective is to review the evidence on (a) ageing and health and (b) the demand for health- and social services among the elderly. Issues are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health- and elderly care? It is not a complete review, but it covers most of recent empirical studies.}, keywords = {Caregiving, Health Trajectories, Life Expectancy, Literature Review, Meta-analyses, Older Adults}, doi = {10.3386/w22521}, url = {http://www.nber.org/papers/w22521.pdf}, author = {Lindgren, Bjorn} } @article {8793, title = {The risks of meddling with Obamacare while the nation{\textquoteright}s health is on the line}, journal = {Dallas Morning News}, year = {2016}, address = {Dallas}, keywords = {Health Conditions and Status, Low incomes, Medicare/Medicaid/Health Insurance, Older Adults, Risk Factors}, url = {http://www.dallasnews.com/opinion/opinion/2016/11/22/nations-health-running-fever-risks-meddling-obamacare}, author = {Jacqueline L. Angel} } @article {8740, title = {Stressed-Out Mate Bad for Your Weight}, volume = {2016}, number = {11/02/2016}, year = {2016}, publisher = {WebMD}, keywords = {BMI, Marriage, Older Adults}, url = {http://www.webmd.com/balance/stress-management/news/20161101/stressed-out-mate-bad-for-your-waistline}, author = {Kathleen Doheny} } @mastersthesis {8718, title = {A study of telomere length as a prospective biomarker of cancer risk}, volume = {Ph.D.}, year = {2016}, pages = {155}, school = {The University of Chicago}, type = {Dissertation}, address = {Chicago}, abstract = {This dissertation is comprised of two peer-reviewed articles and one manuscript, aiming to identify knowledge gaps in terms of the role of telomere length as a biomarker of cancer. Individuals with relatively short telomeres in peripheral blood cells have been shown in epidemiological studies to be at increased risk for mortality and cancer, leading investigators to hypothesize that telomere length and attrition over the life-course is a critical mechanism underlying cancer and many other age-related health conditions. However, such associations are not consistent across all cancers or even within cancer types, with some studies showing null, or even opposite associations. Furthermore, due to the cross-sectional nature of case-control studies, from which most associations of telomere length and cancer risk are obtained, it is possible that telomere shortening occurs after diagnosis (due to the cancer itself or treatment effects), or is confounded by other common risk factors, and therefore may not be a true biomarker of subsequent cancer risk. I employed three strategies for addressing these potential issues: 1) use genetic polymorphisms that influence telomere length as proxies for telomere length to estimate associations between telomere length and cancer risk; 2) perform careful adjustment of potential confounders of the telomere length-cancer association, including the assessment of time-varying effects on smoking, a potential telomere length correlate; and 3) utilize a prospective study design in which baseline telomere length is measured prior to the development of any adverse health outcomes. In the first study of this dissertation (Chapter 2), I used a Mendelian randomization approach to estimate the associations between nine telomere length-associated SNPs and risk for five common cancer types (breast, lung, colorectal, ovarian and prostate cancer, including subtypes) using data on 51,725 cases and 62,035 controls. The long TL genetic score was significantly associated with increased risk of lung adenocarcinoma (P=6.3E -15), with an estimated odds ratio of 2.78. Under Mendelian randomization assumptions, this estimate was interpreted as the odds ratio for lung adenocarcinoma corresponding to a 1000 base pair increase in telomere length. The SNP score was not associated with other cancer types or subtypes. In the second study of this dissertation (Chapter 3), I estimated the associations between telomere length (measured by quantitative PCR using saliva DNA) and concurrent and past smoking status, reported biennially for up to 16 years prior to telomere length measurement, using data from the Health and Retirement Study (n=5,624). Smoking was associated with shorter telomere length when using prospective data on smoking status among men and women, but the association was strongly attenuated in cross-sectional analyses among men. This attenuation was largely due to a higher rate of smoking cessation during the study period among males with shorter telomere length compared to males with longer telomere length. Short telomere length was also associated with poorer overall health in men, suggesting that male smokers with short telomere length were more likely to quit smoking due to poor health. Analyses of years since cessation, smoking duration, and pack-years all support the hypothesis that increased cigarette use shortens telomere length. In the third study of this dissertation (Chapter 4), I investigated the association between arsenic exposure and telomere length, and the association between telomere length and incident arsenical skin lesion in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh. In this prospective study, baseline telomere length was assessed in skin lesion-free subjects who were followed for up to 12 years. No association was observed between baseline arsenic exposure and telomere length. However, we observed higher incident skin lesion risk with shorter telomere length (Ptrend =4.6E-5), with odds ratios of 3.05, 1.30, and 1.21 for the first (shortest), second, and third telomere length quartiles compared to the longest. The role of telomere length as a biomarker of cancer appears to be striking yet nuanced. Addressing the existing knowledge gaps is a critical step towards clarifying the causal relationship between telomere length and cancer, and ultimately, improving cancer prediction and prevention.}, keywords = {Cancer screenings, Health Conditions and Status, Older Adults, Risk Factors, Telomeres}, isbn = {9781339873671}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1799644690?accountid=14667}, author = {Zhang, Chenan} } @conference {8762, title = {Subjective Life Expectancy: Differences by Smoking, Education and Gender}, booktitle = {European Population Conference 2016}, year = {2016}, abstract = {Despite the well-known higher mortality rates among smokers than non-smokers, little investigation has focused on subjective survival probabilities (SSP) by smoking behaviour. We give attention to sub-group differences in subjective survival probabilities, comparing subjective predictions to objective ones (SP) and accounting for the role of education. We use biannual data from the Health and Retirement Study (HRS) from 2000 to 2012 carried out in the USA. Based on a sample of 23,895 respondents aged 50-89, we calculate, for each respondent, the {\textquotedblleft}gap{\textquotedblright} between SSP and the estimated survival probability (SP) from the HRS data. We find that people currently smoking report lower survival probabilities especially if they are low educated. This is consistent with real mortality data that show higher mortality among these groups. When comparing subjective and objective survival probabilities we find that irrespectively of the smoking status, high educated people are more likely to correctly predict their survival probabilities than their low educated counterparts. Within education groups, people who smoked in the past are the best at predicting their mortality. Interestingly, those who currently smoke show the highest probability to incorrectly overestimate their survival probability (i.e., to underestimate the negative effect of smoking on mortality).}, keywords = {Education, Gender Differences, Longevity, Mortality, Older Adults, Smoking}, url = {http://epc2016.princeton.edu/uploads/160554}, author = {Sergei Scherbov and Bruno Arpino and Valeria Bordone} } @article {8791, title = {They{\textquoteright}re Growing Older. Their Mortgage Debt Is Growing Deeper.}, journal = {The New York Times}, year = {2016}, month = {11/18/2016}, pages = {D5}, chapter = {D}, address = {New York City}, keywords = {Debt, Health Shocks, Investing, Mortgages, Older Adults}, url = {http://www.nytimes.com/2016/11/22/health/new-old-age-mortgage-debt.html}, author = {Paula Span} } @mastersthesis {8730, title = {Three essays in life-cycle labor supply and human capital formation}, volume = {Ph.D.}, year = {2016}, pages = {137}, school = {The University of Wisconsin - Madison}, type = {Dissertation}, address = {Madison}, abstract = {This dissertation consists of three independent essays on earnings dynamics, educational production function, and retirement. Each chapter explains labor supply and human capital formation from a life-cycle perspective. In the first chapter, I investigate how two different kinds of uncertainty jointly affect young workers{\textquoteright} decisions. This paper introduces the possibility of multidimensional learning about worker ability and job match quality into a model of work decisions. This mechanism has a unique prediction, negative sorting into job mobility that fades away over time, which is verified in the NLSY79 data if the AFQT score carries over some information unused by workers and employers. I estimate the structural model, which also has flexible skill accumulation, by indirect inference. From simulation results on earnings dynamics, I find that the contribution of job shopping to average earnings growth is higher than previous estimates; also, individual heterogeneity in earnings growth is mostly explained by the process of resolving uncertainties. In the second chapter, which is joint work with Keunkwan Ryu, we estimate the effects of high school class size on college entrance exam scores, using Korean administrative data. For the identification, we exploit quasi-experimental variation in class size arising from distinct institutional settings in Korea: especially, students are separately educated by major from grade 11 with different class sizes between majors. By using multi-level differencing and instrumental variable techniques, we find the effects of high school class size reduction on the test scores are positive but small. In the third chapter, I examine the effects of life expectancy on retirement and related decisions. I construct a structural model which has a realistic description of complicated dynamic incentives facing the elderly, including Social Security. Furthermore, individual heterogeneity in survival beliefs are flexibly modeled, directly using subjective survival probabilities in the Health and Retirement Study (HRS) data. The estimated model suggests that many people in the data believed their wealth was over-annuitized; they would have chosen to work and save less if their average life expectancy had increased. This result partially explains the early retirement puzzle in the last century.}, keywords = {Annuitization, Employment and Labor Force, Life Expectancy, Older Adults, Retirement Planning and Satisfaction}, isbn = {9781339835891}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1796375588?accountid=14667}, author = {Han, Joseph} } @mastersthesis {8994, title = {Three essays on financial self-efficacy beliefs and the saving behavior of older pre-retirees}, volume = {Ph.D.