@article {13578, title = {The impact of a long-term care information campaign on insurance coverage.}, journal = {Journal of Health Economics}, volume = {92}, year = {Forthcoming}, pages = {102822}, abstract = {

I estimate the impact of an information campaign on long-term care planning behaviors. I identify this effect using the staggered timing of the federal-state "Own Your Future" campaign, which urged individuals to plan ahead for long-term care needs and reached 26 states over five years. I find the campaign increased long-term care insurance coverage for individuals in the top quintile of the asset distribution by four percentage points, or seventeen percent. A back-of-the-envelope calculation indicates Medicaid savings of $483 million in present value.

}, keywords = {Information campaigns, Insurance, Long-term Care, Medicaid}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2023.102822}, author = {Brown, Jessica H} } @article {12778, title = {Impact of Chronic Conditions, Healthcare Utilization, and Demographics on Advance Care Planning.}, journal = {American Journal of Hospice and Palliative Medicine}, year = {Forthcoming}, abstract = {

Unraveling the intricacies of what factors influence advance care planning (ACP) is an ongoing research challenge. Research shows much ACP is crisis-based and takes place at the end of life. Complicating this late-stage approach may be demographic differences based on race, ethnicity and socioeconomic status. We examined the relationship between demographic factors, chronic health conditions, and healthcare utilization in predicting who was most likely to engage in ACP activities, including designating a durable power of attorney for healthcare (DPOAHC), having a living will, and discussing wishes with family or others. We conducted a secondary analysis using 2018 Health and Retirement Study (HRS) exit data provided by a proxy for the deceased participant that matched the 2016 survey participant data (N = 884). Generalized linear mixed models were used for the analysis. The number of chronic health conditions and healthcare utilization were not associated with ACP activities, but several of the demographic variables showed strong associations. Participants who were female, white, older, and from a higher socioeconomic status were more likely to have engaged in ACP. People continue to defer ACP discussions and documentation end of life or when facing medical crises. More needs to be done to reach out to younger adults, racial minorities, and those with lower socioeconomic status to encourage them to engage in ACP.

}, keywords = {Advance care planning, Chronic conditions, healthcare utilization, race, socioeconomic status}, issn = {1938-2715}, doi = {10.1177/10499091221132286}, author = {Krishnappa, Vinod and Ludwick, Ruth and Sompalle, Saiaravind and Baughman, Kristin R} } @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 {12643, title = {The Impact of Sustained Ownership of a Pet on Cognitive Health: A Population-Based Study.}, journal = {Journal of Aging and Health}, year = {Forthcoming}, abstract = {

To examine associations between sustained ownership of a pet and cognitive outcomes among a national sample of U.S. adults. Weighted linear mixed models were estimated using the Health and Retirement Study (2010-2016, = 1369) to compare repeated measures of cognitive function between respondents who endorsed owning a pet in a sustained manner (>5~years), versus those who owned a pet <=5~years, and non-pet owners. Respondents aged 65+ who owned a pet >5~years demonstrated higher composite cognitive scores, compared to non-pet owners (β = .76, = .03). Sustained pet ownership was associated with higher immediate (β = .3, = .02) and delayed (β = .4, = .007) word recall scores. There were no significant differences in cognitive scores between pet owners and non-owners aged < 65. Sustained ownership of a pet could mitigate cognitive disparities in older adults. Further studies are needed to examine potential causal pathways, including physical activity and stress buffering, versus selection effects.

}, keywords = {cognitive function, Cognitive health, companion animals, pet ownership, Pets}, issn = {1552-6887}, doi = {10.1177/08982643221122641}, author = {Applebaum, Jennifer W and Shieu, Monica M and McDonald, Shelby E and Dunietz, Galit Levi and Braley, Tiffany J} } @article {13877, title = {Informal care provided in US nursing homes: Reduced from 2010 to 2021 and lower for Medicaid residents.}, journal = {Journal of the American Geriatrics Society}, year = {Forthcoming}, abstract = {

BACKGROUND: Little is known about the trend of informal care (unpaid care provided by family or other caregivers) provided to nursing home residents before or during the COVID-19 pandemic. This study assessed this trend during 2010-2021, for all and Medicaid versus non-Medicaid residents.

METHODS: Using data from the RAND Health and Retirement Study longitudinal file, our study sample included a total of 2025 resident-years (860 for Medicaid and 1165 for non-Medicaid residents). We fit two-part regression models to determine adjusted trends in average amount of informal care over time, and difference by resident Medicaid status.

RESULTS: Informal care received by residents reduced substantially over time, from an average of 39.2 h in the past month of interview in 2010-11 to 23.2 h in 2018-19, and then to 11.2 h in the COVID-19 pandemic (2020-21). The reduced hours were due to both reduced percentages of nursing home residents who received any informal care and reduced hours of care among those who did receive it over time. Multivariable analyses confirmed this trend and similar downward trends for Medicaid versus non-Medicaid residents. Medicaid residents on average received 10.02 fewer hours of informal care per month (95\% confidence interval -17.16, -2.87; p = 0.006) than non-Medicaid residents after adjustment for resident characteristics and time trends.

CONCLUSION: Informal care provided to nursing home residents during 2010-2021 reduced over time, especially during the COVID-19 pandemic (2020-21). Medicaid residents tended to receive less informal care than non-Medicaid residents.

}, keywords = {COVID-19, Family care, Informal care, Medicaid, nursing home, trend}, issn = {1532-5415}, doi = {10.1111/jgs.18904}, author = {Li, Yue and Cai, Xueya and Kim, Yeunkyung Yoon and Kim, Jihye} } @article {13837, title = {Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms.}, journal = {Journal of Affective Disorders}, volume = {354}, year = {Forthcoming}, pages = {434-442}, abstract = {

BACKGROUND: The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association.

METHODS: Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models.

RESULTS: The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR~=~1.360 [95~\% CI: 1.325-1.395]) and the US (RR~=~1.613 [95~\% CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4~\% (95~\% CI: 1.377-1.579) and 71.1~\% (95~\% CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity.

LIMITATIONS: The self-report measures, attribution bias.

CONCLUSIONS: Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.

}, keywords = {China, Depressive symptoms, Interpopulation, Intrapopulation, Physical multimorbidity, The United States}, issn = {1573-2517}, doi = {10.1016/j.jad.2024.03.090}, author = {Yu, Haiyang and Zhang, Yike and Hu, Mengxiao and Xiang, Bowen and Wang, Sijia and Wang, Qing} } @article {REYES2022102783, title = {Intergenerational support and retirement timing among older men and women by race/ethnicity}, journal = {Social Science Research}, year = {Forthcoming}, abstract = {Retirement timing is associated with health and economic outcomes for older adults. However, it is unclear how the pressures of supporting older parents and young adult children are associated with retirement. This study uses a life course perspective to consider how the linked lives of working older adults and their support of adult children and parents are associated with retirement. Cox proportional hazard models are estimated using the Health and Retirement Study (1992{\textendash}2014) to assess the relationship between intergenerational support exchanges and retirement timing by gender and race/ethnicity. Providing most types of intergenerational support and especially providing time support are associated with an increased risk of retirement. Unlike all other respondents, Hispanic women providing intergenerational time support have similar retirement risks as those not providing any intergenerational support. These differing patterns by race/ethnicity suggest that earlier life course trajectories may shape older adults{\textquoteright} ability to respond to family needs.}, keywords = {Family, intergenerational support, life course, Race/ethnicity, Retirement}, issn = {0049-089X}, doi = {https://doi.org/10.1016/j.ssresearch.2022.102783}, author = {Adriana M. Reyes} } @article {12669, title = {Intersecting Early-Life Selection Mechanisms: Socio-Historical Changes in Racially Stratified Effects of Education on Functional Limitations in the United States.}, journal = {Journal of Aging and Health}, year = {Forthcoming}, abstract = {

OBJECTIVE: Scant research has focused on the role of in shaping intersecting early-life selection mechanisms and their impacts on racially stratified effects of education on health across cohorts.

METHOD: Drawing from the , this study fitted negative binomial regression models to assess the impacts of childhood socioeconomic status (SES) on the relationship between education and functional limitations for Black and White adults across birth cohorts ( = 16,269, born 1931-1959).

RESULTS: The disparities between Black adults and White adults in impacts of childhood SES on both education and functional limitations were more pronounced in recent cohorts. The racial stratification in the impacts of education on functional limitations was documented across cohorts. However, after adjusting for childhood SES, this stratification narrowed considerably in recent cohorts.

DISCUSSION: This study underscores the role of a context in shaping the effects of education on health at the intersection of race and cohort.

}, keywords = {Education, Intersectionality, later-life health inequalities, life course}, issn = {1552-6887}, doi = {10.1177/08982643221124657}, author = {Bhatta, Tirth R} } @article {13845, title = {An Intersectional Approach to Understanding the Psychological Health Effects of Combining Work and Parental Caregiving.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, year = {Forthcoming}, abstract = {

OBJECTIVE: Role theory suggests occupying simultaneous family caregiving and employment roles in midlife may exert positive and negative effects on psychological health. However, there is a lack of causal evidence examining the degree to which combinations of these roles influence psychological health at the intersection of gender and racial identity.

METHODS: Longitudinal data from the Health and Retirement Study (2004-2018) are used to estimate a series of individual fixed effects models examining combinations of employment status and parental caregiving situation on CES-D depression scores among Black and White men and women aged 50-65. Subsequent models were stratified by intensity of caregiving situation and work schedule.

RESULTS: Individual fixed effects models demonstrate combining work and parental caregiving is associated with greater depressive symptoms than only working, and with lower depressive symptoms than only caregiving, suggesting that paid employment exerts a protective effect on psychological health while parental caregiving may be a risk factor for depressive symptoms in later life. Analyses using an intersectional lens found that combining paid work with parental caregiving exerted a protective effect on CES-D scores among White women and men regardless of participants{\textquoteright} intensity of care situation or work schedule. This effect was not present for Black men and women.

DISCUSSION: Accounting for intersectionality is imperative to research on family caregiving, work, and psychological health.

}, keywords = {Employment, Family caregiving, Intersectionality, Mental Health}, issn = {1758-5368}, doi = {10.1093/geronb/gbae042}, author = {Brady, Samantha and Patskanick, Taylor and Coughlin, Joseph F} } @article {knapp_lee_2021, title = {Introduction to special issue on institutional influences on retirement, health and well-being}, journal = {Journal of Pension Economics and Finance}, year = {Forthcoming}, abstract = {Countries make differing policy choices. They can serve as a scientific laboratory for drawing lessons on the policy paths to follow or to avoid and the consequences of those institutional choices on individuals at older ages. In this special issue we bring together six articles that evaluate the influence of institutions on retirement decisions, health and well-being of older adults using common data that have emerged with the international network of health and retirement studies to study key life outcomes such as health, work, and lifecycle transitions at older ages.}, keywords = {health, Retirement, Social Security, Well Being}, doi = {10.1017/S1474747221000408}, author = {Knapp, David and Lee, Jinkook} } @article {12777, title = {Investigating biological pathways underpinning the longitudinal association between loneliness and cognitive impairment.}, journal = {The Journals of Gerontology, Series A }, year = {Forthcoming}, abstract = {

BACKGROUND: Loneliness precedes the onset of cognitive impairment (CI) in older adults. Although the mechanisms through which loneliness "gets under the skin" to influence the risk of developing CI has been conceptually proposed, they are rarely empirically examined. The Evolutionary Theory of Loneliness posits that loneliness as a stressor could cause dysregulations in multiple physiological systems. The current study investigated whether inflammatory, cardiovascular, and kidney biomarkers mediate the longitudinal association between loneliness and CI.

METHODS: Cross-lagged panel models (CLPM) were used to examine the hypothesized relationships, using 2006, 2010, and 2014 waves of data from the Health and Retirement Study (N=7,037). Loneliness was measured with the 3-item UCLA loneliness scale. CI was assessed with the modified telephone interview for cognitive status. Biomarkers included HbA1C, LDL cholesterol, HDL cholesterol, CRP, and Cystatin C. Using a stepwise model-building approach, first, the model included only loneliness, CI, and biomarker variables; then, sociodemographic covariates were added; lastly, health and behavioral covariates were controlled for.

RESULTS: In unadjusted and partially adjusted models, loneliness was associated with higher odds of worse cognitive status in an 8-year follow-up. Only HbA1C mediated the longitudinal association between loneliness and CI. However, after further controlling for health status, all associations became non-significant.

CONCLUSIONS: Examining a large number of participants and linking a limited number of biological markers with cognition and loneliness longitudinally, our empirical data did not support theoretical propositions, highlighting the critical importance of controlling for confounders in future studies examining longitudinal mediational relationships underlying loneliness and CI.

}, keywords = {Biomarkers, cognitive aging, Epidemiology, Loneliness, Psychosocial}, issn = {1758-535X}, doi = {10.1093/gerona/glac213}, author = {Yu, Kexin and Ng, Ted Kheng Siang} } @article {11158, title = {Investigating the broad domains of intrinsic capacity, functional ability and environment: An exploratory graph analysis approach for improving analytical methodologies for measuring healthy aging}, journal = {PsyArXiv Preprint}, year = {Forthcoming}, abstract = {The current paper compared the empirical structure of 280 variables from the 2016 wave of the Health and Retirement Study (N = 16,327) estimated using exploratory graph analysis with a theoretical structure based on 20 broad domains of intrinsic capacity, functional ability and environment, identified in the International Classification of Functioning, Disability and Health compendium. The results showed that a structure with 21 first-order factors had the best fit to the data (i.e., lowest total entropy fit value) for both the training and validation sample. A second-order exploratory graph analysis was applied on the interfactor correlation matrix and identified five second-order factors. The five-factor structure presented a better fit than the theoretical three-factor structure (approximately) representing intrinsic capacity, functional ability and environment. A close inspection of the network structure generated by analyzing the rotated network loadings of the 21 first-order factors revealed an interplay between cognition, mobility, need for help with daily activities, walking capacity, physical capacity, liver functioning, positive affect and perceived mastery, low perceived control, and depression/negative mood. Combined, our results can help guide future research by providing a framework for estimating the structure of multi-domain aging research as well as generating questions that can be addressed in future research.}, keywords = {health aging, Methodology}, doi = {10.31234/osf.io/hj5mc}, author = {Golino, Hudson and Thiyagarajan, Jotheeswaran Amuthavalli and Sadana, Ritu and Teles, Mariana and Christensen, Alexander and Boker, Steven} } @article {13771, title = {The impact of informal caregiving on U.S. Veterans Health Administration utilization and expenditures.}, journal = {Social Science \& Medicine (1982)}, volume = {344}, year = {2024}, pages = {116625}, abstract = {