}, year = {2016}, school = {Kansas State University}, type = {Dissertation}, address = {Manhattan, Kansas}, abstract = {This dissertation employed a psychological framework to investigate the saving behavior of older pre-retirees through three essays using data from the Health and Retirement Study (HRS). Understanding the connection between psychological characteristics and saving behavior is critical as this population attempts to bridge the retirement saving gap. Of these characteristics, financial self-efficacy beliefs (FSE) are theoretically vital to saving behavior. With the FSE beliefs of older adults weak and vulnerable to decline, more research is needed to understand how FSE beliefs affect saving behavior and how FSE beliefs can be supported. Essay one investigated the psychological characteristics associated with FSE beliefs according to the Meta-Theoretic Model of Motivation and Personality (3M). Using a sample of 2,070 pre-retirees aged 50 to 70, essay one revealed that FSE beliefs can be supported through the frequent experience of positive affect, reduced negative affect, a stronger perception of mastery, and a higher task orientation, holding all else constant. Essay two investigated the relationship between FSE beliefs and saving behavior (i.e., change in net worth from 2008 to 2012) through the Social Cognitive Theory of Self-Regulation. Using a sample of 844 pre-retirees aged 50 to 70, results revealed that FSE beliefs are significantly and positively related to saving behavior, after controlling for the financial ability and motivation to save. Essay three employed a structural equation model to investigate an integrated psychological approach to saving behavior based upon the 3M. Using a sample of 1,370 pre-retired and partially retired adults aged 50 to 70, essay three revealed that FSE beliefs facilitated the connection between elemental traits (i.e., openness, conscientiousness, extroversion, agreeableness, and neuroticism), compound traits (i.e., positive affect, negative affect, mastery, and task orientation), and saving behavior. Overall, significant evidence was generated supporting a psychological approach to the saving behavior of older pre-retirees. Financial and mental health professionals can utilize this framework to provide holistic retirement saving advice that acknowledges the psychological roots of behavior. Moreover, results established empirical support for the role FSE beliefs play in executing saving behavior. Lastly, results supported the importance of domain specific measurement for self-efficacy beliefs in future research. Advisors/Committee Members: Kristy L. Pederson-ArchuletaMartin Seay.}, keywords = {Financial literacy, Older Adults, Savings}, url = {http://hdl.handle.net/2097/32734}, author = {Asebedo, Sarah D.} } @mastersthesis {8995, title = {Three studies of the associations of cognitive ability, health, and wealth among the elderly}, volume = {Ph.D.}, year = {2016}, school = {Kansas State University}, type = {Dissertation}, address = {Manhattan, Kansas}, abstract = {This dissertation consists of three studies exploring the relationship between cognitive abilities, health, and wealth related variables among the elderly. For all three studies, the life cycle hypotheses provided the basis of the theoretical framework and utilized data from the 2000 through 2010 panels of the Health and Retirement Study (HRS). The first study compared the cognitive abilities of non-married households with the cognitive abilities of married households in order to examine the effect of marital status on household wealth. The second study examines the relationship of two aspects of cognitive ability (fluid intelligence and crystallized intelligence) and wealth for couples married to the same spouse for all HRS panels for 2000 to 2010. The third study examines the relationship of cognitive ability, emotional health, physical health, and wealth for couples married to the same spouse for all HRS panels for 2000 to 2010. Results identified significant associations among marital status, cognitive abilities, and health with wealth. These findings contribute to the field of financial planning by providing useful information about how marital status, cognitive functioning, and health affect the household wealth of the elderly. Financial service practitioners, regulators, researchers, and caregivers can apply these findings to develop approaches to assist the elderly manage their household wealth. Advisors/Committee Members: Maurice M. MacDonald.}, keywords = {Cognitive Ability, Memory, Older Adults}, url = {http://hdl.handle.net/2097/34484}, author = {Fernatt, Frederick Ray} } @article {8842, title = {Time discounting and economic decision-making among the elderly}, number = {Working Paper No. 22438}, year = {2016}, month = {07/2016}, pages = {1-40}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This paper evaluates the extent of heterogeneity in time discounting among elderly Americans, as well as its role in explaining older peoples{\textquoteright} key behaviors. We first show how older Americans evaluate simple (hypothetical) intertemporal choices in which payments now are compared with payments in the future. This adds to the literature on time horizon experiments by focusing on a nationally representative sample of persons age 70+. Using the indicators derived from this experiment, we show how differences in discounting patterns are associated with characteristics of particular importance in elderly populations, such as serious health and mental conditions. We then relate our discounting measure to key outcome variables including wealth, the timing of retirement, investments in health, and decisions about end of life care.}, keywords = {Decision making, Health Conditions and Status, Older Adults}, doi = {10.3386/w22438}, url = {http://www.nber.org/papers/w22438.pdf}, author = {Huffman, David and Maurer, Raimond and Olivia S. Mitchell} } @article {8840, title = {Understanding why black women are not working longer}, number = {Working Paper No. 22680}, year = {2016}, pages = {1-38}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {Black women in current cohorts ages 50 to 72 years have lower employment than similar white women, despite having had higher employment when they were middle-aged and younger. Earlier cohorts of older black women also worked more than their white counterparts. Although it is not surprising that white women{\textquoteright}s employment should catch up to that of black women given trends in increasing female labor force participation, it is surprising that it should surpass that of black women. This chapter discusses factors that contribute to this differential change over time. Changes in education, marital status, home-ownership, welfare, wealth, and cognition cannot explain this trend, whereas changes in occupation, industry, health, and gross motor functioning may explain some of the trend.}, keywords = {Employment and Labor Force, Older Adults, Racial/ethnic differences, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.3386/w22680}, url = {http://www.nber.org/papers/w22680.pdf}, author = {Joanna N Lahey} } @article {8792, title = {U.S. Dementia Rates Are Dropping Even as Population Ages}, journal = {The New York Times}, year = {2016}, month = {11/23/2016}, pages = {A13}, chapter = {Health}, address = {New York City}, keywords = {Aging, Dementia, Health Conditions and Status, Older Adults}, url = {http://www.nytimes.com/2016/11/21/health/dementia-rates-united-states.html}, author = {Gina Kolata} } @article {8797, title = {U.S. life expectancy declines for the first time since 1993}, journal = {The Washington Post}, year = {2016}, month = {12/08/2016}, address = {Washington, D.C. }, keywords = {Life Expectancy, Meta-analyses, Older Adults}, url = {https://www.washingtonpost.com/national/health-science/us-life-expectancy-declines-for-the-first-time-since-1993/2016/12/07/7dcdc7b4-bc93-11e6-91ee-1adddfe36cbe_story.html}, author = {Lenny Bernstein} } @book {leitz2016veterans, title = {Veterans{\textquoteright} Health}, series = {The Civilian Lives of US Veterans: Issues and Identities [2 volumes]}, year = {2016}, pages = {363}, keywords = {Medicare/Medicaid/Health Insurance, Older Adults, Veterans}, author = {Leitz, Lisa} } @article {8591, title = {What digital divide? Seniors embrace social technology}, journal = {Science Daily}, year = {2016}, month = {08/25/2016}, keywords = {Depressive symptoms, Loneliness, Older Adults, Technology}, url = {https://www.sciencedaily.com/releases/2016/08/160825101115.htm} } @article {8780, title = {What Do Academic Studies Have to Say About Americans{\textquoteright} Retirement Saving?}, journal = {Forbes}, year = {2016}, publisher = {Forbes}, keywords = {Income, Older Adults, Retirement Planning and Satisfaction, Saving}, url = {http://www.forbes.com/sites/andrewbiggs/2016/11/11/what-do-academic-studies-have-to-say-about-americans-retirement-saving/$\#$7fd4f098526c}, author = {Andrew G. Biggs} } @article {8601, title = {Why Boomer Women Are Worse Off Financially Than Their Predecessors}, journal = {The Wall Street Journal}, year = {2016}, month = {09/12/2016}, keywords = {Financial literacy, Older Adults, Wealth management, Women and Minorities}, url = {http://blogs.wsj.com/experts/2016/09/11/why-boomer-women-are-worse-off-financially-than-their-predecessors/}, author = {Olivia S. Mitchell} } @article {8523, title = {Work a Little, Play a Little: A New Retirement Strategy}, journal = {The New York Times}, number = {B3}, year = {2016}, month = {May 20, 2016}, pages = {3}, chapter = {B}, address = {New York}, keywords = {Older Adults, Part-time work, Retirement Planning and Satisfaction}, url = {http://www.nytimes.com/2016/05/21/your-money/work-a-little-play-a-little-a-new-retirement-strategy.html}, author = {Hannon, Kerry} } @article {8540, title = {The World report on ageing and health: a policy framework for healthy ageing}, journal = {The Lancet}, volume = {387}, year = {2016}, month = {Jan-05-2016}, pages = {2145 - 2154}, abstract = {Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.}, keywords = {Aging, Life Expectancy, Mortality, Older Adults}, issn = {01406736}, doi = {10.1016/S0140-6736(15)00516-4}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0140673615005164http://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/plain}, author = {Beard, John R and Officer, Alana and de Carvalho, Islene Araujo and Sadana, Ritu and Pot, Anne Margriet and Michel, Jean-Pierre and Lloyd-Sherlock, Peter and Epping-Jordan, JoAnne E and G. M. E. E. Peeters and Mahanani, Wahyu Retno and Thiyagarajan, Jotheeswaran Amuthavalli and Chatterji, Somnath} } @article {8654, title = {You Can Inherit Loneliness}, journal = {New York Magazine}, year = {2016}, keywords = {Depressive symptoms, Genetics, Health Conditions and Status, Loneliness, News, Older Adults}, url = {http://nymag.com/scienceofus/2016/09/you-can-inherit-loneliness-suggests-a-new-nature-study.html}, author = {Melissa Dahl} } @article {8911, title = {Changes in Optimism Are Associated with Changes in Health Over Time Among Older Adults.}, journal = {Social Psychological and Personality Science}, volume = {6}, year = {2015}, month = {2015 Sep}, pages = {814-822}, abstract = {