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

}, keywords = {Adult, Adult children, Health Expenditures, Humans, Inpatients, Investments, Veterans Health}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2024.116625}, author = {Jacobs, Josephine C and Lo, Jeanie and Van Houtven, Courtney H and Wagner, Todd H} } @article {CHEN2024100513, title = {The impact of retirement on health: Empirical evidence from the change in public pensionable age in Japan}, journal = {The Journal of the Economics of Ageing}, volume = {28}, year = {2024}, pages = {100513}, abstract = {The balance between maintaining and enhancing the health, quality of life, and healthy life expectancy of the elderly and their corresponding social costs, including medical and long-term care expenses, is an important policy issue in the context of Japan{\textquoteright}s super-aging society. In this paper, we employ individual panel data from the four waves of the Japanese Study of Aging and Retirement to examine how retirement from the labor market affects the health of elderly males. Numerous empirical studies have shown mixed results concerning the causal effect of retirement on health through diverse and complex mechanisms. However, we present several new insights by focusing on the policy change in 2000 of raising the pensionable age for the earnings-related public pension system which completely eliminates pension income after the statutory retirement age for particular cohorts. Our fixed-effects instrumental variable estimation shows that retirement significantly improves oral function and mental health, but it also makes male retirees more susceptible to lifestyle-related diseases. Supplemental results further suggest that a significant increase in dental care utilization would help improve post-retirement oral function.}, keywords = {Fixed-effects instrumental variable estimation, health, Japan, Oral Health, Pensionable age, Retirement}, issn = {2212-828X}, doi = {https://doi.org/10.1016/j.jeoa.2024.100513}, author = {Fengming Chen and Midori Wakabayashi and Michio Yuda} } @article {13884, title = {The importance of education for understanding variability of dementia onset in the United States}, journal = {Demographic Research}, volume = {50}, year = {2024}, abstract = {Background: Greater levels of education are associated with lower risk of dementia, but less is known about how education is also associated with the compression of dementia incidence. Objective: We extend the literature on morbidity compression by evaluating whether increased levels of education are associated with greater dementia compression. We evaluate these patterns across race and gender groups. Methods: We use the Health and Retirement Study (2000{\textendash}2016), a nationally representative longitudinal study of older adults in the United States. To evaluate the onset and compression of dementia across education groups, we examine the age-specific distribution of dementia events, identifying the modal age of onset and the standard deviation above the mode (a measure of compression). Results: While the modal age of onset is around 85 years among adults with a college degree, the modal age for adults with less than a high school education occurs before age 65 {\textendash} at least a 20-year difference. The standard deviation of dementia onset is about three times greater for adults with less than a high school education compared to adults with a college degree. Patterns were consistent across race and gender groups. Conclusions: This research highlights the variability of dementia experiences in the older population by documenting differences in longevity without dementia and compression of dementia onset among more educated adults and less educated adults. Contribution: We incorporate conceptual insights from the life span variability and compression literature to better understand education{\textendash}dementia disparities in both the postponement and uncertainty of dementia onset in the US population. }, keywords = {Dementia, Education, lifespan variability, modal age, morbidity compression}, doi = {10.4054/DemRes.2024.50.26}, author = {Hyungmin Cha and Mateo P. Farina and Chi-Tsun Chiu and Mark D. Hayward} } @article {13870, title = {In sickness and in health, older couples mostly make Medicare moves together}, year = {2024}, publisher = {Michigan Medicine, University of Michigan}, keywords = {Couples, Medicare, Medicare advantage}, url = {https://medicine.umich.edu/dept/psychiatry/news/archive/202403/sickness-health-older-couples-mostly-make-medicare-moves-together}, author = {Michigan Medicine} } @article {13679, title = {The Income Gap Jeopardizing Retirement for Millions}, year = {2024}, publisher = {The New York Times}, keywords = {income gap, lower middle class, Retirement}, url = {https://www.nytimes.com/2024/01/06/health/retirement-income-middle-class.html}, author = {Paula Span} } @article {13849, title = {Inflation and Economic Security of the Older Population}, year = {2024}, institution = {University of Michigan Retirement and Disability Research Center }, address = {Ann Arbor}, keywords = {economic security, economic vulnerability, Income, inflation, older population}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp480.pdf}, author = {Michael D. Hurd and Susann Rohwedder} } @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} } @mastersthesis {13827, title = {It{\textquoteright}s What They Would Have Wanted... Or Is It?: An Intersectional Exploration of End-of-Life Care Quality Among US Adults}, volume = {Doctor of Philosophy}, year = {2024}, pages = {165}, school = {Miami University}, address = {Oxford, Ohio}, abstract = {Quality end-of-life care necessitates that patient preferences be known and honored by family and health care providers, as well as that care is both accessible and affordable. However, patient preferences are not always assessed, nor is the quality and cost of end-of-life care consistent throughout the United States. For individuals with multiple marginalized identities, achieving high quality end-of-life care is even more challenging, as compounding issues like systemic discrimination on the basis of race/ethnicity and gender are prevalent. The intersectional impact of race/ethnicity and gender on end-of-life care quality is largely understudied. To address this gap, I studied a sample of White, Black, and Hispanic US decedents (N=1,410; representing a weighted sample of nearly six million US adults) with data from the Health and Retirement Study core survey, leave behind questionnaire, and exit survey. Using binary logistic regression analyses, I explored how goal-concordance and satisfaction with end-of-life care are impacted by end-of-life care circumstances and aspects of power and privilege. Race/ethnicity and gender were used as moderating variables. Significant end-of-life care circumstances (i.e., discussing end-of-life care options, receiving home care, and longer length of hospice enrollment) reveal the importance of further integrating person-centered care practices into end-of-life care, educating patients on end-of-life care options, and addressing barriers to hospice enrollment for racial/ethnic minority populations. Several aspects of power and privilege were associated with greater quality of care, including not being eligible for Medicaid and absence of depression, which highlight policy and practice areas in need of reform. Further, race/ethnicity and gender were found to moderate the relationships between adverse childhood experiences and goal-concordant care, and perceived discrimination and satisfaction. These findings may help older adults, care partners, health care and end-of-life care practitioners understand and evaluate end-of-life care quality. Research implications are also discussed, with a particular focus on better understanding end-of-life care disparities among multiply marginalized adults in future research.}, keywords = {cumulative advantage disadvantage, death and dying, healthcare experiences, intersectionality theory, preferences, Quality of care}, doi = {http://orcid.org/0000-0002-2317-0075}, author = {Kunkel, Miranda Ruth Corpora} } @article {13176, title = {The identification of mediating effects using genome-based restricted maximum likelihood estimation.}, journal = {PLoS Genet}, volume = {19}, year = {2023}, month = {2023 Feb}, pages = {e1010638}, abstract = {

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

}, keywords = {Genome, Genome-Wide Association Study, Humans, Likelihood Functions, Multifactorial Inheritance, Phenotype}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1010638}, author = {Rietveld, Cornelius A and de Vlaming, Ronald and Slob, Eric A W} } @article {12854, title = {Identifying cognitive impairment among older participants in a nationally representative internet panel.}, journal = {The Journals of Gerontology, Series B }, year = {2023}, abstract = {

OBJECTIVES: The Health and Retirement Study Telephone Interview for Cognitive Status (HRS TICS) score and its associated Langa-Weir cutoffs are widely used as indicators of cognitive status for research purposes in population-based studies. The classification is based on in-person and phone interviews of older individuals. Our purpose was to develop a corresponding classification for web-based self-administered assessments.

METHOD: Participants were 925 members of a nationally representative internet panel, all aged 50 and older. We conducted (a) a phone interview comprised of cognitive items used to construct the HRS TICS score, and (b) a web counterpart with self-administered cognitive items, while also considering (c) other already administered web-based cognitive tests and instrumental activities of daily living survey questions, all from the same respondents.

RESULTS: The web-administered HRS TICS items have only modest correlations with the same phone items, although neither mode showed universally higher scores than the other. Using latent variable modeling, we created a probability of cognitive impairment score for the web-based battery that achieved good correspondence to the phone Langa-Weir classification.

DISCUSSION: The results permit analyses of predictors, correlates, and consequences of cognitive impairment in web surveys where relevant cognitive test and functional abilities items are available. We discuss challenges and caveats that may affect the findings.

}, keywords = {cognitive function, cognitive testing, Dementia, Internet, questionnaires and surveys}, issn = {1758-5368}, doi = {10.1093/geronb/gbac172}, author = {Gatz, Margaret and Schneider, Stefan and Meijer, Erik and Darling, Jill E and Orriens, Bart and Liu, Ying and Kapteyn, Arie} } @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 {13332, title = {Immigrant Wealth Stratification and Return Migration: The Case of Mexican Immigrants in the United States During the Twentieth Century.}, journal = {Demography}, volume = {60}, year = {2023}, pages = {809-835}, abstract = {

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

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

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

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

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

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

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

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

}, keywords = {Caregivers, Hospitalization, Humans, Mental Health, Nursing homes, psychological well-being}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.115941}, author = {Teo, Hansel} } @article {13456, title = {The Impact of Caregiving History on Later-life Self-Perceptions of Aging.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, abstract = {

OBJECTIVES: Theories suggest that self-perceptions of aging (SPA) reflect structural and cultural ageism together with an individual{\textquoteright}s personal life experiences. We examine the impact of an individual{\textquoteright}s history of informal caregiving on their SPA.

METHODS: Using data from the Health and Retirement Study (HRS, N = 8,372, age range 50 - 102 years), we investigated caregiving history as a determinant of later-life SPA. HRS participants provided reports of up to five episodes of caregiving, the life course timing of each episode (start / end year), and their relationship with the care recipients. SPA was measured by the HRS Attitudes toward Own Aging Scale. We conducted linear regressions to examine associations between specific caregiving histories and later-life SPA. Models included controls for current sociodemographic and health status.

RESULTS: Individuals who were ever a caregiver reported more negative SPA than non-caregivers. Variations in the impact of histories of caregiving were also revealed. Specifically, compared to people who had cared for adult(s) only, HRS participants who cared for both a child with special needs and an adult reported more negative SPA later in life.

DISCUSSION: The study provides insight into potential life course precursors of SPA and highlights the importance of conceptualizing caregiving history as a complex life experience that might impact an individual{\textquoteright}s SPA later in life.

}, keywords = {Informal caregiving; Self-perceptions of aging; life course history; the Health and Retirement Study}, issn = {1758-5368}, doi = {10.1093/geronb/gbad103}, author = {Hu, Rita Xiaochen and Larkina, Marina and Jacqui Smith} } @article {13263, title = {Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.

METHODS: We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (>=12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.

RESULTS: On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.

CONCLUSIONS: The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.

}, issn = {1532-5415}, doi = {10.1111/jgs.18340}, author = {Jester, Dylan J and Palmer, Barton W and Thomas, Michael L and Brown, Lauren L and Tibiri{\c c}{\'a}, Lize and Jeste, Dilip V and Gilmer, Todd} } @article {13156, title = {The impact of hearing loss on trajectories of depressive symptoms in married couples.}, journal = {Soc Sci Med}, volume = {321}, year = {2023}, month = {2023 Mar}, pages = {115780}, abstract = {

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

}, keywords = {Aged, depression, Female, Hearing loss, Humans, Male, Marriage, Retirement, Spouses}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.115780}, author = {West, Jessica S and Smith, Sherri L and Dupre, Matthew E} } @article {13245, title = {The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.}, journal = {Health Serv Res}, year = {2023}, abstract = {

OBJECTIVE: To examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries.

DATA SOURCES: 2010-2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files.

STUDY DESIGN: We estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states.

DATA COLLECTION/EXTRACTION METHODS: The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and residing in the community.

PRINCIPAL FINDINGS: ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95\% CI: 0.020-0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95\% CI: 0.005-0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95\% CI: -0.003 to 0.050, p = 0.079).

CONCLUSIONS: ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care.

}, issn = {1475-6773}, doi = {10.1111/1475-6773.14155}, author = {Mellor, Jennifer M and McInerney, Melissa and Garrow, Renee C and Sabik, Lindsay M} } @article {13269, title = {Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, abstract = {

OBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers{\textquoteright} own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders.

METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal non-caregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into three categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse{\textquoteright}s self-rated health, depressive symptoms, and cognitive functioning.

RESULTS: A total of 3,417 (87.01\%) new spousal caregivers were matched with 129,798 observations of spousal non-caregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18 (SE=0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning.

DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.

}, issn = {1758-5368}, doi = {10.1093/geronb/gbad064}, author = {Liu, Ruotong and Chi, Iris and Wu, Shinyi} } @article {13543, title = {The importance of activities}, year = {2023}, publisher = {McKnights }, keywords = {activities, mental wellbeing}, url = {https://www.mcknightsseniorliving.com/home/columns/editors-columns/the-importance-of-activities/}, author = {Bowers, Lois A.} } @article {13226, title = {Important Correlates of Purpose in Life in a Diverse Population-Based Cohort: A Machine Learning Approach.}, journal = {Am J Geriatr Psychiatry}, year = {2023}, abstract = {

BACKGROUND: Purpose-in-life (PiL) refers to the tendency to derive meaning and purpose from daily life experiences. Individuals with higher PiL were more likely to have better physical, mental, and cognitive health in prospective studies. Here, we aimed to identify important correlates of PiL among people of diverse backgrounds.

METHODS: Participants were recruited by the population-based Health and Retirement Study and provided information on 34 different sociodemographic and psychosocial factors through psychometrically validated measures. To identify important correlates of PiL, we employed regularized regression implemented by Elastic Net on the entire cohort as well as among self-identified black participants only and white participants only, respectively.

RESULTS: A total of 6,620 participants were included in this study, among whom 913 were black and 5,707 were white. We identified 12 and 23 important sociodemographic and psychosocial correlates of PiL among black and white participants, respectively. Notably, all the 12 correlates in black participants were also correlates among white participants. Interestingly, when we examined both black and white participants together, being black was associated with having higher PiL. The correlates with the largest effect on PiL that were shared among black and white participants were hopelessness, perceived constraint on personal control, and self-mastery.

CONCLUSION: Several sociodemographic and psychosocial factors most strongly associated with PiL were shared among black and white participants. Future studies should investigate whether interventions targeting correlates of PiL can lead to higher sense of life purpose in participants of diverse backgrounds.

}, keywords = {diverse, Purpose in life}, issn = {1545-7214}, doi = {10.1016/j.jagp.2023.03.003}, author = {Bhatt, Rishab and Lori, Adriana and Liu, Jiaqi and Mei, Zhen and Wingo, Thomas S and Wingo, Aliza P} } @article {13439, title = {In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.

METHODS: We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.

RESULTS: The sample was 55\% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20\%, CIND: 23\%, PLwD: 29\%; p = 0.04), depressed (NCI: 8\%, CIND: 15\%, PLwD: 14\%; p < 0.01), and both (NCI: 4\%, CIND: 9\%, PLwD: 7\%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).

CONCLUSIONS: One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.