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.

}, keywords = {Health Changes, Health Conditions and Status, Older Adults, Optimism}, issn = {1948-5506}, doi = {10.1177/1948550615590199}, author = {William J. Chopik and Eric S Kim and Jacqui Smith} } @article {8627, title = {Comparing Retirement Wealth Trajectories on Both Sides of the Pond }, number = {Research Brief 33}, year = {2015}, institution = {Institute for Social Research}, type = {Brief}, address = {Ann Arbor}, keywords = {Cross-National, Income, Older Adults, Retirement Planning and Satisfaction}, url = {http://www.mrrc.isr.umich.edu/publications/briefs/pdf/rb333.pdf}, author = {Richard Blundell and Crawford, Rowena and Eric French and Tetlow, Gemma} } @conference {8634, title = {The Comprehensive Wealth of Immigrants and Natives}, booktitle = {17th Annual Joint Meeting of the Retirement Research Consortium}, year = {2015}, publisher = {NBER}, organization = {NBER}, address = {Washington, DC}, abstract = {The 1965 Immigration and Nationality Act had a profound impact on the demographic and skill composition of immigrants arriving in the U.S. A large literature has investigated the relative earnings of immigrants and natives, but much less is known about relative wealth accumulation and the preparation of immigrants for retirement. This paper compares the retirement preparation of older immigrants to that of native-born households using an annualized comprehensive measure of available resources. We find that immigrants have less wealth overall, but that they appear to be drawing down resources at a slower rate. We attempt to make sense of the trends in annualized wealth with the help of a lifecycle framework that incorporates uncertain longevity, bequests, risk in retirement resources, as well as endogenous housing wealth. Simulations from the model indicate that it is difficult to match the observed patterns in annualized wealth without the combination of both an explicit bequest motive and an explicit treatment of housing choice. These patterns mask a good deal of heterogeneity, however, in terms of socioeconomic and demographic characteristics. Some of the largest differences within immigrants occur along the margins of race and ethnicity, as well as the number of years since arrival. The evidence suggests that the typical immigrant is relatively well situated in retirement, but that more recent immigrants have low levels of total resources and are likely to have difficulty maintaining adequate levels of spending in retirement.}, keywords = {Immigrants, Income, Older Adults, Wealth, Women and Minorities}, url = {https://www.nber.org/programs/ag/rrc/rrc2015/papers/4.2\%20-\%20Love,\%20Schmidt.pdf}, author = {Love, David A. and Lucie Schmidt} } @article {8643, title = {Couples{\textquoteright} and Singles{\textquoteright} Savings after Retirement}, journal = {SSRN Electronic Journal}, year = {2015}, month = {Jan-01-2015}, abstract = {We model the saving problem of retired couples and singles facing uncertain longevity and medical expenses in presence of means-tested social insurance. Households can save to self-insure against uncertain longevity and medical expenses, and to leave bequests. Individuals in a couple can be altruistic towards their spouse and other heirs and split bequests optimally. Single people can care about leaving bequests to children and others. Using AHEAD data, we first estimate the model and we then evaluate the relative importance of the various savings motives and the risk exposure of couples{\textquoteright} versus singles.}, keywords = {Marriage, Older Adults, Retirement Planning and Satisfaction, Singles}, doi = {10.2139/ssrn.2664111}, url = {http://www.ssrn.com/abstract=2664111}, author = {Mariacristina De Nardi and Eric French and John Bailey Jones} } @article {8661, title = {Diagnosis and control of hypertension in the elderly populations of Japan and the United States}, journal = {International Journal of Population Studies}, volume = {1}, year = {2015}, month = {Jul-01-2016}, pages = {19-28}, abstract = {The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S. }, keywords = {Blood pressure, Cross-National, Health Conditions and Status, Heart disease, Hypertension, Older Adults}, issn = {2424-8150}, doi = {10.18063/IJPS.2015.01.008}, url = {http://ijps.whioce.com/index.php/ijps/article/view/01008}, author = {Saito, Yasuhiko and Davarian, Shieva and Takahashi, Atsuhiko and Schneider, Edward and Eileen M. Crimmins} } @article {8626, title = {Do Retired Americans Annuitize Too Little? Trends in the Share of Annuitized Income}, number = {CRR WP 2015-9}, year = {2015}, month = {06/2015}, pages = {1-49}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {This paper examines the importance of annuity-like income as a share of total money income received by aged families. The analysis considers the aged (62+) population as a whole as well as different parts of the aged families{\textquoteright} income distribution during the period from the early 1980s through 2009. We use survey data from 1983 through 2009 from the March Current Population Survey (March CPS) and the Survey of Consumer Finances (SCF). The total income amounts reported in the files are compared with data in the National Income and Product Accounts (NIPA). We calculate the family income consisting of annuitized income flows (primarily Social Security and pensions) and measure it as a share of families{\textquoteright} total money income. We also expand the definition of both annuitized and non-annuitized income to include income flows not captured in the surveys, namely, health insurance subsidies and the housing services received by homeowners. Finally, we consider the potential impact on aged families if they were to convert their wealth into private annuities.}, keywords = {Annuitization, Income, Older Adults, Retirement Planning and Satisfaction}, url = {http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-9.pdf}, author = {Barry Bosworth and Gary T. Burtless and Mattan Alalouf} } @article {8625, title = {Does Age-Related Decline in Ability Correspond with Retirement Age?}, number = {CRR WP 2015-24}, year = {2015}, pages = {1-39}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {While declines in physical and mental performance are inevitable as workers age, they are not uniform across the various systems of the body {\textendash} some physical and cognitive abilities decline much earlier than others. This variance implies that workers in occupations that rely on skills that decline early may be unable to work until late ages, even as policy changes like increases in the Full Retirement Age (FRA) encourage them to. Researchers often estimate models of early retirement that include a control for whether a worker is in a blue-collar job {\textendash} basically assuming that less-physical white-collar work allows longer careers. But this assumption ignores the fact that even workers in white-collar occupations may find themselves relying on skills that have declined. This paper instead reviews the literature on aging and constructs a Susceptibility Index meant to reflect how susceptible an occupation is to declines in ability, regardless of whether the occupation relies on physical abilities (as blue-collar occupations do) or cognitive ones.}, keywords = {Bridge employment, Cognitive Ability, Health Conditions and Status, Older Adults, Physical Ability, Retirement Planning and Satisfaction}, url = {http://crr.bc.edu/wp-content/uploads/2015/09/wp_2015-24.pdf}, author = {Belbase, Anek and Geoffrey T. Sanzenbacher and Gillis, Christopher M.} } @article {8635, title = {Does Protecting Older Workers from Discrimination Make It Harder to Get Hired? Evidence from Disability Discrimination Laws}, journal = {National Bureau of Economic Research Working Paper Series}, volume = {No. 21379}, year = {2015}, month = {2015}, abstract = {We explore the effects of disability discrimination laws on hiring of older workers. A concern with anti-discrimination laws is that they may reduce hiring by raising the cost of terminations and {\textendash} in the specific case of disability discrimination laws {\textendash} raising the cost of employment because of the need to accommodate disabled workers. Moreover, disability discrimination laws can affect non-disabled older workers because they are fairly likely to develop work-related disabilities, yet are not protected by these laws. Using state variation in disability discrimination protections, we find little or no evidence that stronger disability discrimination laws lower the hiring of non-disabled older workers. We similarly find no evidence of adverse effects of disability discrimination laws on hiring of disabled older workers.}, keywords = {Ageism, Aging Workforce, Bridge employment, Disabilities, Older Adults}, url = {http://www.nber.org/papers/w21379}, author = {David Neumark and Joanne Song and Patrick Button} } @article {8648, title = {Does Social Security Continue to Favor Couples?}, number = {CRR WP 2015-11}, year = {2015}, month = {06/2015}, pages = {1-44}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hills, MA}, abstract = {While dramatic increases in women{\textquoteright}s labor supply and earnings have led to a substantial decline in the fraction of women eligible for spouse benefits at retirement, most wives still receive a survivor benefit, as wives still typically have lower earnings than their husbands and live longer. Using the MINT microsimulation model and the HRS data linked with Social Security administrative earnings records, this paper examines the extent to which Social Security continues to favor couples and will do so in the future. The paper finds that while the OASI program still distributes lifetime income from singles to couples, the transfers appear to be shrinking over time. Nevertheless, couples are still projected to have a higher benefit/tax ratio, a lower median net tax rate, and a higher share of them will be receiving positive net transfers from the system as compared to those who are never married or divorced. The increased labor force participation and earnings of women have contributed significantly to the decline in redistribution from men to women, and from singles to couples, while the effect of declining marriage rates has only a modest effect. }, keywords = {Divorce, Marriage, Older Adults, Retirement Planning and Satisfaction, Social Security, Women and Minorities}, url = {http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-111.pdf}, author = {Nadia S. Karamcheva and April Yanyuan Wu and Alicia H. Munnell} } @article {8640, title = {The Effect of Health Reform on Retirement}, number = {WP 2015-329}, year = {2015}, pages = {1-26}, address = {Ann Arbor, MI}, abstract = {Many studies have shown that the availability of health insurance is an important determinant of the retirement decision. Beginning in January 2014, the Affordable Care Act (ACA) made affordable alternatives to employer-sponsored health insurance much more widely available than they had been previously through the establishment of health insurance exchanges and, in some states, the expansion of Medicaid eligibility to low-income, childless adults. We analyze whether these new health insurance options led to an increase in retirement or part-time work among individuals ages 55 through 64 during the first 18 months after the policy took effect. Using data from the basic monthly Current Population Survey from January 2005 through June 2015, we find that there was no increase in retirement in 2014 either overall or in Medicare expansion states relative to nonexpansion states. We also find no change in the fraction of older workers who are working part-time. }, keywords = {Health Conditions and Status, Health Shocks, Medicare/Medicaid/Health Insurance, Older Adults, Retirement Planning and Satisfaction}, url = {http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2697092$\#$$\#$}, author = {Helen G Levy and Thomas Buchmueller and Sayeh Nikpay} } @article {8920, title = {Future Monetary Costs of Dementia in the United States under Alternative Dementia Prevalence Scenarios.}, journal = {Journal of Population Ageing}, volume = {8}, year = {2015}, month = {2015 Mar}, pages = {101-112}, abstract = {

Population aging will likely lead to increases is health care spending and the ability of governments to support entitlement programs such as Medicare and Medicaid. Dementia is a chronic condition that is especially pertinent because of its strong association with old age and because care for dementia is labor intensive and expensive. Indeed, prior research has found that if current dementia prevalence rates persist population aging will generate very large increases in health care spending for dementia. In this study we considered two alternative assumptions or scenarios about future prevalence. The first adjusts the prevalence projections using recent research that suggests dementia prevalence may be declining. The second uses growth hypertension, obesity and diabetes, and the relationship between dementia and these conditions to adjust future prevalence rates. We find under the first scenario that if the rates of decline in age-specific dementia rates persist, future costs will be much less than previous estimates, about 40\% lower. Under the second scenario, the growth in those conditions makes only small differences in costs.

}, keywords = {Dementia, Forecasting, Health Conditions and Status, Older Adults}, issn = {1874-7884}, doi = {10.1007/s12062-015-9112-4}, author = {Michael D Hurd and Martorell, Paco and Kenneth M. Langa} } @article {8639, title = {The Impact of Temporary Assistance Programs on the Social Security Claiming Age}, number = {CRR WP 2015-27}, year = {2015}, pages = {1-331}, institution = {Center for Retirement Research at Boston College}, address = {Chestnut Hill, MA}, abstract = {Delaying claiming past the early eligibility age of 62 has taken on increased importance. Individuals turning 62 with no job and limited income may be able to use temporary assistance programs such as Unemployment Insurance (UI), Medicaid, and the Supplemental Nutrition Assistance Program (SNAP) as sources of support prior to collecting Social Security benefits. To what extent do these programs allow recipients to delay Social Security claiming? The challenge in answering this question stems from the fact that program users{\textquoteright} dire economic straits may make them more likely to claim benefits from both Social Security and these programs, generating a misleading correlation between Social Security claiming and temporary assistance benefits. This paper constructs instruments for program generosity that vary with an individual{\textquoteright}s state of residence but should not reflect the characteristics or circumstances of the individual.}, keywords = {Older Adults, Public Health, Public Policy, Social Security, Welfare}, url = {http://crr.bc.edu/wp-content/uploads/2015/10/wp_2015-27.pdf}, author = {Geoffrey T. Sanzenbacher and April Yanyuan Wu and Matthew S. Rutledge} } @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 {8925, title = {Older Adults{\textquoteright} Residential Proximity to Their Children: Changes After Cardiovascular Events.}, journal = {Journals of Gerontology Series B: Psychological Sciences and Social Sciencess}, volume = {70}, year = {2015}, month = {2015 Nov}, pages = {995-1004}, abstract = {

OBJECTIVES: To assess changes in family residential proximity after a first cardiovascular (CV) event among older adults and to identify families most likely to experience such moves.

METHOD: Using a nationally representative longitudinal study of older adults in the United States, we identified respondents with no prior diagnosis of CV disease (CVD). We examined subsequent development of stroke, heart attack, and/or heart failure among these older adults and examined changes in their residential proximity to their closest child before and after the CV event. We then compared the likelihood of changes in proximity between families with and without CV events. Finally, we determined which types of families are most likely to relocate following a CV event.

RESULTS: Having a first CV event increases the 2-year predicted probability of children and adult parents moving in with and closer to each other (relative risk ratio = 1.61 and 1.55, respectively). Families are especially likely to move after a first CV event if the older person experiencing the event is spouseless or has a daughter.

DISCUSSION: CVD is a leading cause of disability, which in turn creates a significant need for personal care among older adults. Assessment of changes in family residential proximity responding to CV events is important to fully understand the consequences of older adults{\textquoteright} CV events including the cost of caregiving.

}, keywords = {Cardiovascular health, Heart disease, Older Adults, Proximity, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbu076}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @inbook {8658, title = {Prolonged working years: Consequences and directions for interventions.}, booktitle = {Sustainable working lives: Managing work transitions and health throughout the life course}, year = {2015}, pages = {269-288}, publisher = {Springer}, organization = {Springer}, address = {Netherlands}, keywords = {Employment and Labor Force, Happiness, Older Adults, Retirement Planning and Satisfaction}, author = {Gwenith G Fisher and Lindsay H Ryan and Amanda Sonnega} } @article {8951, title = {Subjective mortality risk and bequests}, journal = {Journal of Econometrics}, volume = {188}, year = {2015}, month = {Jan-10-2015}, pages = {514 - 525}, abstract = {This paper investigates the ability of subjective expectations about life expectancy to predict wealth holding patterns in later life. Based on panel data from the Asset and Health Dynamics among the Oldest Old, we estimate a structural life-cycle model with bequests. Each individual{\textquoteright}s subjective survival rates in the future are estimated with data on his belief of survival probabilities to a target age. This estimation is build upon a Bayesian updating method developed in Gan et al. (2005). We find that life-cycle model using subjective survival rates performs better than using life-table survival rates in predicting wealth holdings. This result suggests that subjective survival expectations play an important role in deciding consumption and savings. In addition, the estimation results show that most bequests are involuntary or accidental.}, keywords = {Bequests, Mortality, Older Adults}, issn = {03044076}, doi = {10.1016/j.jeconom.2015.03.015}, author = {Gan, Li and Gong, Guan and Michael D Hurd and Daniel McFadden} } @article {8746, title = {Subjective, Objective, and Observed Long-term Survival}, journal = {JAMA Internal Medicine}, volume = {175}, year = {2015}, month = {Jan-12-2015}, pages = {1986}, abstract = {Many professional guidelines recommend using life expectancy when considering diagnostic or treatment interventions in which the time to benefit may exceed patients{\textquoteright} survival.1 When subjected to such tests and treatments, these patients are put at risk for up-front harms with little chance of reaping benefits.2 Patients{\textquoteright} perceptions of prognosis are important. Clinicians who follow recommended guidelines may urge patients to change health routines to which they have become accustomed. Patients who underestimate their survival may choose to forego interventions that are likely to help them, while those who overestimate may choose to undergo interventions that are more likely to cause harm. However, little is known about how well older adults estimate their survival, the aim of this analysis. Methods We drew a sample of 64-, 69-, 74-, 79-, 84-, and 89-year-old participants in the 2000 wave of the Health and Retirement Study (HRS), a nationally representative, longitudinal, prospective cohort study of adults in the United States.3 Institutional review board approval for HRS was received from the University of California, San Francisco, Committee on Human Research. Informed consent was obtained by HRS at the time of the interview. Our variable of interest was participants{\textquoteright} subjective estimate of long-term survival, assessed by the question, {\textquotedblleft}What is the percent chance you will live to be x or more?{\textquotedblright} where x was 75, 80, 85, 90, 95, or 100 years old. Our sampling strategy ensured that all participants predicted survival across the same period. We calculated an objective estimate of life expectancy using the Lee life expectancy calculator.4 Observed survival was determined using mortality through 2010 (confirmed using the National Death Index). We compared participants{\textquoteright} subjective estimates to observed survival (using the C statistic) and the objective estimates (using a best-fit analysis). Participants were classified as underestimating or overestimating their survival if their estimate was more than 25 percentage points less or greater than the calculated prediction, respectively. Results A total of 2018 respondents of the specified ages were interviewed directly in the 2000 wave of the HRS, and our final sample included 1722 participants who had complete responses necessary for the calculator (56\% female, 88\% white). We combined the 84- and 89-year-olds because of the small number of respondents in each group. Overall, discrimination was moderate for participants{\textquoteright} subjective estimates of survival compared with observed survival (C statistic = 0.62; P < .001). The 64- and 69-year-olds were moderately able to estimate their survival (C statistic = 0.62 and 0.58, respectively; P < .001 for both), but older participants fared no better than chance (Table). Substantial dissimilarity was seen between participants{\textquoteright} subjective and the objective estimates of survival (Figure). Overall, 54.7\% of participants had estimates similar to the objective calculation; however, 32.7\% underestimated and 11.5\% overestimated. Underestimation was relatively similar across age groups, but overestimation increased significantly with age (Table) (P < .001). Discussion Our findings have important implications for clinicians. First, approximately half the time, participants accurately estimated survival compared with an objective clinical estimate, and when in error, they were more likely to underestimate than overestimate. Consequently, disclosing prognosis is not necessarily bad news. Second, because of the substantial dissimilarity between the subjective and objective estimates, patients may be hesitant to follow guideline recommendations to change long-standing regimens. Third, our findings make a case for using prognostic calculators, which were more accurate than participants{\textquoteright} subjective estimates and have been shown to be superior to clinician estimates.5 Fourth, participants in the HRS were willing to make an estimate of their survival and report it. Previous research suggests that older adults are generally willing to discuss long-term prognosis.6 Clinicians should solicit patients{\textquoteright} individual perception of prognosis and use this information as a starting point for further discussion, particularly among older patients who may be more prone to errors. Then, in conjunction with prognostic tools, they can begin to bridge the gap between subjective and objective estimates of survival.}, keywords = {Health Conditions and Status, Mortality, Older Adults, Self-reported health}, issn = {2168-6106}, doi = {10.1001/jamainternmed.2015.5542}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.5542}, author = {Rafael D Romo and Sei J. Lee and Yinghui Miao and W John Boscardin} } @article {11429, title = {The Typical American Lives Only 18 Miles From Mom}, journal = {The New York Times}, year = {2015}, chapter = {The Upshot}, address = {New York, New York}, keywords = {children, Geography, Older Adults}, url = {https://www.nytimes.com/interactive/2015/12/24/upshot/24up-family.html$\#$:~:text=Over\%20all\%2C\%20the\%20median\%20distance,to\%20live\%20longer\%20than\%20men}, author = {Bui, Quoctrung and Claire Cain Miller} } @article {8919, title = {US Prevalence And Predictors Of Informal Caregiving For Dementia.}, journal = {Health Affairs}, volume = {34}, year = {2015}, month = {2015 Oct}, pages = {1637-41}, abstract = {In 2010, 5.5 million US adults ages seventy and older received informal care, including 3.6 million with cognitive impairment or probable dementia. Adults with probable dementia received 171 hours of monthly informal care, versus 89 and 66 hours for cognitively impaired without dementia and cognitively normal adults, respectively.}, keywords = {Caregiving, Dementia, Demographics, Long-term Care, Older Adults}, issn = {1544-5208}, doi = {10.1377/hlthaff.2015.0510}, author = {Esther M Friedman and Regina A Shih and Kenneth M. Langa and Michael D Hurd} } @article {8928, title = {Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia.}, journal = {Health Affairs}, volume = {33}, year = {2014}, month = {2014 Apr}, pages = {667-74}, abstract = {

The number of older adults with cognitive impairment is increasing, and such adults often require a surrogate to make decisions about health care. However, little is known about the aggressiveness of end-of-life care for these people, especially those who reside in the community. We found that cognitive impairment is common among older adults approaching the end of life, whether they live in the community or in a nursing home, and that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive-as measured by Medicare spending ($11,461 less per patient), likelihood of in-hospital death (17.9 percentage points lower), and use of the intensive care unit (9.4 percentage points lower). In contrast, advance directives were not associated with differences in care for people with normal cognition or mild dementia, whether they resided in the community or in a nursing home. Timely advance care planning after a diagnosis of cognitive impairment may be particularly important for older adults who reside in the community.

}, keywords = {Advance directives, Dementia, Disabilities, End-of-life care, Nursing homes, Older Adults}, issn = {1544-5208}, doi = {10.1377/hlthaff.2013.1258}, author = {Lauren Hersch Nicholas and Julie P W Bynum and Theodore J Iwashyna and David R Weir and Kenneth M. Langa} } @article {8926, title = {Economic development and gender inequality in cognition: a comparison of China and India, and of SAGE and the HRS sister studies.}, journal = {Journal of Economics of Ageing}, volume = {4}, year = {2014}, month = {2014 Dec 01}, pages = {114-125}, abstract = {

This paper examines cognition measures by age and gender from two types of studies in China and India. It finds that despite some notable differences in samples and measures, a general strong association of cognition in older ages with education emerges as a potential explanation for gender gaps and cohort differences. Female disadvantage in cognition is greater in India, both before and after controlling for education. The process of rural-urban migration draws more cognitively able women to cities in China but not in India. The advent of modern longitudinal studies of aging in these developing countries holds great promise for future work.

}, keywords = {CHARLS, Economics, Gender Differences, LASI, Older Adults, SAGE, Sister studies}, issn = {2212-828X}, doi = {10.1016/j.jeoa.2014.08.002}, author = {David R Weir and Margaret Lay and Kenneth M. Langa} } @article {8559, title = {The Economic Importance of Financial Literacy: Theory and Evidence {\textdagger}}, journal = {Journal of Economic Literature}, volume = {52}, year = {2014}, month = {Jan-03-2014}, pages = {5 - 44}, abstract = {This paper undertakes an assessment of a rapidly growing body of economic research on financial literacy. We start with an overview of theoretical research, which casts financial knowledge as a form of investment in human capital. Endogenizing financial knowledge has important implications for welfare, as well as policies intended to enhance levels of financial knowledge in the larger population. Next, we draw on recent surveys to establish how much (or how little) people know and identify the least financially savvy population subgroups. This is followed by an examination of the impact of financial literacy on economic decision making in the United States and elsewhere. While the literature is still young, conclusions may be drawn about the effects and consequences of financial illiteracy and what works to remedy these gaps. A final section offers thoughts on what remains to be learned if researchers are to better inform theoretical and empirical models as well as public policy.}, keywords = {Decision making, Financial literacy, Older Adults, Welfare}, issn = {0022-0515}, doi = {10.1257/jel.52.1.5}, url = {http://pubs.aeaweb.org/doi/abs/10.1257/jel.52.1.5}, author = {Annamaria Lusardi and Olivia S. Mitchell} } @article {8927, title = {Education, brain health, and improving life opportunities for women}, journal = {The Journal of the Economics of Ageing}, volume = {4}, year = {2014}, month = {Jan-12-2014}, pages = {56 - 58}, abstract = {The paper by Lei et al. in this issue adds to the growing body of empirical evidence that education and cognitive stimulation, both in early-life and in later-life, seem especially important for cognitive health and the prevention of cognitive decline with aging. The expanding educational opportunities for girls and women in developing countries such as China over the last few decades appear to have played an important role in improving their cognitive health and, in turn, have likely expanded their opportunities to participate more fully and successfully in both work and social roles. While {\textquotedblleft}curing{\textquotedblright} dementia in the coming decades seems unlikely, decreasing the risk of cognitive impairment and disability in both developed and developing countries through increasing education, life-long cognitive stimulation, and improved control of cardiovascular risk appears achievable. Success would benefit people of all ages by keeping older adults more independent and productive, and minimizing the burden of support on younger generations.}, keywords = {Education, Gender Differences, Life opportunities, Older Adults, Women and Minorities}, issn = {2212828X}, doi = {10.1016/j.jeoa.2014.08.001}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2212828X14000176http://api.elsevier.com/content/article/PII:S2212828X14000176?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X14000176?httpAccept=text/plain}, author = {Kenneth M. Langa and Eric B Larson} } @article {8914, title = {Loneliness in a day: activity engagement, time alone, and experienced emotions.}, journal = {Psychology and Aging}, volume = {29}, year = {2014}, month = {2014 Jun}, pages = {297-305}, abstract = {