}, keywords = {Dementia, depression, health, Loneliness, Marital quality, sickness, Spouses}, issn = {1532-5415}, doi = {10.1111/jgs.18520}, author = {Hsu, Kristie Y and Cenzer, Irena and Harrison, Krista L and Ritchie, Christine S and Waite, Linda and Kotwal, Ashwin} } @article {HERNANDEZ2023101453, title = {In the wake of a crisis: Caught between housing and healthcare}, journal = {SSM - Population Health}, year = {2023}, pages = {101453}, abstract = {Objective To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession. Methods Data came from Medicare beneficiaries aged 65+ years from the 2006{\textendash}2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008-2012. Results Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64\% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast. Conclusion This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.}, keywords = {Foregone medication due to cost, Great Recession, Health Disparities, Housing insecurity, Medicare Beneficiaries}, issn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2023.101453}, author = {Monica Hernandez and Rebeca Wong and Xiaoying Yu and Neil Mehta} } @article {13126, title = {Incident edentulism and number of comorbidities among middle-aged and older Americans.}, journal = {Gerodontology}, year = {2023}, month = {2023 Jan 27}, abstract = {

BACKGROUNDS: Certain chronic non-communicable diseases have been associated with the loss of all natural permanent teeth, referred to as edentulism. It has been suggested that edentulism, a chronic dental state, involving the loss of all teeth and poorer masticatory efficiency, could be associated with multiple chronic conditions as people age. In this study, we describe the association between the number of comorbidities and incident edentulism in a representative sample of older Americans.

METHODS: We took data from the Health and Retirement Study (HRS). Dentate participants aged 50 or older at the baseline of 2006 (N~=~13 221) and 2012 (N~=~13 938) were linked to their dentate and survival status at the follow-up interviews in 2012 and 2018, respectively. The association between the number of comorbidities and incident edentulism was investigated by using multinomial logistic regression models.

RESULTS: Over the two observation periods, the number of selected chronic conditions was predictive of edentulism 6 years later. A 10\% higher chance of becoming edentulous by 2012 (OR~=~1.10, 95\% CI~=~1.01, 1.20) was found for every additional comorbid condition to those who remained dentate in 2012. A similar association was identified for the 2012-2018 period.

CONCLUSION: Among older adults, the number of comorbidities was predictive of incident edentulism, and the same association pattern was found across two longitudinal study periods. Older adults with an increase in the number of comorbidities may experience a higher chance of tooth loss later in time.

}, keywords = {americans, middle-aged}, issn = {1741-2358}, doi = {10.1111/ger.12675}, author = {TUNG, HO-JUI and Ford, Randall} } @article {13407, title = {Income-Related Inequalities in Physical and Cognitive Health Domains Over the Later Life Course: Longitudinal Evidence From the U.S. (1992-2016).}, journal = {Res Aging}, year = {2023}, pages = {1640275231183438}, abstract = {

This study aims to investigate changes in the income-health gradient over the later life course. We test the age-as-leveler, the cumulative advantage/disadvantage, and the persistent inequality pattern for physical and cognitive health domains, and analyze whether these patterns are gendered. We used HRS data (1992-2016) and Poisson growth curve models to predict multimorbidity (33,860 participants) as an indicator of physical health and memory (25,291 participants) as an indicator of cognitive health. We disentangled the within-participant from the between-participant effects. For multimorbidity, the income-health gradient weakened as individuals aged; whereas for memory, the income-health gradient strengthened as individuals aged. The cumulative advantage/disadvantage of higher/lower income on memory may be more pronounced among women than men. Findings were confirmed by sensitivity analyses. Findings suggest that the support for the age-as-leveler or cumulative advantage/disadvantage pattern may depend on health domains and the effect strength may depend on gender.

}, keywords = {cognitive, Income, inequalities, physical}, issn = {1552-7573}, doi = {10.1177/01640275231183438}, author = {Cheng, Mengling and Sommet, Nicolas and Jopp, Daniela S and Spini, Dario} } @article {doi:10.1086/728403, title = {Increased Schooling Reduces Hospitalization Later in Life: New Evidence with Optimal Instruments from the United States}, journal = {American Journal of Health Economics}, year = {2023}, abstract = {We investigate the causal effect of education on hospitalization. We apply novel techniques to estimate a sparse model that uses the least absolute selection and shrinkage operator (LASSO) regression with a data-driven penalty to construct optimal cross-validated instrumental variables and select a parsimonious set of controls. This method yields consistent and more efficient estimates relative to conventional instrumental variable procedures and overcomes the limitations of previous studies using compulsory schooling laws in the United States. We also use an approach for a valid inference that allows instruments to be only plausibly exogenous. Using the 1992-2016 Health and Retirement Study, our results suggest that an additional year of schooling in early life lowers the likelihood of two-year hospitalizations later in life by 2.6 percentage points (or about 9.5\%). This estimate is robust to different model specifications and plausible amounts of imperfect exogeneity and is similar to the local treatment effect among potential compliers. }, keywords = {Education, Hospitalization, Optimal instruments, Plausibly, Sparse model}, doi = {10.1086/728403}, author = {Yue, Dahai and Ponce, Ninez A. and Needleman, Jack and Ettner, Susan L. and Lleras-Muney, Adriana} } @article {13234, title = {Individual and Dyadic Health-Related Quality of Life of People Living with Dementia and their Caregivers}, year = {2023}, abstract = {Many interventions target dyads of people living with Alzheimer{\textquoteright}s disease and related dementias (ADRD) and their caregivers. Without a dyadic measure of health-related quality of life (HRQOL), cost-utility analyses of these interventions require using the HRQOL of people with ADRD and caregivers, separately. We developed a dyadic measure of HRQOL that incorporates the interdependence between HRQOL of people living with ADRD and their caregivers and measures the dyad{\textquoteright}s collective benefits. First, we estimated dyadic HRQOL time trade-off-weights (TTO-weights), a dyadic preference-based measure of HRQOL. Second, we estimated the association between ADRD clinical features and TTO-weights. We used the Aging, Demographics, and Memory Study to identify people living with ADRD (n = 308) and their caregivers (n = 160 dyads) and predict their TTO-weights. We estimated dyadic TTO-weights using an Archimedean bivariate utility copula with a quadratic generating function. Finally, we used adjusted linear regression to examine the association between predicted TTO-weights and ADRD clinical features. Average (standard deviation) TTO-weights of people living with ADRD, and caregivers were 0.67 (0.14) and 0.83 (0.09), respectively. Average dyadic TTO-weight was 0.75(0.05). When the dyadic TTO-weight was <= 0.60, an increase in the TTO-weight of the dyad-member with the lowest HRQOL resulted in a larger gain in the dyadic TTO-weight than a similar increase in the TTO-weight for the dyad-member with the higher baseline TTO-weight (i.e., non-proportional tradeoffs). When the dyadic TTO-weight is > 0.60, an increase in the TTO-weight for either member of the dyad increases the dyad TTO-weight equally (constant tradeoffs). An additional functional limitation resulted in more than twice the decline in the TTO-weight of people living with ADRD compared to an additional behavioral symptom (-0.008 vs. -0.003). Behavioral symptoms were significantly associated with a decline in caregivers{\textquoteright} and dyadic TTO-weights. The HRQOL of people living with ADRD and their caregivers are correlated. The dyadic TTO-weights for people living with ADRD and their caregivers can be used in cost-utility analyses to assess the collective gains in HRQOL and tradeoffs of interventions that target members of the dyad.}, keywords = {Caregivers, Dementia}, doi = {https://doi.org/10.1007/s11482-023-10157-0}, author = {Mauricio Lopez-Mendez and Rowan Iskandar and Eric Jutkowitz} } @booklet {RePEc:dem:wpaper:wp-2023-002, title = {Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States}, year = {2023}, abstract = {Existing research on multimorbidity (two or more co-existing chronic diseases) has mainly been cross-sectional, prevalence-based, and from high-income countries, although rates of chronic diseases and related mortality are highest in low- and middle-income countries. There is also a lack of research comparing countries at varying levels of development to determine how multimorbidity progression might differ. This study uses longitudinal data from Costa Rica, Mexico, and the United States and an incidence-based multistate Markov approach to estimate multimorbid life expectancy (MMLE): the years someone is expected to live with multimorbidity. We disaggregate MMLE into disability-free and disabling states to understand severity progression and stratify models by gender and education to study within-country heterogeneity. Individuals from Costa Rica have the lowest MMLE, followed by those from Mexico, then the United States. Individuals from the United States spend about twice as long with disability-free MMLE compared to others. Women generally have higher MMLE than men across countries. In the United States, disability-free MMLE increases and disabling MMLE decreases with education. This study found widespread MMLE inequalities in gender, education, and disability status. More attention must be paid to the drivers of these disparities, such as life course and health system differences across contexts.}, keywords = {Ageing, Chronic Diseases, Costa Rica, Developing Countries, Inequality, Life Expectancy, Mexico, USA}, doi = {10.4054/MPIDR-WP-2023-002}, author = {Anastasia A. Lam and Katherine Keenan and Genevieve Cezard and Hill Kulu and Mikko Myrskyl{\"a}} } @article {13180, title = {Inequalities in Retirement Life Span in the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, month = {2023 May 11}, pages = {891-901}, abstract = {

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

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

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

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

}, keywords = {Aged, Educational Status, Employment, Female, Humans, Life Expectancy, Life Tables, Longevity, Male, Middle Aged, Retirement, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbac180}, author = {Shi, Jiaxin and Dudel, Christian and Monden, Christiaan and van Raalte, Alyson} } @article {13154, title = {Inequality and class divides in parental transfers to young adults in the United States}, year = {2023}, institution = {School of Social and Political Science, University of Edinburgh}, address = {Edinburgh, United Kingdom}, abstract = {Parental transfers of money and co-residence to young-adult children can serve as means of status reproduction. Yet, the relationship between inequality and social class gaps in these forms of parental support is understudied. Inequality may widen socio-economic differentials in monetary and co-residential transfers, potentially hindering social mobility. I test the relationship between income inequality and socio-economic divides in parental support to children aged 22{\textendash}35 in the United States (U.S.), a context where the economic dependence of young adults has increased over decades of high or rising inequality. I link state-level inequality data to longitudinal data on 36,018 parent-child dyads from the Health and Retirement Study (1992{\textendash}2018). Using fixed-effects models I investigate how changes in income inequality within states relate to changes in wealth, income, and educational gradients in parental transfers over time. As inequality increases, upper-class parents transfer greater amounts of money to their children, while lower-class parents are less likely to give money, give smaller amounts on average, and are more likely to provide co-residence. Previous research shows that receiving large sums of money is related to improved labour and housing market outcomes, while coresidence may restrict economic opportunities among young adults from disadvantaged backgrounds. In light of this, my findings suggest that rising U.S. inequality may hinder social mobility by shifting the socio-economic distribution of intergenerational support.}, author = {Ginevra Floridi} } @article {13255, title = {Inequality in housing transitions during cognitive decline.}, journal = {PLoS One}, volume = {18}, year = {2023}, pages = {e0282329}, abstract = {

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

}, keywords = {Caregivers, Cognitive Dysfunction, Dementia, Housing, Humans, Nursing homes, Quality of Life, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0282329}, author = {Mawhorter, Sarah L and Wilkie, Rachel Z and Jennifer A Ailshire} } @article {11464, title = {The Influence of Cognitive Impairment on Post-Operative Outcomes.}, journal = {Annals of Surgery}, volume = {277}, year = {2023}, pages = {e212-e217}, abstract = {

OBJECTIVE: To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery.

BACKGROUND: Mild cognitive impairment (MCI) is common among older adults, but the impact of MCI on surgical outcomes is understudied.

METHODS: We conducted a retrospective cohort study of individuals >=65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified Telephone Interview for Cognitive Status score and categorized as normal cognition (score: 12-27), MCI (7-11), and dementia (<7). Outcomes were 30- and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics.

RESULTS: In 6,590 patients, 69.9\% had normal cognition, 20.1\% had MCI, and 9.9\% had dementia. Patients with MCI (79.9\%) and dementia (73.6\%) were less likely to undergo elective surgery than patients with normal cognition (85.9\%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2\% vs. 8.4\%, p=0.002) and readmission rates (13.9\% vs. 17.3\%, p=0.038).

CONCLUSION: Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.

}, keywords = {cognition impairment, Postoperative Period}, issn = {1528-1140}, doi = {10.1097/SLA.0000000000004799}, author = {Blair, Emilie M and Deborah A Levine and Hu, Hsou Mei and Kenneth M. Langa and Mohammed U Kabeto and Waljee, Jennifer} } @article {13351, title = {Influence of physical activity and the MIND diet on cognition}, journal = {Alzheimer{\textquoteright}s Dementia}, volume = {19}, year = {2023}, abstract = {Background Physical activity or the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet as a neuroprotective diet is known to be beneficial for cognitive health among older adults, but little is known about the influence on cognition when both behaviors are combined. Therefore, this study was conducted to investigate whether engaging in both behaviors is associated with better cognitive health compared with either behavior alone or neither behavior. Method Data were from the Health and Retirement Study for this cross-sectional, observational study. A total of 3,463 non-demented participants with the mean age of 68.0 {\textpm} 10.0 years were included. Associations of physical activity (PA) and the MIND diet (MIND) with global cognition and odds of cognitive decline were explored using multivariate linear regression and binary logistic regression models with interaction terms between PA and MIND. Result Compared with neither behavior (PA-/MIND-), PA only (PA+/MIND-) was not associated with cognitive outcomes. Compared with PA-/MIND-, MIND only (PA-/MIND+) predicted higher global cognition (mean difference, d = 0.81; p < 0.001) and lower odds of cognitive decline (odds ratio, OR = 0.68; p < 0.01). Compared with PA-/MIND-, both behaviors (PA+/MIND+) predicted higher global cognition (d = 0.98; p < 0.001) and lower odds of cognitive decline (OR = 0.69; p < 0.01). Compared with PA+/MIND-, PA+/MIND+ predicted higher global cognition (d = 0.60; p < 0.001), but did not predict a risk of cognitive decline. Compared with PA-/MIND+, PA+/MIND+ did not predict cognitive outcomes. Conclusion Adherence to both physical activity and the MIND diet was associated with better cognitive outcomes than non-adherence to both or adherence to physical activity only. Encouraging both behaviors would be important for the cognitive health of older adults.}, doi = {https://doi.org/10.1002/alz.062948}, author = {Sangwoo Ahn} } @article {article, title = {Influences of Loneliness, Life Purpose, and Aging Satisfaction on Depression in Older US Adults: Analysis of 12-Year Longitudinal Data}, journal = {International Journal of Mental Health and Addiction}, year = {2023}, pages = {1-13}, abstract = {The objective of this study is to examine the separate effects of loneliness, life purpose, and aging satisfaction on depression in older adults, using 12 years of longitudinal data. The research used data from the Health and Retirement Study (2008{\textendash}2020) for adults 60 years or older, with a sample of 7836 individuals. The data was analyzed using a generalized estimating equation (GEE) model to evaluate the impact of the independent variables on depression. The results showed that factors such as sex, age, and subjective economic level were found to have a significant correlation with depression among the elderly. Additionally, loneliness was found to have a positive correlation with depression, while aging satisfaction and life purpose were found to have an inverse association with depression in older adults. This study suggests that having a positive outlook on life and aging is crucial in preventing depression in older adults.}, keywords = {Elderly depression, Loneliness, longitudinal study, Purpose in life, Satisfaction in aging}, doi = {10.1007/s11469-023-01184-x}, author = {Pak, Gunhwi and Bae, Sung-Man} } @article {13307, title = {Informal Helping and Subsequent Health and Well-Being in Older U.S. Adults.}, journal = {Int J Behav Med}, year = {2023}, pages = {1-13}, abstract = {

BACKGROUND: Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being.