The experience of chronic loneliness has been associated with poorer physical health and well-being, including declines in cardiovascular health and higher levels of distressed affect. Given the long-term effects of loneliness on health and well-being, much research has focused on loneliness in older age. The purpose of the current study was to obtain a more detailed picture of the experience of loneliness in midlife and older adulthood by incorporating the context of a day{\textquoteright}s activities. We use a modified day reconstruction task to examine the activities in which middle-age and older adults engaged, the amount of time they spent alone, and the emotions experienced while engaging in a day{\textquoteright}s activities. Lonely individuals did not participate in different daily activities or spend more time alone during the day; however, loneliness was associated with engaging in more activities alone than with others. In regards to emotional experiences, daily activities yield a different profile of positive emotional experiences for lonelier individuals. The social context of daily activities was an important factor in understanding the effects of loneliness on experienced negative emotions. The results of this study provide insight into the influence of loneliness on the structure of a day and context for understanding the emotional experiences of lonely older adults.

}, keywords = {Depressive symptoms, Loneliness, Marriage, Older Adults}, issn = {1939-1498}, doi = {10.1037/a0036889}, author = {Tara L Queen and Stawski, Robert S and Lindsay H Ryan and Jacqui Smith} } @article {8743, title = {Optimism and Death: Predicting the Course and Consequences of Depression Trajectories in Response to Heart Attack}, journal = {Psychological Science}, volume = {25}, year = {2014}, month = {Jan-12-2014}, pages = {2177 - 2188}, abstract = {The course of depression in relation to myocardial infarction (MI), commonly known as heart attack, and the consequences for mortality are not well characterized. Further, optimism may predict both the effects of MI on depression as well as mortality secondary to MI. In the current study, we utilized a large population-based prospective sample of older adults (N = 2,147) to identify heterogeneous trajectories of depression from 6 years prior to their first-reported MI to 4 years after. Findings indicated that individuals were at significantly increased risk for mortality when depression emerged after their first-reported MI, compared with resilient individuals who had no significant post-MI elevation in depression symptomatology. Individuals with chronic depression and those demonstrating pre-event depression followed by recovery after MI were not at increased risk. Further, optimism, measured before MI, prospectively differentiated all depressed individuals from participants who were resilient.}, keywords = {Depressive symptoms, Health Shocks, Heart disease, Mortality, Older Adults, Optimism}, issn = {0956-7976}, doi = {10.1177/0956797614551750}, url = {http://pss.sagepub.com/lookup/doi/10.1177/0956797614551750}, author = {Isaac R Galatzer-Levy and George A. Bonanno} } @article {8913, title = {Spousal social support and strain: impacts on health in older couples.}, journal = {Journal of Behavioral Medicine}, volume = {37}, year = {2014}, month = {2014 Dec}, pages = {1108-17}, abstract = {

Using a nationally representative sample of couples aged 51+ in the United States (N~=~1,923 couples), the current study investigated whether both partners{\textquoteright} perceptions of relationship support and strain are associated with an individual{\textquoteright}s self-rated health and functional limitations. The sample had an average age of 67.17~years (SD~=~9.0; range 50-97). Actor-Partner Interdependence Models adjusting for couple interdependencies were applied using multilevel models. After accounting for age, education, gender, race, and couple differences in length of marriage, results indicate that individual perceptions of support were significantly associated with higher self-rated health and fewer functional limitations. These individual-level benefits increased if the spouse also perceived positive support and low strain. Finally, the negative association of an individual{\textquoteright}s perceived support on functional limitations was greater in those with a spouse reporting low levels of perceived strain. Findings are discussed relative to theory on behavioral and psychological pathways between partners{\textquoteright} perceptions of support and health.

}, keywords = {Health Conditions and Status, Marriage, Older Adults, Social Support, Stress}, issn = {1573-3521}, doi = {10.1007/s10865-014-9561-x}, author = {Lindsay H Ryan and Wylie H Wan and Jacqui Smith} } @article {8946, title = {Dementia Risk and Financial Decision Making by Older Households: The Impact of Information.}, journal = {Journal of Human Capital}, year = {2013}, month = {2013 Apr 01}, pages = {45}, abstract = {

The knowledge and reasoning ability needed to manage one{\textquoteright}s finances is a form of human capital. Alzheimer{\textquoteright}s disease and other dementias cause progressive declines in cognition that lead to a complete loss of functional capacities. In this paper we analyze the impact of information about cognitive decline on the choice of household financial decision-maker. Using longitudinal data on older married couples in a novel application of survival analysis, we find that as the financial decision maker{\textquoteright}s cognition declines, the management of finances is eventually turned over to his cognitively intact spouse, often well after difficulties handling money have already emerged. However, a memory disease diagnosis increases the hazard of switching the financial respondent by over 200 percent for couples who control their retirement accounts, like 401(k) accounts, relative to those who passively receive retirement income. This finding is consistent with a model of the value of information: households with the most to gain financially from preparation are most responsive to information about cognitive decline.

}, keywords = {Decision making, Dementia, Finances, Older Adults}, issn = {1932-8575}, doi = {10.2139/ssrn.2339225}, author = {Joanne W. Hsu and Robert J. Willis} } @article {8931, title = {Depression, antidepressant medications, and risk of Clostridium difficile infection.}, journal = {BMC Medicine}, volume = {11}, year = {2013}, month = {2013 May 07}, pages = {121}, abstract = {

BACKGROUND: An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

METHODS: In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

RESULTS: The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95\% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95\% CI 168.0 to 226.1). The odds of CDI were 36\% greater in persons with major depression (95\% CI 1.06 to 1.74), 35\% greater in individuals with depressive disorders (95\% CI 1.05 to 1.73), 54\% greater in those who were widowed (95\% CI 1.21 to 1.95), and 25\% lower in adults who did not live alone (95\% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

CONCLUSIONS: Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

}, keywords = {Antidepressants, Clostridium, Depressive symptoms, Infection, Older Adults}, issn = {1741-7015}, doi = {10.1186/1741-7015-11-121}, author = {Mary A M Rogers and M. Todd Greene and Vincent B Young and Sanjay Saint and Kenneth M. Langa and John Y Kao and David M. Aronoff} } @article {8933, title = {The Estate Tax and Inter Vivos Transfers over Time}, journal = {American Economic Review}, volume = {103}, year = {2013}, month = {Jan-05-2013}, pages = {478 - 483}, keywords = {Economics, Estate tax, Inter Vivos Transfers, Older Adults}, issn = {0002-8282}, doi = {10.1257/aer.103.3.478}, url = {http://pubs.aeaweb.org/doi/10.1257/aer.103.3.478http://pubs.aeaweb.org/doi/pdf/10.1257/aer.103.3.478}, author = {Kathleen McGarry} } @article {8930, title = {Expenditures in the elderly with peripheral neuropathy: Where should we focus cost-control efforts?}, journal = {Neurology. Clinical Practice}, volume = {3}, year = {2013}, month = {2013 Oct}, pages = {421-430}, abstract = {

To optimize care in the evaluation of peripheral neuropathy, we sought to define which tests drive expenditures and the role of the provider type. We investigated test utilization and expenditures by provider type in those with incident neuropathy in a nationally representative elderly, Medicare population. Multivariable logistic regression was used to determine predictors of MRI and electrodiagnostic utilization. MRIs of the neuroaxis and electrodiagnostic tests accounted for 88\% of total expenditures. Mean and aggregate diagnostic expenditures were higher in those who saw a neurologist. Patients who saw a neurologist were more likely to receive an MRI and an electrodiagnostic test. MRIs and electrodiagnostic tests are the main contributors to expenditures in the evaluation of peripheral neuropathy, and should be the focus of future efficiency efforts.

}, keywords = {Medical Expenses, Medicare/Medicaid/Health Insurance, Older Adults, Peripheral Neuropathy}, issn = {2163-0402}, doi = {10.1212/CPJ.0b013e3182a78fb1}, author = {Brian C. Callaghan and James F. Burke and Rodgers, Ann and Ryan J McCammon and Kenneth M. Langa and Eva L Feldman and Kevin Kerber} } @article {8953, title = {Heterogeneity in spending change at retirement.}, journal = {Journal of the Economics of Ageing}, volume = {1-2}, year = {2013}, month = {2013 Nov}, pages = {60-71}, abstract = {

The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates at retirement, rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. We find substantial heterogeneity in spending change at retirement: in the upper half of the wealth distribution spending increased. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be early retirement due to poor health, possibly augmented by a short planning horizon by a minority of the population.

}, keywords = {Older Adults, Retirement Planning and Satisfaction}, issn = {2212-828X}, doi = {10.1016/j.jeoa.2013.09.002}, author = {Michael D Hurd and Susann Rohwedder} } @book {8650, title = {The Market for Financial Advice}, series = {Pension Research Council Series}, year = {2013}, pages = {368}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, keywords = {Economics, Financial literacy, Market analyses, Older Adults, Retirement Planning and Satisfaction}, author = {Olivia S. Mitchell and Smetters, Kent} } @article {7807, title = {Marriage, marital history, and Black-White wealth differentials among older women}, journal = {Journal of Marriage and Family}, volume = {75}, year = {2013}, pages = {342-362}, publisher = {75}, abstract = {This study investigated the impact of union history and marital transitions on wealth inequality between older Black and White women (N = 7,026). Cohort data from the Health and Retirement Study show large and increasing Black - White differences in wealth. Marital and relationship histories are associated with the wealth accumulation process among older women. Women who married and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage - wealth nexus is sensitive to a woman{\textquoteright}s position in the wealth distribution. Quantile regression results revealed that racial differences in total wealth holdings between Black and White women exist throughout the wealth distribution, whereas the relationship between current union history and wealth differentials is significant at the lower tail and middle of the distribution. Decomposition analyses highlighted the nontrivial role of racial disparities in marital histories in accounting for the racial wealth gap. As members of the baby boom generation enter their retirement years, it will be more important than ever to monitor the wealth accumulation process among older single and racial/ethnic minority women.}, keywords = {Adult children, Older Adults, Racial/ethnic differences, Women and Minorities}, doi = {10.1111/jomf.12007}, url = {http://onlinelibrary.wiley.com/doi/10.1111/jomf.12007/abstract}, author = {Fenaba R. Addo and Lichter, Daniel T.} } @article {8929, title = {New insights into the dementia epidemic.}, journal = {New England Journal of Medicine}, volume = {369}, year = {2013}, month = {2013 Dec 12}, pages = {2275-7}, keywords = {Aging, Cognitive Ability, Dementia, Health Conditions and Status, Older Adults}, issn = {1533-4406}, doi = {10.1056/NEJMp1311405}, author = {Eric B Larson and Kristine Yaffe and Kenneth M. Langa} } @article {8642, title = {Optimal Financial Knowledge and Wealth Inequality}, number = {18669}, year = {2013}, pages = {1-49}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {While financial knowledge is strongly positively related to household wealth, there is also considerable cross-sectional variation in both financial knowledge and net asset levels. To explore these patterns, we develop a calibrated stochastic life cycle model featuring endogenous financial knowledge accumulation. The model generates substantial wealth inequality, over and above that of standard life cycle models; this is because higher earners typically have more hump-shaped labor income profiles and lower retirement benefits which, when interacted with precautionary saving motives, boost their need for private wealth accumulation and thus financial knowledge. Our simulations show that endogenous financial knowledge accumulation has the potential to account for a large proportion of wealth inequality. The fraction of the population which is rationally financially "ignorant" depends on the generosity of the retirement system and the level of means-tested benefits. Educational efforts to enhance financial savvy early in the life cycle so as to produce one percentage point excess return per year would be valued highly by people in all educational groups.}, keywords = {Financial literacy, Older Adults, Wealth Inequality, Women and Minorities}, doi = {10.3386/w18669}, url = {http://www.nber.org/papers/w18669.pdf}, author = {Annamaria Lusardi and Pierre-Carl Michaud and Olivia S. Mitchell} } @article {8633, title = {Aging and the Macroeconomy: Long-Term Implications of an Older Population}, year = {2012}, institution = {The National Academies Press}, address = {Washington, DC}, keywords = {Economics, Older Adults, Public Policy, Society}, url = {http://pages.stern.nyu.edu/~dbackus/BCH/demography/NAS_aging_12.pdf} } @article {8954, title = {The Displacement Effect of Public Pensions on the Accumulation of Financial Assets.}, journal = {Fiscal Studies}, volume = {33}, year = {2012}, pages = {107-128}, abstract = {

The generosity of public pensions may depress private savings and provide incentives to retire early. While there is plenty of evidence supporting the latter effect, there remains considerable controversy whether public pensions crowd out private savings. This paper uses international micro-datasets collected over recent years to investigate whether public pensions displace private savings. The identification strategy relies not only on cross-country differences in generosity but also on differences in the progressivity or non-linearity of pension formulas across countries. We estimate that an extra dollar of pension wealth depresses accumulated financial assets around the time of retirement by 22 cents. An extra ten thousand dollars in public pension wealth reduces the average retirement age by roughly one month which implies an elasticity of retirement years with respect to pension wealth of -0.15.

}, keywords = {Finances, Older Adults, Pensions, Retirement Planning and Satisfaction}, issn = {0143-5671}, doi = {10.1111/j.1475-5890.2012.00154.x}, author = {Michael D Hurd and Pierre-Carl Michaud and Susann Rohwedder} } @article {8637, title = {Functional Disabilities and Nursing Home Admittance}, number = {WP 2012-19}, year = {2012}, institution = {Pension Research Council, University of Pennsylvania}, address = {Philadelphia, PA}, abstract = {This paper examines how inability to perform activities of daily living relates to the risk of nursing home admission over older adults{\textquoteright} life courses. Using longitudinal data on persons over age 50 from the Health and Retirement Study, we show that aging one year boosts the probability of having two or more disabilities by 9 to 12 percent in a multivariate logistic model. Moreover, at least three-fifths of all 65-year-old men and three-quarters of women will experience disability levels during their remaining lifetimes severe enough to trigger nursing home admission. Our analysis also suggests that certain types of disability are more important than others in predicting nursing home admittance and use, which has implications for the design and benefits triggers for long-term care insurance programs.}, keywords = {Disabilities, Hospitalization, Long-term Care, Mortality, Older Adults}, doi = {10.2139/ssrn.2157548}, author = {Joelle H Fong and Benedict S K Koh and Olivia S. Mitchell} } @inbook {8641, title = {The Outlook for Financial Literacy}, booktitle = {Financial Literacy: Implications for Retirement Security and the Financial Marketplace}, year = {2012}, publisher = {Oxford University Press}, organization = {Oxford University Press}, chapter = {1}, address = {Oxford, UK}, keywords = {Financial literacy, Forecasting, Future, Older Adults}, author = {Annamaria Lusardi and Olivia S. Mitchell} } @article {8557, title = {Financial literacy and retirement planning in the United States}, journal = {Journal of Pension Economics and Finance}, volume = {10}, year = {2011}, pages = {509 - 525}, abstract = {We examine financial literacy in the US using the new National Financial Capability Study, wherein we demonstrate that financial literacy is particularly low among the young, women, and the less-educated. Moreover, Hispanics and African-Americans score the least well on financial literacy concepts. Interestingly, all groups rate themselves as rather well-informed about financial matters, notwithstanding their actual performance on the key literacy questions. Finally, we show that people who score higher on the financial literacy questions are much more likely to plan for retirement, which is likely to leave them better positioned for old age. Our results will inform those seeking to target financial literacy programmes to those in most need.}, keywords = {Education, Financial literacy, Older Adults, Retirement Planning and Satisfaction}, issn = {1474-7472}, doi = {10.1017/S1474747211000448}, author = {Annamaria Lusardi and Olivia S. Mitchell} } @book {8649, title = {Financial Literacy: Implications for Retirement Security and the Financial Marketplace}, series = {Pension Research Council Series}, year = {2011}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, abstract = {As financial markets grow ever more complex and integrated, households must make increasingly sophisticated and all-too-often irreversible economic decisions. This is particularly evident in retirement decision-making. Traditional defined benefit pension schemes are being replaced with defined contribution pensions; employer and government judgment regarding how much to save and where to invest has been replaced by employees having to make these choices on their own (sometimes assisted by advisers); and retirees have become responsible for managing their own pension assets. This volume explores how financial literacy can enhance peoples{\textquoteright} ability to make informed economic choices. It proposes that financial literacy determines how well people make and execute saving, investing, borrowing, and planning decisions. It examines causality using controlled settings to disentangle whether financial literacy causes saving or vice versa, and demonstrates that financial education programs do indeed enhance financial decision-making and asset accumulation.}, keywords = {Economics, Financial literacy, Older Adults, Retirement Planning and Satisfaction}, isbn = {0-19-969681-9}, url = {https://pensionresearchcouncil.wharton.upenn.edu/publications/books/financial-literacy-implications-for-retirement-security-and-the-financial-marketplace/}, author = {Olivia S. Mitchell and Annamaria Lusardi} } @article {8939, title = {Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns.}, journal = {BMC Geriatrrics}, volume = {11}, year = {2011}, pages = {65}, abstract = {

BACKGROUND: It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates.

METHODS: Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen{\textquoteright}s behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects.

RESULTS: We identified 948 individuals (17.2\% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5\%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently presented to the ED with non-severe episodes. When contrasted with 1,177 individuals with a persistent pattern of indeterminate severity ED use, persons with severe patterns were older (AOR 1.36), more likely to be obese (AOR 1.36), and experience heart disease (AOR 1.49) and hypertension (AOR 1.36) while persons with non-severe patterns were less likely to smoke (AOR 0.63) and have diabetes (AOR 0.67) or lung disease (AOR 0.58).

CONCLUSIONS: We distinguished three large, readily identifiable groups of older adults which figure prominently in the use of EDs across the United States. Our results suggest that one group affects the general capacity of the ED to provide care as they persistently present with severe episodes requiring urgent staff attention and greater resource allocation. Another group persistently presents with non-severe episodes and creates a considerable share of the excess demand for ED care. Future research should determine how chronic disease management programs and varied co-payment obligations might impact the use of the ED by these two large and distinct groups of older adults with consistent ED use patterns.