METHODS: This study evaluated if changes in informal helping (between t;2006/2008 and t;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t;2014/2016) using data from 12,998 participants in the Health and Retirement study - a national cohort of US adults aged > 50.

RESULTS: Over the four-year follow-up period, informal helping >= 100 (versus 0) hours/year was associated with a 32\% lower mortality risk (95\% CI [0.54, 0.86]), and improved physical health (e.g., 20\% reduced risk of stroke (95\% CI [0.65, 0.98])), health behaviors (e.g., 11\% increased likelihood of frequent physical activity (95\% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95\% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged.

CONCLUSIONS: Encouraging informal helping may improve various aspects of individuals{\textquoteright} health and well-being and also promote societal well-being.

}, issn = {1532-7558}, doi = {10.1007/s12529-023-10187-w}, author = {Nakamura, Julia S and Lee, Matthew T and VanderWeele, Tyler J and Kim, Eric S} } @article {13487, title = {An inheritance can be life-changing {\textemdash} here{\textquoteright}s who is missing out}, year = {2023}, publisher = {MarketWatch}, keywords = {Bequests, Inheritance, Racial Disparities}, url = {https://www.marketwatch.com/story/an-inheritance-can-make-all-the-difference-in-the-world-heres-who-is-missing-out-d664606f}, author = {Alicia H. Munnell} } @article {13632, title = {Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {94}, year = {2023}, pages = {1431-1441}, abstract = {

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

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

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

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

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

}, keywords = {Antihypertensive Agents, Cognition, Humans, Hypertension, Retirement, Risk Factors}, issn = {1875-8908}, doi = {10.3233/JAD-230398}, author = {Wei, Jingkai and Xu, Hanzhang and Zhang, Donglan and Tang, Huilin and Wang, Tiansheng and Steck, Susan E and Divers, Jasmin and Zhang, Jiajia and Merchant, Anwar T} } @article {13306, title = {Insomnia Symptom Trajectory of Spouse Caregivers of Older Adults with Functional Limitations.}, journal = {Clin Gerontol}, year = {2023}, pages = {1-12}, abstract = {

OBJECTIVES: This study examined the long-term impact of spouse caregiving on insomnia symptoms, compared to propensity-score matched non-caregivers.

METHODS: Health and Retirement Study data between 2006 and 2018 were used. Caregivers ( = 403) were respondents (aged 50+) who assisted their heterosexual spouses in performing (instrumental) activities of daily living at baseline. Non-caregivers were matched using a propensity score matching procedure based on baseline characteristics. Insomnia symptoms were measured every 4 years for both groups. Poisson mixed-effect models estimated the association between caregiver status and insomnia symptoms.

RESULTS: Compared to matched non-caregivers, caregivers had similar severity of insomnia symptoms at baseline ( = 0.018, 95\% CI = -0.089, 0.124) and reported a similar yearly change rate ( = -0.008, 95\% CI = -0.017, 0.001). No moderation effects of care-recipients{\textquoteright} dementia status and social support were significant.

CONCLUSIONS: In this study sample, there is no evidence that spouse caregivers, specifically those who performed light duties, experience more severe insomnia symptoms than non-caregivers.

CLINICAL IMPLICATIONS: Spouse caregiving, especially in a light-duty capacity, may not be detrimental to the caregivers{\textquoteright} sleep health. More data are needed regarding insomnia in spouse caregivers with heavy duties of care to fully assess the health impact of the caregiving experience.

}, issn = {1545-2301}, doi = {10.1080/07317115.2023.2211560}, author = {Kong, Dexia and Lu, Peiyi and Lou, Vivian W Q and Shelley, Mack} } @article {12982, title = {Insomnia Symptoms and Risk for Stroke in Younger Individuals}, year = {2023}, publisher = {Neurology Advisor}, keywords = {insomnia, stroke risk}, url = {https://www.neurologyadvisor.com/topics/stroke/insomnia-symptoms-and-risk-for-stroke-in-younger-individuals/}, author = {Goldberg, Ron} } @article {Sawadogo1412, title = {Insomnia Symptoms Trajectories and increased risk of Stroke: A Prospective Cohort Study (P1-5.021)}, journal = {Neurology}, volume = {100}, year = {2023}, abstract = {Objective: To investigate the trajectory of insomnia symptoms over time and their association with stroke events.Background: Insomnia is a frequent disorder affecting over one-third of the U.S population. However, the association between insomnia symptoms and stroke is less studied and it is unclear whether insomnia symptoms remain constant or change over time.Design/Methods: We used the Health and Retirement Study from 2002 to 2020. The independent variable was insomnia symptoms classified on a scale ranging from 0 to 8 and including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated measures latent class analysis was used to identify subgroups among the study participants with different insomnia trajectories over time. Cox proportional hazards regression models were employed to investigate the association between the subgroup of insomnia symptoms and stroke events.Results: A total of 31,126 participants were included with a mean follow-up of 9 years. Three subgroups of insomnia symptoms were identified based on 3 consecutive measurements of insomnia symptoms at 2-year intervals. The subgroups were named: {\textquotedblleft}constantly no symptoms{\textquotedblright}, {\textquotedblleft}constantly low symptoms{\textquotedblright}, and {\textquotedblleft}constantly high insomnia symptoms{\textquotedblright}. Compared to participants classified as {\textquotedblleft}constantly no symptoms{\textquotedblright}, participants classified as {\textquotedblleft}constantly low symptoms{\textquotedblright} had an increased risk of stroke (hazard ratio (HR) = 1.15, 95\% confidence interval (CI): 1.00, 1.32). Similarly, compared to participants classified as {\textquotedblleft}constantly no symptoms{\textquotedblright}, participants classified as {\textquotedblleft}constantly high symptoms{\textquotedblright} had an increased risk of stroke (HR= 1.42, 95\% CI: 1.22, 1.64).Conclusions: Our findings indicate that insomnia symptoms remain constantly reported over time in this population. There is a need for better awareness and management of insomnia symptoms to prevent stroke occurrence.Disclosure: Dr. Sawadogo has nothing to disclose. Prof. Adera has nothing to disclose.}, issn = {0028-3878}, doi = {10.1212/WNL.0000000000201917}, author = {Wendemi Sawadogo and Tilahun Adera} } @mastersthesis {13477, title = {Integrated Multi-Omics Approach to Predict Dementia: Using an Explainable Variational Autoencoder (E-VAE) Classifier Model}, year = {2023}, pages = {111}, type = {phd}, abstract = {Alzheimer{\textquoteright}s disease (AD) and AD-related dementias (ADRD) are complex multifactorial processes where epigenetic and biochemical changes occur many years before the onset of clinical symptoms. During the last decade, large amounts of high-throughput molecular data including genetic variants, and epigenetic and transcriptomic data from blood and brain tissues have improved our understanding of complex molecular mechanisms associated with pathways of AD/ADRD. The application of deep learning methods to analyze integrated multi-omics data may be a powerful approach to elucidate the biological mechanisms in AD. This dissertation aims to develop a framework to process high-dimensional genomics data and to integrate multi-omics data to classify dementia utilizing an end-to-end deep learning classifier model. We developed an end-to-end deep learning explainable variational autoencoder (E-VAE) classifier model, using genome-wide genetic variants (GWAS SNPs) with an accuracy = 0.71 and sensitivity = 0.73 (Chapter 2), and transcriptome (RNA-Seq) with an accuracy = 0.83 and sensitivity = 0.77 (Chapter 3) and epigenetic (DNA methylation) with an accuracy = 0.79 and sensitivity = 0.88 (Chapter 4) collected from 2700 study participants in the Health and Retirement Study (HRS). We utilized a framework to integrate genetic variants and RNAseq data and developed a multi-omics (GWAS SNPs + RNAseq) explainable variational autoencoder (E-VAE) classifier model to predict dementia (Chapter 5) with an accuracy = 0.73 and sensitivity = 0.73. We evaluated the generalizability of the E-VAE classifier models in an external dataset from Religious Orders Study/Memory and Aging Project (ROSMAP) and the multi-omics E-VAE classifier model achieved an accuracy = 0.67 and sensitivity = 0.77. We found that the integrated multi-omics E-VAE classifier model achieved better generalizability in the external data compared to a penalized logistic regression model (accuracy = 0.73 and sensitivity = 0.33) trained using GWAS SNPs and RNAseq. Utilizing the linear decoder in the E-VAE classifier model, we extracted biological interpretable latent features and translated the top-weighted genes into biological insights. We identified genes known to be involved in the pathogenesis of AD/ADRD and novel genes that were not studied previously in association with AD/ADRD. In summary, this dissertation demonstrates the utility of deep learning methods to analyze complex multi-omics data to classify AD/ADRD. The explainable deep learning model, allowed us to interpret the biological importance of deep representations of multi-omics features by optimizing a classifier model for dementia and generating new hypotheses to advance our understanding of the pathobiology of AD/ADRD.}, keywords = {0307:Molecular biology, 0317:Neurosciences, 0369:Genetics, 0715:Bioinformatics, AD-related dementias, Alzheimer{\textquoteright}s disease, Bioinformatics, Epigenetic, Genetics, Molecular biology, Neurosciences, Predict dementia, Variational autoencoder}, isbn = {9798379926434}, url = {https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/integrated-multi-omics-approach-predict-dementia/docview/2840861078/se-2}, author = {Vivek,Sithara} } @article {13073, title = {Internet usage and the prospective risk of dementia: A population-based cohort study.}, journal = {Journal of the American Geriatrics Society}, year = {2023}, abstract = {

BACKGROUND: Little is known about the long-term cognitive impact of internet usage among older adults. This research characterized the association between various measures of internet usage and dementia.

METHODS: We followed dementia-free adults aged 50 to 64.9 for a maximum of 17.1 (median=7.9) years using the Health and Retirement Study. The association between time-to-dementia and baseline internet usage was examined using cause-specific Cox models, adjusting for delayed entry and covariates. We also examined the interaction between internet usage and education, race-ethnicity, sex, and generation. Furthermore, we examined whether the risk of dementia varies by the cumulative period of regular internet usage to see if starting or continuing usage in old age modulates subsequent risk. Finally, we examined the association between the risk of dementia and daily hours of usage. Analyses were conducted from September 2021 to November 2022.

RESULTS: In 18,154 adults, regular internet usage was associated with approximately half the risk of dementia compared to non-regular usage, CHR (Cause-specific Hazard Ratio)=0.57, 95\%CI=0.46-0.71. The association was maintained after adjustments for self-selection into baseline usage (CHR=0.54, 95\%CI=0.41-0.72) and signs of cognitive decline at the baseline (CHR=0.62, 95\%CI=0.46-0.85). The difference in risk between regular and non-regular users did not vary by educational attainment, race-ethnicity, sex, and generation. In addition, additional periods of regular usage were associated with significantly reduced dementia risk, CHR=0.80, 95\%CI=0.68-0.95. However, estimates for daily hours of usage suggested a U-shaped relationship with dementia incidence. The lowest risk was observed among adults with 0.1-2 hours of usage, though estimates were non-significant due to small sample sizes.

CONCLUSIONS: Regular internet users experienced approximately half the risk of dementia than non-regular users. Being a regular internet user for longer periods in late adulthood was associated with delayed cognitive impairment, although further evidence is needed on potential adverse effects of excessive usage. This article is protected by copyright. All rights reserved.

}, keywords = {Dementia, Health Disparities, Internet usage}, issn = {1532-5415}, doi = {10.1111/jgs.18394}, author = {Cho, Gawon and Betensky, Rebecca A and Chang, Virginia W} } @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 {13179, title = {The Interplay Among Natural Menopause, Insomnia, and Cognitive Health: A Population-Based Study.}, journal = {Nat Sci Sleep}, volume = {15}, year = {2023}, month = {2023}, pages = {39-48}, abstract = {

PURPOSE: The interrelationships among age at menopause, sleep, and brain health have been insufficiently studied. This study sought to examine the influence of age at natural menopause and insomnia symptoms on long-term cognitive function among US women.

PATIENTS AND METHODS: Our study included a nationally representative cohort of US adults age 50+ from the Health and Retirement Study (2008-2018). We restricted this cohort to 5880 women age 50+, from a diverse racial and ethnic groups. Age at menopause was retrieved from baseline (2008) for women having natural menopause. Five questions were used to identify women with insomnia symptoms (2010 and 2012): trouble falling asleep, nighttime awakenings, early morning awakenings, feelings of nonrestorative sleep, and use of sleep aids. A battery of four neuropsychological tests was conducted biennially (years) to evaluate cognitive function. Longitudinal associations between age at natural menopause and cognitive function were estimated with mixed effects models with a random intercept. Insomnia symptoms were examined as potential mediators or modifiers in the pathway between age at menopause and cognition.

RESULTS: One year earlier in age at menopause was associated with a 0.49 lower mean in composite cognitive score, in any given survey year (adjusted p = 0.002). Earlier age at menopause was associated with higher risk of developing insomnia symptoms (eg, trouble falling asleep OR = 0.97; 95\% CI: 0.96, 0.99), and insomnia symptoms were associated with worse cognitive performance (eg, trouble falling asleep, beta = -0.5, p-value = 0.02). Therefore, insomnia symptoms could potentially mediate the association between age at natural menopause and cognition.

CONCLUSION: Earlier age at menopause is associated with a lower score in cognitive performance. This association may be mediated by insomnia symptoms. Our findings spotlight that among women who experience early menopause, there is the need for studies of sleep-based interventions to mitigate cognitive decline.

}, keywords = {Cognitive health, insomnia, Menopause}, issn = {1179-1608}, doi = {10.2147/NSS.S398019}, author = {Shieu, Monica M and Braley, Tiffany J and Becker, Jill and Dunietz, Galit Levi} } @article {13062, title = {Invited Commentary: Algorithmic Dementia Classification-Promises and Challenges.}, journal = {Am J Epidemiol}, volume = {192}, year = {2023}, pages = {535-538}, abstract = {

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

}, keywords = {Cognition, Cognitive Dysfunction, Dementia, Humans}, issn = {1476-6256}, doi = {10.1093/aje/kwad003}, author = {Mayeda, Elizabeth Rose and Shaw, Crystal} } @article {12567, title = {Identifying pathways to increased volunteering in older US adults.}, journal = {Scientific Reports}, volume = {12}, year = {2022}, pages = {12825}, abstract = {

While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)-a diverse, longitudinal, and national sample of older adults in the United States-we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t; 2006/2008 and t; 2010/2012) were associated with volunteer activity four years later (t; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity >= 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.