}, keywords = {Emergency services, Health Shocks, Medicare/Medicaid/Health Insurance, Older Adults}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-65}, author = {Kaskie, Brian and Maksym Obrizan and Michael P Jones and Suzanne E Bentler and Paula A Weigel and Jason Hockenberry and Robert B Wallace and Robert L. Ohsfeldt and Gary E Rosenthal and Frederic D Wolinsky} } @article {8769, title = {Accurately Measuring Health Over the Life Course}, number = {WP$\#$2010-5}, year = {2010}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {This paper develops a new method of estimating rich, dynamic models of health based on multiple health measures available in the HRS. We apply these methods to investigate what generates the large socioeconomic gradient in health. Preliminary results suggest a large role for initial differences in health at age 50 that persist into old age.}, keywords = {Health Conditions and Status, Meta-analyses, Mortality, Older Adults}, url = {https://crr.bc.edu/working-papers/accurately-measuring-health-over-the-life-course/}, author = {Lange, Fabian and McKee, Douglas} } @inbook {8646, title = {Human Capital Risk and Pension Outcomes}, booktitle = {Evaluating the Financial Performance of Pension Funds}, year = {2010}, pages = {119-151}, publisher = {World Bank}, organization = {World Bank}, address = {Washington, DC}, keywords = {Older Adults, Pensions, Retirement Planning and Satisfaction, Risk Factors}, author = {Olivia S. Mitchell and John A. Turner} } @article {8944, title = {Key themes in research on the demography of aging.}, journal = {Demography}, volume = {47 Suppl}, year = {2010}, pages = {S5-15}, abstract = {For years, researchers and policymakers have attempted to focus attention on population aging by discussing the likely implications to individuals, governments, and society of the baby boom generation reaching old age. No longer can researchers and policymakers say that these are issues that will arise far into the future; the leading edge of the baby boom cohort{\textemdash}born in 1946{\textemdash}will turn age 65 next year. The future is upon us. The implications of this change in age structure are tremendous, although we may not fully understand the impact for years to come. However, an incredibly rich research infrastructure is now in place that did not exist just 20 years ago. Drawing on this infrastructure, scientists of today and tomorrow will generate new knowledge that will allow us to more intelligently address the most pressing social and economic issues facing society, issues such as the ones examined in this special issue.}, keywords = {Aging, Demographics, Meta-analyses, Older Adults}, issn = {0070-3370}, doi = {10.1353/dem.2010.0001}, author = {Robert F. Schoeni and Mary Beth Ofstedal} } @article {8760, title = {Reducing selection bias in analyzing longitudinal health data with high mortality rates}, journal = {Journal of Modern Applied Statistical Methods}, volume = {9}, year = {2010}, pages = {Article 2}, abstract = {Two longitudinal regression models, one parametric and one nonparametric, are developed to reduce selection bias when analyzing longitudinal health data with high mortality rates. The parametric mixed model is a two-step linear regression approach, whereas the nonparametric mixed-effects regression model uses a retransformation method to handle random errors across time. }, keywords = {Bias, Meta-analyses, Mortality, Older Adults}, url = {http://digitalcommons.wayne.edu/cgi/viewcontent.cgi?article=1394\&context=jmasm}, author = {Xian Li and Engel, Charles C. and Han Kang and Kristie L. Gore} } @article {8556, title = {Hypothetical versus Actual Earnings Profiles: Implications for Social Security Reform}, journal = {Journal of Financial Transformation}, volume = {24}, year = {2009}, pages = {102-04}, keywords = {Income, Older Adults, Social Security}, author = {Olivia S. Mitchell and John W R Phillips} } @article {8629, title = {Social Security Research at the Michigan Retirement Research Center}, journal = {Social Security Bulletin}, volume = {69}, year = {2009}, pages = {51-64}, chapter = {51}, abstract = {Social Security has been a topic of widespread discussion in the last decade. Rising longevity and falling fertility have led to an aging population, which increases solvency challenges for the Social Security system. Public concerns over low national saving have led to an extensive dialog on the merits of reform that might change the U.S. system into one with fully or partially funded personal accounts. Meanwhile, pensions in the private sector have been evolving from predominantly defined benefit (DB) to predominantly defined contribution (DC), raising concerns that workers preparing for retirement have more personal responsibility, with more complex financial challenges, than ever before.}, keywords = {Meta-analyses, Older Adults, Research, Social Security}, url = {https://www.ssa.gov/policy/docs/ssb/v69n4/v69n4p51.pdf}, author = {R.V. Burkhauser and Alan L Gustman and John Laitner and Olivia S. Mitchell and Amanda Sonnega} } @article {8787, title = {Differential Mortality in Europe and the U.S.: Estimates Based on Subjective Probabilities of Survival}, journal = {SSRN Electronic Journal}, year = {2008}, abstract = {Estimates of differential mortality by socioeconomic status play an important role in several domains: in public policy for assessing distributional effects of public programs; in financial markets for the design of life insurance and annuities; and in individual decision making when figuring out how much to save for retirement. Traditionally, reliable estimates of differential mortality require rich panel data with large sample size. This paper proposes a new, less data-intensive approach relying on just a single cross-section of data. Rather than using observations on actual mortality in panel over time, the authors propose relating individuals{\textquoteright} subjective probabilities of survival to variables of socioeconomic status in cross-section. They formulate the method in a model of survey response and provide an empirical validation based on data from the Health and Retirement Study comparing the alternative estimates to the traditional estimates of differential mortality for the same sample of baseline respondents. They present two applications. First, they document an increase in differential mortality in the U.S. over time, and second, they produce comparable estimates of differential mortality for 10 European countries and the U.S. based on subjective probabilities of survival.}, keywords = {Cross-National, Longevity, Mortality, NDI, Older Adults, Survival}, doi = {10.2139/ssrn.1265705}, author = {Delavande, Adeline and Susann Rohwedder} } @article {8768, title = {The effect of spousal caregiving and bereavement on depressive symptoms}, journal = {Aging \& Mental Health}, volume = {12}, year = {2008}, month = {Jan-01-2008}, pages = {100 - 107}, abstract = {The objective of the study was to determine whether spousal caregiving and bereavement increases caregiver depressive symptoms. We followed 1,967 community-dwelling elderly couples from the 1993 Health and Retirement Study (HRS) until 2002 (five bi-annual surveys) or death. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. Adjusted depressive symptoms were higher for females for three of the four caregiving arrangements tested (as were unadjusted baseline levels). Depressive symptoms were lowest when neither spouse received caregiving (adjusted CESD of 2.97 for males; 3.44 for females, p < 0.001). They were highest when females provided care to their husband with assistance from another caregiver, (4.01) compared to (3.37; p < 0.001) when males so cared for their wife. A gender by caregiving arrangements interaction was not significant (p = 0.13), showing no differential effect of caregiving on CESD by gender. Depressive symptoms peaked for bereaved spouses within three months of spousal death (4.67; p < 0.001) but declined steadily to 2.75 (p < 0.001) more than 15 months after death. Depressive symptoms initially increased for the community spouse after institutionalization of the care recipient, but later declined. We conclude that caregiving increases depressive symptoms in the caregiver, but does not have a differential effect by gender. Increases in depressive symptoms following bereavement are short-term.}, keywords = {Bereavement, Caregiving, Depressive symptoms, Marriage, Mortality, Older Adults}, issn = {1360-7863}, doi = {10.1080/13607860801936631}, url = {http://www.tandfonline.com/doi/abs/10.1080/13607860801936631}, author = {Donald H. Taylor Jr. and Kuchibhatla, Maragatha and Truls Ostbye and Brenda L Plassman and Elizabeth C. Clipp} } @mastersthesis {6195, title = {Nursing home placement among older adults: A national study of risk perceptions, access and placement outcomes}, year = {2007}, month = {2007}, school = {University of Iowa}, abstract = {In health services research, race and gender are frequently included as demographic variables along with other relevant predictors. Frequently, however, routine inclusion of race and gender is of a cursory nature, and does not inform researchers of the great differences that can be evident between groups. To address this, particularly in long-term care research, the principle purpose of this dissertation research was to explore the additive and interactive effects of race and gender on several aspects of nursing home use including expectations for placement, the risk for placement, access to nursing home services, and outcomes of nursing home use. Data were drawn from the Health and Retirement Study, specifically, the study on Asset and Health Dynamics among the Oldest Old (AHEAD). 7,447 AHEAD study respondents were 70 years and older at baseline data collection in 1993. The observation period lasted through 2004. Multivariate binary and multinomial logistic regression models, as well as ordinary least squares, and hazard modeling techniques were used. Study results confirmed that risk perceptions as reported by respondents were rational, and that older adults can accurately assess their risk for placement in 5 years. Overwhelmingly, Blacks were at a lower risk for placement in a nursing home in 5 years, or after 11 years. However, the risk for placement was significantly impacted by the growth of assisted living beds over the study period which expanded access for Whites, but limited long-term care options for Blacks to nursing homes. Women experienced higher risk for placements, especially multiple placements over time, suggesting a possible reliance on nursing homes for respite care due to more limited caregiver options in the community. Study results suggest that early identification of individuals at risk informs budget planning for Medicaid and other payers, and directs resources to individuals and communities that are in greatest need. Planning for the anticipated growth in the need for long-term care services are also improved by identifying demographic and other personal and market factors that contribute to temporary, multiple, or terminal use of long-term care services by older adults.}, keywords = {Demographics, Healthcare, Nursing homes, Older Adults, Risk Factors}, author = {Adaeze B Akamigbo} } @article {8600, title = {Preparing for the Future: Latinos{\textquoteright} Financial Literacy and Retirement Planning}, journal = {The Business Journal of Hispanic Research}, volume = {1}, year = {2007}, month = {08/2007}, pages = {54-68}, chapter = {54}, abstract = {Over the past three decades, the burden of responsibility for retirement savings has shifted from employer to employee. Saving for retirement has changed from an insured, employer-provided benefit to an uninsured employee-provided deduction from a paycheck. When retirement planning and investment decision-making is largely relegated to individuals, financial literacy is essential. Financial illiteracy, however, is widespread throughout the population and is of particular concern for Latinos. Closing the gap between what American workers generally and Latino workers, in particular, need to know to prepare for retirement and their current level ofp reparation is an urgent need. This paper disaggregates ethnic differences between Latinos, both foreign and US born, and non-Latino Blacks and Whites in the analysis of core and supplemental data from the 2004 Health and Retirement Study (HRS). While other analyses of data from the survey deal with aggregates, this study explains how individual characteristics among ethnic groups affect financial literacy.}, keywords = {Financial literacy, Older Adults, Retirement Planning and Satisfaction, Women and Minorities}, url = {https://latinostudies.nd.edu/assets/95325/original/preparing_for_the_future.pdf}, author = {Wei Sun and Gia Barboza and Karen Richman} } @article {8785, title = {Differential Mortality, Uncertain Medical Expenses, and the Saving of Elderly Singles}, year = {2006}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {People have heterogenous life expectancies: women live longer than men, rich people live longer than poor people, and healthy people live longer than sick people. People are also subject to heterogenous out-of-pocket medical expense risk. We construct a rich structural model of saving behavior for retired single households that accounts for this heterogeneity, and we estimate the model using AHEAD data and the method of simulated moments. We find that the risk of living long and facing high medical expenses goes a long way toward explaining the elderly{\textquoteright}s savings decisions. Specifically, medical expenses that rise quickly with both age and permanent income can explain why the elderly singles, and especially the richest ones, run down their assets so slowly. We also find that social insurance has a big impact on the elderly{\textquoteright}s savings.}, keywords = {Medical Expenses, Mortality, Older Adults, Savings, Singles}, doi = {10.3386/w12554}, url = {http://www.nber.org/papers/w12554.pdf}, author = {Mariacristina De Nardi and Eric French and John Bailey Jones} } @article {8761, title = {Veterans and Functional Status Transitions in Older Americans}, journal = {Military Medicine}, volume = {171}, year = {2006}, month = {Jan-10-2006}, pages = {943 - 949}, abstract = {Objectives: This research examines the relationship of veteran status with functional status transitions in older Americans. Methods: Data for this study come from the Survey of Asset and Health Dynamics among the Oldest Old. We use a structural multinomial logit model to decompose the effect of older veterans into the direct effect and the indirect effects via physical health conditions and mental disorders on functional status transitions. Results: Although there is no distinct association among those functionally independent at baseline, veteran status significantly impacts age-dependent transitions from functional dependence to other statuses. At age 85, the excess mortality and the lower level of functional resolution among functionally dependent veterans are considerable. Conclusions: Physical health is more important than mental health in transmitting the effect of veteran status on functional status transitions in functionally dependent persons.