}, keywords = {Physical Health, Volunteering, Well-being}, issn = {2045-2322}, doi = {10.1038/s41598-022-16912-x}, author = {Nakamura, Julia S and Lee, Matthew T and Chen, Frances S and Archer Lee, Yeeun and Fried, Linda P and VanderWeele, Tyler J and Kim, Eric S} } @article {12920, title = {Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis.}, journal = {PLoS One}, volume = {17}, year = {2022}, pages = {e0278178}, abstract = {

We used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.

}, keywords = {Health Behavior, Prospective Studies, psychological distress, Psychosocial Intervention, Retirement}, issn = {1932-6203}, doi = {10.1371/journal.pone.0278178}, author = {Cowden, Richard G and Nakamura, Julia S and Chen, Zhuo Job and Case, Brendan and Kim, Eric S and VanderWeele, Tyler J} } @article {12327, title = {Identifying Racial and Rural Disparities of Cognitive Functioning among Older Adults: The Role of Social Isolation and Social Technology Use.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {1779-1790}, abstract = {

OBJECTIVES: Social isolation is associated with poorer cognitive outcomes among older adults. The use of online social technology platforms may provide a means to reduce social isolation. However, research examining whether social technology can mitigate the negative effects of social isolation on cognitive functioning is limited. This study investigates the interaction between social isolation and social technology use on cognitive functioning among older adults and seeks to identify racial and rural-urban differences in this relationship.

METHOD: Data was obtained from the Health and Retirement Study 2014 to 2018 waves (N=5,358). Participants (aged 50-102) completed self-report measures of social isolation, loneliness, and frequency of online social communication and completed the modified Telephone Interview for Cognitive Status (TICS-m), which assesses cognitive functioning. Examinations of race focused on differences between Black/African American and White/Caucasian groups; rurality was operationalized using Beale Rural-Urban Continuum Codes. Data was analyzed using structural equation models.

RESULTS: Social technology use moderated the negative relationship between social isolation and cognitive functioning, controlling for age, education, gender, wealth, and general computer usage. Greater social technology use was associated with better cognitive functioning among socially isolated older adults. Results showed evidence of racial, but not rural-urban, differences in the relationship between social technology use and cognitive functioning. Regardless of degree of social isolation, frequent social technology use was associated with improved cognitive functioning in Black/African American older adults but not White/Caucasians older adults.

DISCUSSION: Social technology may represent a way to mitigate cognitive decline, particularly among Black/African American older adults.

}, keywords = {Cognition, rurality, Social Interaction, Social networks, Technology}, issn = {1758-5368}, doi = {10.1093/geronb/gbac055}, author = {Byrne, Kaileigh A and Ghaiumy Anaraky, Reza} } @article {12546, title = {Identifying the Relationship between Leisure Walking and Prevalence of Alzheimer{\textquoteright}s Disease and Other Dementias.}, journal = {Interntional Journal of Environmental Research and Public Health}, volume = {19}, year = {2022}, pages = {8076}, abstract = {

The literature suggests that leisure walking can play an important role in preventing dementia. The purpose of the present study was to investigate the relationship between leisure walking and the prevalence of Alzheimer{\textquoteright}s disease (AD) and other dementias among older adults. Using the 2020 Health and Retirement Study (HRS), 4581 responses constituted the sample for the present study. A hierarchical logit regression analysis was conducted to investigate the relationship between leisure walking and the prevalence of AD and dementia. The results show that leisure walking has been negatively associated with the prevalence of AD and other dementias-that is, they indicate that older adults who frequently engaged in leisure walking were less likely to develop AD and other dementias. This finding suggests the importance of leisure walking as a dementia prevention program for older adults.

}, keywords = {Alzheimer{\textquoteright}s disease, Dementia, leisure walking}, issn = {1660-4601}, doi = {10.3390/ijerph19138076}, author = {Kim, Junhyoung and Lee, Jungjoo and Kim, Yu-Sik and Park, Se-Hyuk} } @article {12813, title = {If your mother was pregnant during the Great Depression, years might have been taken off your life by the economy, study says}, year = {2022}, publisher = {Fortune}, keywords = {Aging, economic stress, Great Depression, Life Expectancy, Pregnancy}, url = {https://fortune.com/well/2022/11/10/aging-study-die-sooner-age-faster-live-shorter-study-economy-epigenetic-dna-methylation-clock-age/}, author = {Prater, Erin} } @article {Ghilarduccijor.2022.1.104, title = {The Illusory Benefit of Working Longer on Retirement Financial Preparedness: Rethinking Advice That Working Longer Increases Retirement Income}, journal = {The Journal of Retirement}, volume = {9}, year = {2022}, abstract = {This article demonstrates that although working longer can, in theory, substantially improve financial preparedness for retirement, it yields much smaller improvements in practice. Multivariate analysis using data from the Health and Retirement Study reveals that working longer improves financial preparedness only for workers who also delay claiming Social Security. But most older workers combine work with Social Security benefits, do not increase their financial wealth, and miss out on the delayed retirement credit. For many, early claiming is a rational choice because their low and often part-time earnings fall short of projected post-retirement income.}, keywords = {financial preparedness, Older workers, Social Security, Working Longer}, issn = {2326-6899}, doi = {10.3905/jor.2022.1.104}, author = {Ghilarducci, Teresa and Papadopoulos, Michael and Webb, Anthony} } @article {12225, title = {The Impact of Caregiving Intensity and Religiosity on Spousal Caregivers{\textquoteright} Health and Mortality in the US (2004-2014).}, journal = {Journal of Aging and Health}, volume = {34}, year = {2022}, pages = {640-652}, abstract = {

OBJECTIVES: Despite adverse physical and mental health outcomes related to caregiving, family caregivers also experience lower mortality rates compared to noncaregivers. However, research has not yet examined the role of caregiving intensity and religiosity with health and mortality among spousal caregivers.

METHODS: Data include spousal caregivers (=5,214 person-wave observations) and noncaregivers (=50,311 person-wave observations) from the Health and Retirement Study (2004-2014 waves). Multinomial logistic regression was used to explore how caregiving intensity and religiosity were associated with health and mortality among spousal caregivers, compared health and mortality between caregivers and noncaregiving peers, and examined gender differences in these mechanisms.

RESULTS: Greater religious salience and attending religious services, although dependent on gender and caregiving intensity, are protective for caregivers{\textquoteright} health and mortality.

DISCUSSION: Religiosity may buffer adverse effects of caregiving on health and mortality for spousal caregivers. Continuation of prior religiosity may enhance positive aspects of caregiving and decrease caregiver burden.

}, keywords = {caregiver well-being, Life Expectancy, Religion}, issn = {1552-6887}, doi = {10.1177/08982643211052725}, author = {Koumoutzis, Athena and Mehri, Nader} } @article {11941, title = {Impact of Comorbid Dementia on Patterns of Hospice Use.}, journal = {Journal of Palliative Medicine}, volume = {25}, year = {2022}, pages = {396-404}, abstract = {

The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Of 3123 decedents, 465 (14.9\%) had a primary hospice diagnosis of dementia and 943 (30.2\%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95\% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95\% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95\% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95\% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95\% CI: 2.37-7.82). Approximately 45\% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

}, keywords = {Comorbidity, Dementia, end of life, Health Services Research, Hospice}, issn = {1557-7740}, doi = {10.1089/jpm.2021.0055}, author = {Aldridge, Melissa D and Hunt, Lauren and Husain, Mohammed and Li, Lihua and Amy Kelley} } @article {su14106316, title = {The Impact of COVID-19 on Depressive Symptoms and Loneliness for Middle-Aged and Older Adults}, journal = {Sustainability}, volume = {14}, year = {2022}, pages = {6316}, abstract = {This study examines the impact of the COVID-19 pandemic on depressive symptoms and loneliness in older adults, using the Protection Motivation Theory Framework. Using data collected between March 2020 and May 2021 as part of the Health and Retirement Study (N = 2145 adults over age 50), the roles of threat and coping appraisals as predictors of protective health behaviors and, ultimately, mental health outcomes, were analyzed using structural equation modeling. Being at high risk for COVID-19 complications and death was associated with more depressive symptoms and loneliness. Higher levels of concern about COVID-19 were associated with more depressive symptoms while knowing someone who had died of the coronavirus was associated with less loneliness. Lower scores for perceived control over one\’s health and social life were associated with more depressive symptoms and higher loneliness. These results suggest that moving forward, mental health assessments should consider the impact of the pandemic and include measures specifically asking about COVID-19 concerns and experiences (e.g., death of close friends or family due to COVID-19, protective health measures). Additionally, future responses to this pandemic and other public health emergencies should consider the influence that self-efficacy has on health behaviors and mental health. The pandemic has raised public awareness of the negative consequences of social isolation and acted to destigmatize mental illness, and this greater awareness could encourage middle-aged and older adults to seek various treatments for depression and loneliness.}, keywords = {COVID-19, Depressive symptoms, Loneliness}, issn = {2071-1050}, doi = {10.3390/su14106316}, author = {Curl, Angela L. and Wolf, Katie E.} } @article {WANG202269, title = {Impact of health on driving for America{\textquoteright}s older adults: A nationwide, longitudinal study}, journal = {Transport Policy}, volume = {120}, year = {2022}, pages = {69-79}, abstract = {By 2030, one in every five Americans will be 65 or older. To better serve the mobility needs of a rapidly aging population, a better understanding of older adults{\textquoteright} driving behavior is needed. This study explores the impact of health on driving reduction for America{\textquoteright}s older adults, using a nationwide, longitudinal dataset from the Health and Retirement Study (HRS). I propose two outcome variables: having driven in the past month, and having driven beyond nearby places; and measure health using overall self-rated health status and specific sensory, mobility and physical conditions. Controlling for socio-demographics, residential patterns, personal fixed effects, time fixed effects, and regional fixed effects, I find that older adults with lower self-rated health were less likely to drive or drive beyond nearby places. The magnitudes of such effects vary by race but not by gender. I also identify specific health conditions that could predict driving reduction. The findings imply that in the near future, there will be a large number of older adults suffering from unmet travel demands due to declining health conditions. Hence, planners and policy makers should be proactive in seeking for solutions, including using my findings to identify at-risk older drivers and provide various types of mobility assistance.}, keywords = {Aging, Elderly, Mode choice, Well Being}, issn = {0967-070X}, doi = {10.1016/j.tranpol.2022.02.005}, author = {Xize Wang} } @article {12076, title = {The Impact of Marital Quality as Older Couples Adjust to Dementia Onset.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {1026-1036}, abstract = {

OBJECTIVES: A burgeoning literature links being married to better cognitive health, but less attention has been paid to how couples view their marital relationships. Couples do not always concur in their assessments, and such discrepancies affect both partners{\textquoteright} health. We present a dyadic study on whether and how overall and discrepant views of marital quality predicted (a) dementia onset and (b) changes in older adults{\textquoteright} depressive symptoms with spousal dementia.

METHOD: A pooled sample of couples aged 50+ (dyad N = 3,936) from the Health and Retirement Study rated positive and negative marital quality at baseline (2006/2008). Each participant reported whether they had been told of having dementia and their depressive symptoms once every other year (2006-2016).

RESULTS: Cox proportional hazards regression revealed that older adults who rated their marriages either more positively or more negatively than their spouses were more likely to develop dementia. We applied multiphase growth curve modeling to older adults whose spouses developed dementia, finding that those in marriages that were more negative overall reported more depressive symptoms but exhibited a smaller increase in these symptoms in response to spousal dementia.

DISCUSSION: This study adds to the literature by showing how discrepant marital assessments shape cognitive aging and offers new insights into identifying older adults with greater dementia risk. Findings also revealed the impact of overall negative marital quality on older adults{\textquoteright} psychological adjustment to spousal dementia, which could inform interventions intended to help couples better cope with early-stage dementia from a relational perspective.

}, keywords = {dementia onset, Mental Health, spousal discrepancy}, issn = {1758-5368}, doi = {10.1093/geronb/gbab235}, author = {Huo, Meng and Kim, Kyungmin and Sae Hwang Han} } @article {12455, title = {The Impact of the COVID-19 Pandemic on Business Ownership Across Racial/Ethnic Groups and Gender.}, journal = {Journal of Economics, Race, and Policy}, volume = {5}, year = {2022}, pages = {307-317}, abstract = {

This study examined the economic impact of the COVID-19 pandemic on US older entrepreneurs{\textquoteright} businesses using the Health and Retirement Study. We estimated logistic regression models to document the odds of experiencing economic impact. The COVID-19 pandemic has affected nearly 76\% of US older entrepreneurs but has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs. Older Black entrepreneurs had significantly higher odds of facing business closure (OR = 2.31, < .01), implementing new procedures (OR = 2.44, < .01), workers quitting (OR = 2.95, < .001), and difficulty paying regular bills (OR = 2.88, < .001) than their White counterparts. Older Hispanic entrepreneurs also had significantly higher odds of instituting new procedures (OR = 2.27, < .05), workers quitting (OR = 2.26, < .01), and difficulty paying regular bills (OR = 2.35, < .01) than their White counterparts. Similarly, older Asian/other races entrepreneurs were significantly more likely to report difficulty paying regular bills since the start of the pandemic than their White counterparts (OR = 3.11, < .01). Women entrepreneurs were significantly more likely to close their businesses than their male counterparts (OR = 2.11, < .001). These significant associations persisted after controlling for confounders. Support for underserved racial/ethnic groups and older women entrepreneurs should focus on accessibility to financial services, capital, and support packages as well as legislative support for ensuring business continuity and success.

}, keywords = {COVID-19, Entrepreneurship, gender, Race/ethnicity}, issn = {2520-842X}, doi = {10.1007/s41996-022-00102-y}, author = {Choi, Shinae L and Harrell, Erin R and Watkins, Kimberly} } @article {11929, title = {The Impact of Total Joint Arthroplasty on Long-Term Physical Activity: A Secondary Analysis of the Health and Retirement Study.}, journal = {Physical Therapy \& Rehabilitation Journal}, volume = {102}, year = {2022}, pages = {pzab231}, abstract = {

OBJECTIVE: Physical inactivity is the fourth leading cause of global mortality and is prevalent among people with lower extremity osteoarthritis. Lower extremity osteoarthritis is the most common arthritis type afflicting older adults, and total joint arthroplasty (TJA) performed to address the condition is Medicare{\textquoteright}s largest annual expense. Despite TJA intervention to address the disabling effects of osteoarthritis, physical activity (PA) level remains stable 6~months after TJA; however, the effect of TJA on long-term PA $\Big(\ge$2 y) in a representative sample of older adults is unknown. The purpose of this study was to test the hypothesis that PA would remain stable in the long term.

METHODS: In this longitudinal observational study, a probability-weighted difference-in-differences analysis was conducted to observe the predictive margins of nontraumatic hip or knee TJA on levels of vigorous and moderate PA after 2~years. A combined Health and Retirement Study data set of community-dwelling adults who were > 55~years old, had symptomatic osteoarthritis, and were in need of TJA between 2008 and 2018 (N = 4652) was used.

RESULTS: TJA was not associated with vigorous PA ($\updelta$ = 2.37; SE = 5.23) or moderate PA ($\updelta$ = -2.84; SE = 7.76) after 2~years.

CONCLUSION: TJA was not associated with increased long-term PA in older adults with osteoarthritis.

IMPACT: Physical therapists should not assume that there will be a natural increase in PA after functional recovery from TJA procedures. Older adults with lower extremity osteoarthritis may benefit from PA screening and promotion practices in physical therapy services.

LAY SUMMARY: Receiving a total joint replacement does not lead to increased physical activity levels 2~years after surgery.

}, keywords = {Physical activity, Preventive Health Services, Total Joint Arthroplasty}, issn = {1538-6724}, doi = {https://doi.org/10.1093/ptj/pzab231}, author = {LeDoux, Cherie V and Richard C Lindrooth and Stevens-Lapsley, Jennifer E} } @article {12210, title = {Impacts of State Paid Family Leave Policies for Older Workers with Spouses or Parents in Poor Health}, number = {IZA DP No. 15007}, year = {2022}, institution = {Institute of Labor Economics}, address = {Bonn, Germany}, abstract = {Since 2004 six states plus Washington, DC have implemented laws that provide paid leave benefits to workers caring for family members who have a disability or serious medical condition. Focusing on the most established state programs{\textemdash}California and New Jersey{\textemdash}this paper investigates whether paid family leave (PFL) policies facilitate greater labor supply, caregiving, and improvements in health outcomes for those likely to provide family care. Using our preferred estimation method, we find that women with a spouse in poor health are 7.4 percentage points more likely to work while providing care after the implementation of PFL compared to those not living in a PFL state. Similarly, women living within 10 miles of a parent in poor health are more likely to work while providing care (5.6 percentage points) after PFL. The implementation of state PFL also leads to improvements in mental health outcomes for these two groups of women. We fail to find strong evidence that PFL affects labor and care decisions for women living more than 10 miles from a parent in poor health. PFL also has less consistent effects on men.}, keywords = {Caregiving, family leave, Older workers}, url = {https://docs.iza.org/dp15007.pdf}, author = {Braga, Breno and Barbara A Butrica and Mudrazija, Stipica and Peters, Elizabeth H.} } @article {12701, title = {Importance of Asking Older Adults Whether They Are Having Difficulty Managing Finances.}, journal = {JAMA Network Open}, volume = {5}, year = {2022}, pages = {e2231442}, keywords = {Activities of Daily Living, cognitive impairment}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2022.31442}, author = {Karlawish, Jason} } @article {12346, title = {The importance of chronic conditions for potentially avoidable hospitalizations among non-Hispanic Black and non-Hispanic White older adults in the US: a cross-sectional observational study.}, journal = {BMC Health Services Research}, volume = {22}, year = {2022}, pages = {468}, abstract = {

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

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

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

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

}, keywords = {Aged, Asthma, chronic, Chronic Obstructive, Heart Failure, Hospitalization, Humans, Medicare, Pulmonary Disease, Renal Insufficiency}, issn = {1472-6963}, doi = {10.1186/s12913-022-07849-y}, author = {J{\o}rgensen, Terese Sara H{\o}j and Allore, Heather and Elman, Miriam R and Nagel, Corey and Qui{\~n}ones, Ana R} } @article {12966, title = {Improving identification of Medicaid eligible community-dwelling older adults in major household surveys with limited income or asset information}, journal = {Health Services and Outcomes Research Methodology }, year = {2022}, abstract = {Analysis of public policy affecting dual eligibles requires accurate identification of survey respondents eligible for both Medicare and Medicaid. Doing so for Medicaid is particularly challenging given the complex eligibility rules tied to income and assets. In this paper we provide guidance on how to best identify eligible respondents in household surveys that have limited income or asset information, such as the National Health Interview Survey, American Community Survey, Current Population Survey, and Medical Expenditure Panel Survey. We show how two types of errors{\textemdash}false negative and false positive errors{\textemdash}are impacted by incorporating limited income or asset information, relative to the commonly-used approach of solely comparing total income to the income threshold. With the 2018 Health and Retirement Study, which has detailed income and asset information, we mimic the income and asset information available in those other household surveys and quantify how errors change when imposing income or asset tests with limited information. We show that incorporating all available income and asset data results in the lowest number of errors and the lowest overall error rates. We recommend that researchers adjust income and impose the asset test to the fullest extent possible when imputing Medicaid eligibility for Medicare enrollees.}, keywords = {Eligibility Determination, Income, Medicaid, Socioeconomic factors}, doi = {10.1007/s10742-022-00297-5}, author = {McInerney, Melissa and Mellor, Jennifer M. and Ramamoorthy, Venkatesh and Sabik, Lindsay M} } @article {12556, title = {Improving vision may help prevent dementia}, year = {2022}, publisher = {Harvard Health}, keywords = {Dementia, Prevention, vision}, url = {https://www.health.harvard.edu/mind-and-mood/improving-vision-may-help-prevent-dementia}, author = {Solan, Matthew} } @article {12445, title = {In Older Americans, Rising Debt May Adversely Affect Health}, number = {June 5, 2022}, year = {2022}, publisher = {The New York Times}, abstract = {Research shows that debt has risen among older people, and those who owe are more likely to have multiple diagnosed illnesses.}, keywords = {Debt, health, multimorbidity}, url = {https://www.nytimes.com/2022/06/05/health/elderly-medical-health-debt.html}, author = {Paula Span} } @article {12685, title = {In retirement, you may not need to spend so much}, number = {Sept 28,2022}, year = {2022}, publisher = {The New York Times}, keywords = {Retirement, Spending}, url = {https://www.nytimes.com/2022/09/28/opinion/retirement-spending.html}, author = {Coy, Peter} } @article {10.3389/fpubh.2022.920637, title = {In the eyes of the beholder: Race, place and health}, journal = {Frontiers in Public Health}, volume = {10}, year = {2022}, abstract = {Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, as a result of historical systemic inequities, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Degree of exposure to neighborhood disorder may alter peoples{\textquoteright} perception of their neighborhoods, however, with those most exposed (e.g., historically marginalized racial/ethnic groups) perhaps perceiving less threat from signs of neighborhood disorder. The purpose of the present study was to examine the complex interrelationships between people and place by investigating whether exposure to neighborhood physical disorder relates to residents{\textquoteright} (1) perceptions of neighborhood safety and (2) perceptions of their health, and (3) examining whether these links vary by race/ethnicity. Using 2016{\textendash}2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n = 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine the role of neighborhood disorder in relation to both perceived neighborhood safety and self-rated health. Results indicated that greater neighborhood physical disorder was statistically significantly related to feeling less safe among non-Hispanic Whites and Hispanics, but not non-Hispanic Blacks. Regarding self-rated health, neighborhood physical disorder was statistically significantly related to poorer health among all racial/ethnic groups. These findings suggest that, despite differential interpretation of neighborhood disorder as a threat to safety, this modifiable aspect of peoples{\textquoteright} environment is related to poor health regardless of one{\textquoteright}s race/ethnicity.}, keywords = {Health Disparities, neighborhood disorder, race and ethnicity}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.920637}, author = {Velasquez, Alfredo J. and Douglas, Jason A. and Guo, Fangqi and Robinette, Jennifer W.} } @article {12814, title = {In utero exposure to the Great Depression is reflected in late-life epigenetic aging signatures.}, journal = {PNAS}, volume = {119}, year = {2022}, pages = {e2208530119}, abstract = {

Research on maternal-fetal epigenetic programming argues that adverse exposures to the intrauterine environment can have long-term effects on adult morbidity and mortality. However, causal research on epigenetic programming in humans at a population level is rare and is often unable to separate intrauterine effects from conditions in the postnatal period that may continue to impact child development. In this study, we used a quasi-natural experiment that leverages state-year variation in economic shocks during the Great Depression to examine the causal effect of environmental exposures in early life on late-life accelerated epigenetic aging for 832 participants in the US Health and Retirement Study (HRS). HRS is the first population-representative study to collect epigenome-wide DNA methylation data that has the sample size and geographic variation necessary to exploit quasi-random variation in state environments, which expands possibilities for causal research in epigenetics. Our findings suggest that exposure to changing economic conditions in the 1930s had lasting impacts on next-generation epigenetic aging signatures that were developed to predict mortality risk (GrimAge) and physiological decline (DunedinPoAm). We show that these effects are localized to the in utero period specifically as opposed to the preconception, postnatal, childhood, or early adolescent periods. After evaluating endogenous shifts in mortality and fertility related to Depression-era birth cohorts, we conclude that these effects likely represent lower bound estimates of the true impacts of the economic shock on long-term epigenetic aging.

}, keywords = {Aging, DNA Methylation, Epigenesis, Epigenomics, genetic, Great Depression, Prenatal Exposure Delayed Effects}, issn = {1091-6490}, doi = {10.1073/pnas.2208530119}, author = {Schmitz, Lauren L and Duque, Valentina} } @article {LIU2021102683, title = {Incarceration, polygenic risk, and depressive symptoms among males in late adulthood}, journal = {Social Science Research}, volume = {104}, year = {2022}, pages = {102683}, abstract = {This study demonstrates how social and genetic factors jointly influence depression in late adulthood. We focus on the effect of incarceration, a major life event consistently found to be associated with mental health problems. Drawing on data from males in the Wisconsin Longitudinal Study and the Health and Retirement Study, we conduct a polygenic score analysis based on a genome-wide association study on depressive symptoms. Our analysis produces two important findings. First, incarceration experience mediates the association between the depression polygenic score and depressive symptoms in late adulthood (i.e., greater polygenic scores are associated with elevated incarceration risk, which increases depressive symptoms in late adulthood). Second, about one-fifth of the association between incarceration experience and late-adulthood depressive symptoms is accounted for by the depression polygenic score and childhood depression. These findings reveal complex biological and social mechanisms in the development of depression and, more broadly, provide important insights for causal inference in social science research.}, keywords = {Depressive symptoms, incarceration, Male, polygenic risk}, issn = {0049-089X}, doi = {https://doi.org/10.1016/j.ssresearch.2021.102683}, author = {Hexuan Liu and Peter T. Tanksley and Ryan T. Motz and Rachel M. Kail and J.C. Barnes} } @article {12231, title = {Incidence of potentially disruptive medical and social events in older adults with and without dementia.}, journal = {Journal of the American Geriatrics Society}, volume = {70}, year = {2022}, pages = {1461-1470}, abstract = {

BACKGROUND: Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia.

METHODS: Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n~=~9346), including a subset who were married-partnered at baseline (n~=~5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia.

RESULTS: PWD (n~=~596) were older (mean age 84 vs. 75) and a higher proportion were female (67\% vs. 57\%) than people without dementia (PWoD) (n~=~8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95\% CI 94.3, 131.9) compared to PWoD (62.1; 95\% CI 54.7, 69.5), as were hip fractures (12.3; 95\% CI 9.1, 15.6 for PWD compared to 8.1; 95\% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95\% CI 20.1, 30.5) compared to PWoD (21.9; 95\% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95\% CI 1.34, 3.75 versus female IRR 1.31 95\% CI 0.92,1.86); interaction term p~=~0.02).

CONCLUSIONS: Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.

}, keywords = {Dementia, Hip fracture, Pneumonia, Widowhood}, issn = {1532-5415}, doi = {10.1111/jgs.17682}, author = {Hunt, Lauren J and R Sean Morrison and Gan, Siqi and Espejo, Edie and Katherine A Ornstein and W John Boscardin and Smith, Alexander K} } @article {12496, title = {Incident Functional Limitations Among Community-Dwelling Adults Using Opioids: A Retrospective Cohort Study Using a Propensity Analysis with the Health and Retirement Study.}, journal = {Drugs \& Aging}, volume = {39}, year = {2022}, pages = {559-571}, abstract = {

BACKGROUND: Opioid analgesics are commonly used to manage pain; however, it is unclear how they affect patient function. This study examines the association between opioid analgesics and incident limitations in activities of daily living (ADL), instrumental activities of daily living (IADL), and cognitive functioning among community-dwelling older adults.

METHODS: Data included 10,003 participants of the 2016 and 2018 waves of the Health and Retirement Study, which sampled US adults aged 51-98 years. The primary exposure was self-reported opioid pain medication use in 2016. Outcomes included incident limitations in ADL, IADL, and cognitive functioning in 2018. Statistical methods adjusted for confounding using multivariable logistic regressions, inverse probability of treatment weighting, and propensity scores.

RESULTS: Opioid use (adjusted odds ratio [aOR]: 1.34, 95\% confidence interval [CI] 1.07-1.68) was associated with a statistically significant higher odds of incident ADL limitation in multivariable regression and in propensity score adjustment (aOR: 1.41, 95\% CI 1.13-1.76). The association between opioid use and ADL and IADL limitations was modified by age. Adults aged <~65 years had a higher odds of incident ADL (aOR: 1.83, 95\% CI 1.38-2.42) and IADL (aOR: 1.42, 95\% CI 1.06-1.90) limitations compared with those aged >=~65 years.

CONCLUSIONS: Community-dwelling adults using opioid analgesics to manage pain may be at risk for incident ADL limitations. Middle-aged adults, compared with those older than 65 years of age, experienced the greatest odds for incident ADL and IADL limitations following opioid use. According to sensitivity analyses, our findings were robust to unmeasured confounding.