}, keywords = {Older Adults, Retirement Planning and Satisfaction, Transitions, Veterans}, issn = {0026-4075}, doi = {10.7205/milmed.171.10.943}, author = {Xian Li and Engel, Charles C. and Han Kang and Armstrong, David W.} } @article {8754, title = {Differences in leisure-time, household, and work-related physical activity by race, ethnicity, and education}, journal = {Journal of General Internal Medicine}, volume = {20}, year = {2005}, month = {Jan-03-2005}, pages = {259 - 266}, abstract = {Background: Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. Objective: To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores and strenuous job activities), and total physical activity (TPA) by race, ethnicity, and education. Design, Setting, and Participants: Cross-sectional analyses of data from the 1992 Health and Retirement Study for a nationally representative cohort of 9,621 community-dwelling adults aged 51{\textendash}61 years. Measurements: Physical activity scores for LTPA, WRPA, and TPA based upon self-reported frequency of light or vigorous recreational activities, heavy household chores, and strenuous job-related physical activities. Main Results: LTPA was lower for blacks and Hispanics compared to whites, and LTPA steadily declined with lower levels of education. WRPA showed the reverse pattern, being lowest for whites and persons with greater education. Education was far more important than race/ethnicity as a determinant of LTPA and WRPA in multivariate analyses. After adjusting for differences in overall health and physical functioning, mean TPA scores were similar across racial/ethnic and education categories; blacks (β=1.0; 95\% confidence interval [CI], 0.5 to 1.5) and Spanish-speaking Hispanics (β=1.1; 95\% CI, 0.3 to 1.9) had slightly higher levels of TPA than whites (P<.01 and P=.01, respectively). Conclusions: Differences in educational attainment and health status accounted for virtually all of the racial and ethnic differences in LTPA. After accounting for WRPA, TPA was similar across race, ethnicity, and education subgroups.}, keywords = {Education, Leisure activities, Mortality, Older Adults, Physical activity, Racial/ethnic differences}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2005.40198.x}, url = {http://link.springer.com/10.1111/j.1525-1497.2005.40198.xhttp://www.springerlink.com/index/pdf/10.1111/j.1525-1497.2005.40198.x}, author = {Xiaoxing He and David W. Baker} } @article {6930, title = {The effect of part-time work on wages: Evidence from the Social Security Rules}, journal = {Journal of Labor Economics}, volume = {22}, year = {2004}, pages = {329-352}, publisher = {22}, abstract = {This article identifies the part-time wage effect, using hours variation caused by the Social Security rules. We show that work hours and wages drop sharply at ages 62 and 65. We argue that the hours decline causes the wage decline, resulting in a 25 wage penalty for men who cut their work week from 40 to 20 hours. However, we find little evidence for such an effect among women. We also show that models that fail to account for the joint determination of hours and wages will understate the labor supply response to a tax change by about 26 .}, keywords = {Employment and Labor Force, Older Adults, Social Security}, doi = {10.1086/381252}, author = {Aaronson, Daniel and Eric French} } @article {8554, title = {The Impact of Health Status and Out-of-Pocket Medical Expenditures on Annuity Valuation}, number = {wp086}, year = {2004}, institution = {Michigan Retirement Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health.}, keywords = {Annuitization, Health Insurance, Medicare/Medicaid/Health Insurance, Older Adults}, url = {https://ideas.repec.org/p/mrr/papers/wp086.html}, author = {Cassio M. Turra and Olivia S. Mitchell} } @article {6886, title = {Functional Status and Health Outcomes in Older Americans with Diabetes: Should diabetes management be targeted to health status?}, journal = {Journal of the American Geriatrics Society}, volume = {51}, year = {2003}, pages = {745-53}, publisher = {51}, abstract = {OBJECTIVES: To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM). DESIGN: Nationally representative cross-sectional and longitudinal health interview survey. SETTING: Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States. PARTICIPANTS: AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM). MEASUREMENTS: At baseline, the entire sample was divided into three groups: high-functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39\%); low-functioning group, having three or more limitations or IADL/ADL disabilities (24\%); and intermediate-functioning group, those in the middle (36\%). Older adults with and without DM, within each of the functioning groups, were compared at 2-year follow-up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow-up functioning. RESULTS: Of people aged 70 and older, 28\% with DM and 41\% without were high functioning; 38\% with DM and 22\% without were low functioning (both P < .001). High-functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high-functioning people without DM. Low-functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low-functioning people without DM, but their 2-year outcomes were similar. The intermediate-functioning group showed the most differences between those with and without DM; those with DM were significantly (P < .01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2-year functioning and to have experienced falls (P < .001). CONCLUSION: Differences in baseline functional status in older adults with DM were associated with outcome differences. High-functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low-functioning people with and without DM had similar outcomes. However, intermediate-functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most-relevant outcomes in the heterogeneous older population with DM.}, keywords = {Diabetes Mellitus, Functional status, Older Adults}, doi = {10.1046/j.1365-2389.2003.51256.x}, author = {Caroline S Blaum and Mary Beth Ofstedal and Kenneth M. Langa and Linda A. Wray} } @article {8753, title = {The Impact of Poor Health Behaviors on Workforce Disability }, number = {WP 2003-057 }, year = {2003}, month = {06/2003}, pages = {1-22}, institution = {University of Michigan Retirement Research Center}, address = {Ann Arbor}, abstract = {The effects of poor health habits on mortality have been studied extensively. However, few studies have examined the impact of these health behaviors on workforce disability. In the Health and Retirement Study, a nationally representative cohort of 6044 Americans who were between the ages of 51 and 61 and who were working in 1992, we found that both baseline smoking status and a sedentary lifestyle predict workforce disability six years later. If this relationship is causal, cost-benefit analyses of health behavior intervention that neglect workforce disability may substantially underestimate the benefits of such interventions. }, keywords = {Disabilities, Health Behavior, Labor force participation, Older Adults}, url = {https://core.ac.uk/download/pdf/7189096.pdf}, author = {Richardson, Caroline R. and Jennifer T. Hanlon and Hillary J. Mull and Sandeep Vijan and Rodney A. Hayward and Linda A. Wray and Kenneth M. Langa} } @article {8631, title = {Perspectives from the President{\textquoteright}s Commission on Social Security Reform}, journal = {Journal of Economic Perspectives}, volume = {17}, year = {2003}, pages = {149-172}, chapter = {149}, abstract = {Social Security faces a severe financial problem. In about 15 years, the program will begin to experience permanent annual cash deficits, when annual benefit payments will exceed the amount collected in payroll tax revenues. By 2041, according to the Social Security Trustees 2002 Report, the Social Security trust fund is projected to be insolvent, meaning that the program will be legally unable to pay scheduled benefits. One way of expressing the financial shortfall is to compute the present value of the difference between system outlays and revenues over a 75-year horizon, which is currently equal to a permanent and immediate tax rate increase of 1.86 percent of payroll, or equivalent to $3.2 trillion in present value. If the policy of pay-as-you-go financing is continued for the next 25 years, a 50 percent payroll tax increase will be required at that time to pay scheduled benefits.}, keywords = {Older Adults, Retirement Planning and Satisfaction, Social Security, Taxes}, url = {https://web.stanford.edu/class/econ21si/coganmitchell_prescommission.pdf}, author = {John F. Cogan and Olivia S. Mitchell} } @article {6819, title = {Upstream Intergenerational Transfers}, journal = {Southern Economic Journal}, volume = {69}, year = {2002}, pages = {363-80}, publisher = {69}, abstract = {This study analyzes upstream intergenerational transfers from middle-aged children to their elderly parents. We formulate a model in which the middle-aged child transfers both money and time to an elderly parent based on an altruistic motive. We examine substitution between financial transfers and time transfers using data from the Health and Retirement Study (HRS). Empirical results support the assumption that upstream transfers are motivated by altruism, particularly financial transfers. Parents financially worse off than their middle-aged children receive more money. They are more likely to live nearby if not coresident. Overall, the results for time transfers provide weaker support for our model than financial transfers. A child with a high wage tends to transfer money rather than time, suggesting that the two types of transfers are partial substitutes. Reprinted by permission of the publisher.}, keywords = {Altruism, Error rates, Expected values, Nursing homes, Older Adults, Parents, Siblings, Standard of living, Wage rate}, doi = {10.2307/1061677}, author = {Frank A Sloan and Zhang, Harold H. and Wang, Jingshu} } @article {8628, title = {Mortality Risk, Inflation Risk, and Annuity Products}, number = {7812}, year = {2000}, month = {07/2000}, pages = {1-34}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {As growing numbers of retirees reach retirement age with substantial balances in self-directed retirement plans, annuities are likely to become increasingly important instruments for drawing down retirement savings. This study explores recent trends in the pricing of single-premium annuity products in the United States. Virtually all of the annuity products currently available in the United States offer fixed nominal payouts, rather than an inflation-linked payout stream. After describing the money{\textquoteright}s worth{\textquoteright} of the various types of nominal annuity products, this study considers the extent to which existing U.S. private annuity markets provide retirees with inflation-protected retirement income flows. Although there is effectively no market yet for inflation-indexed annuities in the United States, such products are available in other countries. The paper concludes by summarizing recent data on the pricing of both nominal and inflation-linked annuities in the United Kingdom and several other nations.}, keywords = {Annuitization, Mortality, Older Adults, Risk Factors}, url = {https://www.nber.org/papers/w7812.pdf}, author = {Brown, Jeffrey R. and Olivia S. Mitchell and James M. Poterba} } @book {8562, title = {Prospects for Social Security Reform}, series = {Pension Research Council Publications}, year = {1999}, publisher = {University of Pennsylvania Press}, organization = {University of Pennsylvania Press}, address = {Philadelphia}, keywords = {Older Adults, Retirement Planning and Satisfaction, Social Security}, isbn = {9780812234794}, url = {https://www.upenn.edu/pennpress/book/4266.html$\#$:~:text=Prospects\%20for\%20Social\%20Security\%20Reform\%20informs\%20the\%20debate\%20by\%20exploring,reform\%20might\%20affect\%20the\%20economy.}, author = {Olivia S. Mitchell and Myers, Robert and Young, Howard} } @article {8782, title = {Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults}, journal = {New England Journal of Medicine}, volume = {337}, year = {1997}, month = {Nov-12-1997}, pages = {1705 - 1714}, abstract = {BACKGROUND Alcohol consumption has both adverse and beneficial effects on survival. We examined the balance of these in a large prospective study of mortality among U.S. adults. METHODS Of 490,000 men and women (mean age, 56 years; range, 30 to 104) who reported their alcohol and tobacco use in 1982, 46,000 died during nine years of follow-up. We compared cause-specific death rates and rates of death from all causes across categories of base-line alcohol consumption, adjusting for other risk factors, and related drinking and smoking habits to the cumulative probability of dying between the ages of 35 and 69 years. RESULTS Causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. The mortality from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.6). The rates of death from all cardiovascular diseases were 30 to 40 percent lower among men (relative risk, 0.7; 95 percent confidence interval, 0.7 to 0.8) and women (relative risk, 0.6; 95 percent confidence interval, 0.6 to 0.7) reporting at least one drink daily than among nondrinkers, with little relation to the level of consumption. The overall death rates were lowest among men and women reporting about one drink daily. Mortality from all causes increased with heavier drinking, particularly among adults under age 60 with lower risk of cardiovascular disease. Alcohol consumption was associated with a small reduction in the overall risk of death in middle age (ages 35 to 69), whereas smoking approximately doubled this risk. CONCLUSIONS In this middle-aged and elderly population, moderate alcohol consumption slightly reduced overall mortality. The benefit depended in part on age and background cardiovascular risk and was far smaller than the large increase in risk produced by tobacco. }, keywords = {Alcohol Consumption, Health Conditions and Status, Mortality, Older Adults, Smoking}, issn = {0028-4793}, doi = {10.1056/NEJM199712113372401}, author = {Michael J Thun and Peto, Richard and Lopez, Alan D. and Monaco, Jane H. and Henley, S. Jane and Heath, Clark W. and Doll, Richard} }