}, keywords = {ADL, Community-dwelling, Functional limitations, IADL, Opioids}, issn = {1179-1969}, doi = {10.1007/s40266-022-00953-y}, author = {Pritchard, Kevin T and Downer, Brian and Raji, Mukaila A and Baillargeon, Jacques and Kuo, Yong-Fang} } @article {MITCHELL2022100371, title = {Income trajectories in later life: Longitudinal evidence from the Health and Retirement Study}, journal = {The Journal of the Economics of Ageing}, volume = {22}, year = {2022}, pages = {100371}, abstract = {We track low-income respondents in the longitudinal Health and Retirement Study for 23 years, to observe how their financial situations unfolded as they aged. We document that (a) real incomes remained relatively stable as individuals entered retirement and progressed through their later years; and (b) labor force participation declined and thus earnings became less important with age, while Social Security and retirement savings rose as a proportion of annual income. Low-income people near retirement also tended to fare poorly during retirement.}, keywords = {Aging, Financial literacy, Financial resilience, Vulnerable groups}, issn = {2212-828X}, doi = {10.1016/j.jeoa.2022.100371}, author = {Olivia S. Mitchell and Robert L. Clark and Annamaria Lusardi} } @mastersthesis {12476, title = {Individual and Partner Exercise Status and Cognitive Function in Older Adults}, volume = {M.S.}, year = {2022}, school = {Virginia Polytechnic Institute and State University }, address = {Blacksburg, VA}, abstract = {The present study used a linear mixed model analytic approach to assess the association between a combined respondent and spousal exercise score and cognitive outcomes of older adult respondents drawn from a nationally representative dataset, The Health and Retirement Study. Informed by the Scaffolding Theory of Aging and Cognition (STAC), the present study sought to understand the role of both an individual and their spouse{\textquoteright}s aerobic physical activity in an individual{\textquoteright}s cognitive outcomes and trajectories. Utilizing longitudinal survey data collected across twelve years (N=3,189), the combined exercise status of a married couple was found to be a significant predictor of cognitive outcomes; when an interaction between time and couple exercise status was included in the model, this was also found to be a significant predictor of four specific cognitive outcomes. The highest cognitive benefit was identified among individuals where both they and their partner participated in the recommended amount of aerobic physical activity, suggesting an additive effect. These findings and their implications are discussed further.}, keywords = {aerobic exercise, Cognition, Physical activity, Spouses}, url = {https://vtechworks.lib.vt.edu/bitstream/handle/10919/110402/Ratliff_KG_T_2022.pdf?sequence=1\&isAllowed=y}, author = {Kathryn Georgette Ratliff} } @article {ASEBEDO2022111854, title = {Individual differences in personality and positive emotion for wealth creation}, journal = {Personality and Individual Differences}, volume = {199}, year = {2022}, pages = {111854}, abstract = {This study identified evidence of a bidirectional causal relationship between positive emotions and net wealth using a random intercept cross-lagged panel model with three time points (2008, 2012, and 2016) within a sample of 10,898 Americans over age 50 from the Health and Retirement Study. The Great Recession might have contributed to net wealth{\textquoteright}s effect on positive emotions during this study. The results also suggest that positive emotions shape net wealth, providing evidence favoring the broaden-and-build theory of positive emotions and the potential effectiveness of positive psychological interventions for personal finance behaviors. Furthermore, a cross-level interaction of all Big-five personality traits with positive emotion and net wealth showed large cross-lag effects when positive emotion is a predictor of net wealth. Likewise, the interaction of positive emotion by the Big Five traits was a predictor of net wealth, indicating the need for further examination of the moderated effect of positive emotion in the context of personality traits and net wealth.}, keywords = {Big Five personality traits, Broaden-and-build theory of positive emotions, net wealth, random intercept cross-lagged panel model}, issn = {0191-8869}, doi = {https://doi.org/10.1016/j.paid.2022.111854}, author = {Sarah D. Asebedo and Taufiq Hasan Quadria and Ying Chen and Esteban Montenegro-Montenegro} } @article {12910, title = {Individual Risk Aversion, Inheritance Expectation and Household Annuity Ownership}, journal = {Journal of Financial Counseling and Planning}, volume = {33}, year = {2022}, pages = {314-323}, abstract = {Although risk preferences and inheritance expectations should affect annuitization decisions, few studies have empirically tested these relations. This study bridges the gap in the prior literature by investigating potential effects that consumer risk aversion and inheritance expectations have on annuitization. Using data from the 2012 wave of the Health and Retirement Study, this study finds that consumers who are more risk averse have a higher likelihood of owning household annuity income compared to consumers who are less risk averse. Consumers with a higher inheritance expectation are more likely to have household annuity income compared to those with a lower inheritance expectation. Finally, when risk aversion is interacted with inheritance expectation, it increases the likelihood of household annuity ownership.}, keywords = {household annuity, Inheritance, Risk Aversion}, doi = {10.1891/JFCP-2021-0075}, author = {Guillemette, Michael and Liu, Yi} } @article {12344, title = {Inequalities in Retirement Lifespan in the United States}, number = {WP 2022-015}, year = {2022}, institution = {Max Planck Institute for Demographic Research}, address = {Germany}, abstract = {Objectives Persistent and substantial disparities in old-age mortality suggest that there may be great inequalities in the length of retirement life. This study aims to assess gender and educational differences in the average retirement lifespan and the variation in retirement lifespan, taking into account individual labor-force exit and re-entry dynamics. Methods We used longitudinal data from the Health and Retirement Study in 1996{\textendash}2016, focusing on respondents aged 50 and above (N = 32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement lifespan, as well as absolute and relative inequalities in retirement lifespan, were calculated analytically. Results We found that among women there was a persistent educational gradient in average retirement lifespan over the whole period studied; among men, the relationship between education and retirement expectancy was different across periods. Women and the lower-educated had higher absolute inequality in retirement lifespan than men and the highereducated{\textemdash}yet these relationships were reversed when examined by relative inequality. Discussion Our multistate approach provides an accurate and comprehensive picture of the retirement lifespan of older Americans in the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential impacts on retirement initiation and re-entry dynamics.}, keywords = {Education, gender, Inequality, Retirement, work-related issues}, doi = {10.4054/MPIDR-WP-2022-015}, author = {Shi, Jiaxin and Christian Dudel and Monden, Christiaan and van Raalte, Alyson A.} } @article {12570, title = {The inequitable burden of the COVID-19 pandemic among marginalized older workers in the United States: an intersectional approach.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {1928-1937}, abstract = {

OBJECTIVES: The COVID-19 pandemic has profoundly affected the lives of people globally, widening longstanding inequities. We examined the COVID-19 pandemic{\textquoteright}s impact on employment conditions by race/ethnicity, gender, and educational attainment and the association between such conditions and well-being in older adults in the United States.

METHODS: Using data from the Health and Retirement Study respondents interviewed between May 2020 and May 2021 when they were >=55 years of age, we examined intersectional patterns in COVID-19-related changes in employment conditions among 4,107 participants working for pay at the start of the pandemic. We also examined the compounding nature of changes in employment conditions and their association with financial hardship, food insecurity, and poor self-rated health.

RESULTS: Relative to non-Hispanic White men with greater than high school education (>HS), Black and Latinx men and women were more likely to experience job loss irrespective of education; among those who did not experience job loss, men with <=HS reporting Black, Latinx, or "other" race were >90\% less likely to transition to remote work. Participants who experienced job loss with decreased income or continued in-person employment with decreased income/shift changes had greater prevalence of financial hardship, food insecurity, and poor/fair self-rated health than others.

DISCUSSION: The impact of COVID-19 on employment conditions is inequitably patterned and is associated with financial hardship, food insecurity, and adverse health in older adults. Policies to improve employment quality and expand social insurance programs among this group are needed to reduce growing inequities in well-being later in life.

}, keywords = {COVID-19, Employment, Inequities, Intersectionality}, issn = {1758-5368}, doi = {10.1093/geronb/gbac095}, author = {Andrea, Sarah B and Eisenberg-Guyot, Jerzy and Blaikie, Kieran J and Owens, Shanise and Oddo, Vanessa M and Peckham, Trevor and Minh, Anita and Hajat, Anjum} } @article {12619, title = {Is inflation taking a summer vacation?}, journal = {Business}, year = {2022}, publisher = {CNN}, keywords = {COVID-19, Finances, inflation, Retirement}, url = {https://us.cnn.com/2022/08/09/investing/premarket-stocks-trading/index.html}, author = {Goodkind, Nicole} } @article {12329, title = {The Influence of Loneliness on the Smoking and Physical Activity of Community-Dwelling Older Adults: Results from the Health and Retirement Study.}, journal = {American Journal of Health Promotion}, volume = {36}, year = {2022}, pages = {959-966}, abstract = {

PURPOSE: To use the loneliness model in examining the influence of loneliness on the number cigarettes smoked per day and the different intensity levels of physical activity among community-dwelling older Americans in the United States.

DESIGN, SETTING, SAMPLE: This study analyzed a nationally representative sample of older adults aged 65+ in two waves (2010 and 2012) of data from the Health and Retirement Study. Response rates for the two waves were 81\% and 89.1\%. The sample size for smoking model was 199, and for physical activity models was 3018.

MEASURES: Outcomes included number of cigarettes smoked per day and physical activity at three intensity levels: light, moderate, and vigorous. Independent variable was the UCLA loneliness scale.

ANALYSIS: A lagged dependent approach for modeling longitudinal data was adopted. Models controlled for outcomes at the first timepoint (Wave 1), health/physical functioning, and demographic variables.

RESULTS: Loneliness was associated with an increased number of cigarettes smoked per day (β = 2.93, < .05) and decreased engagement in moderate and vigorous physical activity for older adults (β = .12, < .05; β = .12, <. 05), after controlling for these behaviors at baseline and other covariates.

CONCLUSION: The findings call for smoking reduction and physical activity enhancement interventions targeting older adults who have high levels of loneliness. Efforts to enhance social support will be crucial to eradicating the harmful health impact of loneliness. Critical limitations include self-reported measures and unobserved confounders.

}, keywords = {Exercise, perceived isolation, purpose, Smoking}, issn = {2168-6602}, doi = {10.1177/08901171221081136}, author = {Yang, Jie and Yockey, R Andrew and Chu, Yoosun and Lee, Joseph G L} } @article {12732, title = {The Influence of the Val66Met Variant on the Association Between Physical Activity/Grip Strength and Depressive Symptoms in Persons With Diabetes.}, journal = {Clinical Nursing Research}, year = {2022}, abstract = {

The rs6265 in the (BDNF) is associated with depression in people with diabetes. Both physical activity (PA) and grip strength are negatively associated with depression. We conducted cross-sectional analyses of the wave 10 survey data for a nationally representative sample of 1,051 diabetes participants of the Health and Retirement Study. Both greater PA (β = -.15) and stronger grip strength (β = -.02) were independently associated with depression. Although the interaction between rs6265 and PA on depressive symptoms was not significant, the negative PA-depression association was stronger among female non-Met carriers (β = -.19) and male Met carriers (β = -.14). Meanwhile, grip strength was associated with depression only in Met carriers (β = -.04), and similar association was observed in both males and females. In conclusion, female non-Met carriers and male Met carriers may benefit from PA, and Met carriers may benefit from grip strength to relieve depression.

}, keywords = {Brain-Derived Neurotrophic Factor, Depressive symptoms, Diabetes, Grip strength, Physical activity}, issn = {1552-3799}, doi = {10.1177/10547738221119343}, author = {Zeng, Bin and Yue, Yan and Liu, Tingting and Ahn, Hyochol and Li, Changwei} } @mastersthesis {12592, title = {The Influence of Work-Life Balance Directionality on Retirement Decisions}, volume = {M.S. }, year = {2022}, school = {California State University, San Bernardino}, address = {San Bernardino, CA}, abstract = {The retirement landscape is ever shifting and has become a dual-decision process more so now than ever before. Employees consider retirement through a family lens and particularly so when there is conflict between life and work domains. Researchers have suggested that work-life directionality does influence work-related decisions (Wiktorowicz, 2018). The impact of work-life directionality, however, on retirement choices has not been substantially examined. Further, socioeconomic status (SES) has been found to influence retirement decisions to some degree (Dushi et al., 2017). Therefore, in the present study, data from a total of 17,146 participants were used from the 2018 wave of the Health and Retirement Study (HRS) to examine the influence of work-life directionality, as well as the moderating effects of income, on bridge employment and planned age to stop working permanently. The findings indicate that work-life and life-work conflict influence planned age to stop working permanently, as the presence of work-life conflict reduces the planned age and life-work conflict increases the planned age. Also, the interaction between work-life and life-work significantly influences planned age to stop working but not bridge employment. Implications of these finding for both theory and practice are discussed.}, keywords = {Bridge employment, Income, Retirement Decision, Work-life balance}, url = {https://scholarworks.lib.csusb.edu/etd/1550/}, author = {Craig, Joshua} } @article {12082, title = {Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes.}, journal = {Health Affairs}, volume = {41}, year = {2022}, pages = {105-111}, abstract = {

Informal care, or care provided by family and friends, is the most common form of care received by community-dwelling older adults with functional limitations. However, less is known about informal care provision within residential care settings including residential care facilities (for example, assisted living) and nursing homes. Using data from the Health and Retirement Study (2016) and the National Health and Aging Trends Study (2015), we found that informal care was common among older adults with functional limitations, whether they lived in the community, a residential care facility, or a nursing home. The hours of informal care provided were also nontrivial across all settings. This evidence suggests that informal caregiving and some of the associated burdens do not end when a person transitions from the community to residential care or a nursing home setting. It also points to the large role that families play in the care and well-being of these residents, which is especially important considering the recent visitor bans during the COVID-19 epidemic. Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones. Providers and policy makers could improve the lives of both the residents and their caregivers by acknowledging, incorporating, and supporting this workforce.

}, keywords = {Caregiving, Informal care}, issn = {1544-5208}, doi = {10.1377/hlthaff.2021.01239}, author = {Norma B Coe and Werner, Rachel M} } @mastersthesis {Nakamura_2022, title = {Informal helping and subsequent health and well-being in older U.S. adults}, volume = {M.A.}, year = {2022}, school = {University of British Columbia}, abstract = {While there is a large and growing body of evidence around the health and well-being benefits of formal volunteering, less is known about the downstream benefits of informal helping behaviors. A small literature has evaluated associations between informal helping and health and well-being outcomes. However, epidemiological studies have not evaluated if changes in informal helping are associated with subsequent health and well-being. Using data from 12,998 participants in the Health and Retirement Study, a national cohort of US adults aged >50, we evaluated if changes in informal helping (between t0;2006/2008 and t1;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2;2014/2016). Over the four-year follow-up period, informal helping >=100 (versus 0) hours/year was associated with a 32\% lower mortality risk (95\% CI [0.54, 0.86]), and improved physical health (e.g., 21\% reduced risk of stroke (95\% CI [0.64, 0.96])), health behaviors (e.g., 11\% increased physical activity (95\% CI [1.04, 1.19])), and psychosocial outcomes (e.g., higher purpose in life (β=0.13, 95\% CI [0.08, 0.18])). However, there was also evidence that informal helping was associated with higher negative affect (β=0.06, 95\% CI [0.003, 0.12]) and little evidence of associations with various other outcomes. In secondary analyses, we adjusted for formal volunteering and caregiving and results were largely unchanged. Encouraging informal helping may improve various aspects of health and well-being and also promote societal well-being.}, keywords = {health, informal helping, Well-being}, doi = {http://dx.doi.org/10.14288/1.0417297}, author = {Nakamura, Julia Sharon} } @article {12028, title = {Inner child of the past: long-term protective role of childhood relationships with mothers and fathers and maternal support for mental health in middle and late adulthood.}, journal = {Social Psychiatry and Psychiatric Epidemiology}, volume = {57}, year = {2022}, pages = {1399-1416}, abstract = {

PURPOSE: National longitudinal studies that investigate the long-term association between early family life and mental health in middle and older adulthood are limited. This study aims to fill the gap by examining the protective effect of positive childhood relationships with mothers and fathers and parental support against depression among women and men in middle and late adulthood.

METHODS: The sample of 12,606 adults (7319 females; 5287 males) from the US Health and Retirement Study was nationally representative with the inclusion of 7 depression measures from 2008 to 2018. Two depression measures, CESD-8 scale and binary indicators of severe depressive symptoms, were used. Generalized estimation equations (GEE)-negative binomial models were estimated for CESD-8 and GEE-logit models were estimated for the binary indicator of severe depression. This study aimed to assess how positive parent-child relationships and maternal support protect the mental health of women and men in adulthood. Other risk and psychosocial factors, such as childhood depression, traumatic life events, stressful life events, marital status, and social support in adulthood were adjusted for.

RESULTS: Positive childhood relationships with mothers, fathers, or both parents and increased maternal support were associated with a lower risk of depression among both females and males from middle to old age, even if they experienced trauma, stressful life events, divorce, singlehood, widowhood, or little social support. Females benefited more psychologically than males from positive mother-daughter relationships and high-quality relationships with both parents. However, compared to mother-child relationships, positive father-child relationships protected men better psychosocially than females.

CONCLUSION: Findings underscore the importance of fathers{\textquoteright} roles in promoting their children{\textquoteright}s, especially sons{\textquoteright}, emotional well-being. Interventions in early mother-child and father-child relationships and parental support are crucial for healthy aging in mental development.

}, keywords = {depression, Mental Health, Paternal support}, issn = {1433-9285}, doi = {10.1007/s00127-021-02200-y}, author = {Chen, Ping} } @article {11902, title = {Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older.}, journal = {Sleep and Breathing}, volume = {26}, year = {2022}, pages = {1409-1416}, abstract = {

PURPOSE: To evaluate the association of the different degrees of insomnia symptoms with subsequent incidence of type 2 diabetes mellitus (T2DM).

METHODS: The data were extracted from Health and Retirement Study 2006-2014 waves. The association of insomnia symptoms with T2DM incidence was evaluated by the competing risk model with cumulative incidence function (death was considered a competing event) and Cox proportional hazard model with the Kaplan-Meier method. Population attributable fraction (PAF) was calculated. All analyses related to our study were conducted between November 2020 and January 2021.

RESULTS: A total of 14,112 patients were included in this study, with an average follow-up of 6.4~years, and the incidence density was 17.9 per 1000 person-years. Insomnia symptoms were positively associated with T2DM incidence compared with those with no insomnia symptoms, regardless of competing risk model (>= 1 symptoms: sub-distribution hazard ratio (SHR) 1.13; 95\% confidence interval (CI) 1.02-1.26; P-trend = 0.012) and Cox proportional hazard model (>= 1 symptoms: hazard ratio (HR) 1.13; 95\% CI 1.02-1.26; P-trend = 0.013). The cumulative incidence function (Gray{\textquoteright}s test, p < 0.001) and Kaplan-Meier estimate (log-rank test, p < 0.001) also presented this positive relationship. This positive association was more apparent in women and participants with ages from 50 to 65 years. The PAF was 4.1\% with 95\% CI (0.7-7.9\%).

CONCLUSIONS: Insomnia symptoms may be an important risk factor for the development of T2DM, which is unbiased by the death competing risk. These findings suggest that management of sleep problems may be an important part of strategies to prevent T2DM.

}, keywords = {Competing risk model, Cox proportional hazard model, insomnia symptoms, type 2 diabetes mellitus}, issn = {1522-1709}, doi = {10.1007/s11325-021-02497-8}, author = {Yao, Wenqin and Luo, Jia and Yu, Xiaohui and Jiang, Wenjie and Zhang, Dongfeng} } @article {12807, title = {Integrating Medicare And Medicaid Data To Improve Care Quality And Advance Health Equity Among Dual-Eligible Beneficiaries}, year = {2022}, institution = {Health Affairs}, abstract = {Policy makers continue to test new models to integrate Medicare and Medicaid coverage for the dually eligible population, with the goal of improving quality of care and health equity. However, evaluations of these integrated models are limited by the fact that few data resources comprehensively measure need for, use of, or spending on care among dual eligibles.}, keywords = {dual-eligible beneficiaries, health equity, Medicaid, Medicare}, doi = {10.1377/hpb20221011.325614}, author = {Brown-Podgorski, Brittany and Roberts, Eric} } @article {13505, title = {Interactions between the apolipoprotein E4 gene and modifiable risk factors for cognitive impairment: a nationally representative panel study.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {938}, abstract = {

BACKGROUND: Few studies using rigorous clinical diagnosis have considered whether associations with cognitive decline are potentiated by interactions between genetic and modifiable risk factors. Given the increasing burden of cognitive impairment (CI) and dementia, we assessed whether Apolipoprotein E ε4 (APOE4) genotype status modifies the association between incident CI and key modifiable risk factors .

METHODS: Older adults (70+) in the US were included. APOE4 status was genotyped. Risk factors for CI were self-reported. Cognitive status (normal, CI, or dementia) was assigned by clinical consensus panel. In eight separate Cox proportional hazard models, we assessed for interactions between APOE4 status and other CI risk factors.

RESULT: The analytical sample included 181 participants (mean age 77.7 years; 45.9\% male). APOE4 was independently associated with a greater hazard of CI in each model (Hazard Ratios [HR] between 1.81-2.66, p < 0.05) except the model evaluating educational attainment (HR 1.65, p = 0.40). The joint effects of APOE4 and high school education or less (HR 2.25, 95\% CI: 1.40-3.60, p < 0.001), hypertension (HR 2.46, 95\% CI: 1.28-4.73, p = 0.007), elevated depressive symptoms (HR 5.09, 95\% CI: 2.59-10.02, p < 0.001), hearing loss (HR 3.44, 95\% CI: 1.87-6.33, p < 0.0001), vision impairment (HR 5.14, 95\% CI: 2.31-11.43, p < 0.001), smoking (HR 2.35, 95\% CI: 1.24-4.47, p = 0.009), or obesity (HR 3.80, 95\% CI: 2.11-6.85, p < 0.001) were associated with the hazard of incident CIND (compared to no genetic or modifiable risk factor) in separate models. The joint effect of Apolipoprotein ε4 and type 2 diabetes was not associated with CIND (HR 1.58, 95\% CI: 0.67-2.48, p = 0.44).

DISCUSSION: The combination of APOE4 and selected modifiable risk factors conveys a stronger association with incident CI than either type of risk factor alone.

}, keywords = {Apolipoprotein E4, Cognitive Dysfunction, Dementia, Risk Factors}, issn = {1471-2318}, doi = {10.1186/s12877-022-03652-w}, author = {Kolli, Ajay and Zhou, Yunshu and Chung, Grace and Ware, Erin B and Kenneth M. Langa and Ehrlich, Joshua R} } @article {11913, title = {Internet Use and Cognitive Functioning in Later Life: Focus on Asymmetric Effects and Contextual Factors.}, journal = {Gerontologist}, volume = {62}, year = {2022}, pages = {425-435}, abstract = {

BACKGROUND AND OBJECTIVES: Despite emerging literature linking Internet usage and cognitive functioning in later life, research seldom takes changes in older adults{\textquoteright} Internet use into account. How changes in Internet use influence older adults{\textquoteright} cognitive decline over time, particularly in the context of sociodemographic factors that shape Information and Communications Technology (ICT) use, remains an open question.

RESEARCH DESIGN AND METHODS: Using nine waves of panel data from the Health and Retirement Study (2002-2018), we examined within-person asymmetric effects of transitioning into and out of Internet use on cognitive functioning, and whether the associations vary across birth cohorts and by living arrangement.

RESULTS: Transitioning into Internet use (i.e., Internet use onset) was associated with improved cognitive functioning at a given wave and decelerated cognitive decline over time. Transitioning out of the Internet (i.e., Internet use cessation) was associated with worse cognitive functioning at a given wave and accelerated cognitive decline over time. Further, birth cohort and living arrangement moderated these associations. The detrimental effect of transitioning out of Internet use was worse for older adults born in 1941 or before. The cognitive benefits of transitioning into Internet use were greater for those older adults who live alone.

DISCUSSION AND IMPLICATIONS: These findings highlight the interplay between technology, social environment, and cognitive functioning in later life. The salubrious effects of using the Internet, as well as the deleterious effects of ceasing to use such technology, underscores the importance of promoting digital literacy and access to ICT among the older adult population.

}, keywords = {Cognition, Internet use, sociodemographic factors}, issn = {1758-5341}, doi = {10.1093/geront/gnab149}, author = {Kim, Yijung K and Sae Hwang Han} } @article {ANG2022100514, title = {Internet use and cohort change in social connectedness among older adults}, journal = {Advances in Life Course Research}, volume = {54}, year = {2022}, pages = {100514}, abstract = {Social connections are an integral part of living in society, and trends in social connectedness are thus closely scrutinized. The phenomenon of networked individualism argues that densely knit communities organized around formal social groups such as households and workplaces are becoming less common. Due to advances in technology, individuals are able to develop personalized communities that are more diverse and less geographically-bound. The objective of this study was to determine how both average levels and the variability of social connectedness have changed across cohorts, and how much of this is due to increased internet use. Data from 2006, 2008, 2016, and 2018 waves of the Health and Retirement Study were used to investigate cohort changes in various indicators of social connectedness. The analytical sample consisted of older adults aged 58{\textendash}69 from the Silent Generation (born 1920{\textendash}1947) and Baby Boomers (born 1948{\textendash}1965). Heteroscedastic regression models and decomposition methods were used to investigate the role of increased internet use in driving some of these changes. Findings suggest that increases in internet use was associated with increases in the variance of social participation (i.e., contact with friends and family) in the United States. However, evidence around more subjective measures of social connectedness (i.e., social support, loneliness) was less clear. Future research should seek to understand how cohort change in technological use may affect objective and subjective aspects of social connectedness in different ways.}, keywords = {Cohort change, Internet use, Social connectedness}, issn = {1040-2608}, doi = {https://doi.org/10.1016/j.alcr.2022.100514}, author = {Shannon Ang} } @article {Shieu1052, title = {The interplay between age at menopause, insomnia, and cognitive health: A population-based study (P1-6.001)}, journal = {Neurology}, volume = {98}, year = {2022}, abstract = {Objective: To examine associations between age at menopause, insomnia, and long-term cognitive function among US women. Background: Female sex hormones are postulated to have long-lasting neuroprotective effects. However, the influence of sleep on this association has been insufficiently studied. Design/Methods: We utilized 2008{\textendash}2016 data from the Health and Retirement Study, a nationally representative cohort of US adults age 50+. In a cohort restricted to women, age at menopause was retrieved from baseline (2008). Prevalence of insomnia in 2010 was identified from self-reported items on trouble falling asleep, nighttime awakenings, early morning awakenings, and use of sleep aids. Cognitive function was assessed biennially using a composite score of immediate and delayed trials of a 10-item word recall test, serial sevens subtraction test, and backwards counting test (range: 0{\textendash}27). Women with normal cognitive function (score 12{\textendash}27) and natural transition to menopause were included. Longitudinal associations between age at menopause and cognitive function were estimated with mixed effects models with a random intercept; subsequent models with interaction terms examined whether insomnia moderated the menopause-cognition associations. Results: Among 4,708 women, 23\% reported early menopause (age<=45). Over eight years, women who transitioned early to menopause had a mean follow-up cognitive score that was nearly three points lower than those who transitioned to menopause after age 45 (p\<.0001). This association was moderated by insomnia, such that women with insomnia had worse cognitive decline. In stratified analyses within ethnoracial groups, Black women who experienced early menopause had the highest rate of cognitive decline (beta=-4.0}, keywords = {Cognitive health, insomnia, Menopause, women}, issn = {0028-3878}, url = {https://n.neurology.org/content/98/18_Supplement/1052}, author = {Shieu, Monica and Braley, Tiffany and Zaheed, Afsara and Perry, Julie and Becker, Jill and Dunietz, Galit} } @article {12853, title = {The Interplay of Epigenetic, Genetic, and Traditional Risk Factors on Blood Pressure: Findings from the Health and Retirement Study.}, journal = {Genes }, volume = {13}, year = {2022}, pages = {1959}, abstract = {

The epigenome likely interacts with traditional and genetic risk factors to influence blood pressure. We evaluated whether 13 previously reported DNA methylation sites (CpGs) are associated with systolic (SBP) or diastolic (DBP) blood pressure, both individually and aggregated into methylation risk scores (MRS), in 3070 participants (including 437 African ancestry (AA) and 2021 European ancestry (EA), mean age = 70.5 years) from the Health and Retirement Study. Nine CpGs were at least nominally associated with SBP and/or DBP after adjusting for traditional hypertension risk factors ( < 0.05). MRS was positively associated with SBP in the full sample (β = 1.7 mmHg per 1 standard deviation in MRS; = 2.7 {\texttimes} 10) and in EA (β = 1.6; = 0.001), and MRS with DBP in the full sample (β = 1.1; = 1.8 {\texttimes} 10), EA (β = 1.1; = 7.2 {\texttimes} 10), and AA (β = 1.4; = 0.03). The MRS and BP-genetic risk scores were independently associated with blood pressure in EA. The effects of both MRSs were weaker with increased age ( < 0.01), and the effect of MRS was higher among individuals with at least some college education ( = 0.02). In AA, increasing MRS was associated with higher SBP in females only ( = 0.01). Our work shows that MRS is a potential biomarker of blood pressure that may be modified by traditional hypertension risk factors.

}, keywords = {Blood pressure, DNA Methylation, genetic risk score, Genetics, interaction, methylation risk score.}, issn = {2073-4425}, doi = {10.3390/genes13111959}, author = {Zhang, Xinman and Ammous, Farah and Lin, Lisha and Ratliff, Scott M and Ware, Erin B and Jessica Faul and Zhao, Wei and Sharon L R Kardia and Smith, Jennifer A} } @article {doi:10.1177/23294965211053835, title = {The Intersecting Consequences of Race-Gender Health Disparities on Workforce Engagement for Older Workers: An Examination of Physical and Mental Health}, journal = {Social Currents}, volume = {9}, year = {2022}, pages = {45-69}, abstract = {The dramatic growth of older adults{\textquoteright} labor participation over the past 25 years, including women and people of color, is reshaping the American labor force. The current study contributes new knowledge concerning why individuals over age 50 years may be working longer despite negative impacts of deteriorating physical and mental health associated with aging. Inquiries regarding who continues to work and why can be answered, in part, by addressing how workforce engagement and health are shaped by notable social inequities along the dimensions of age, race, and gender. Guided by cumulative advantage/disadvantage and intersectionality frameworks, we examine whether having multiple chronic conditions (MCC){\textemdash}two or more physical conditions{\textemdash}and depression affect workforce participation. Using multinomial logistic regression models, we analyze the 2014{\textendash}2016 waves of the Health and Retirement Study (N = 4250). Findings reveal that having multiple chronic illnesses increase the likelihood of labor force exit, especially among workers who also have depression. We also discover intersectional nuances which illuminate complex race-gender dynamics related to health and work processes in later life. We conclude with recommendations for workplace policy that promote the retention of older workers with chronic illness and depression and aim to decrease disparities in older workers{\textquoteright} work engagement.}, keywords = {Aging and the life course, gender, Health Disparities, Labor, Occupations, organizations, race}, doi = {10.1177/23294965211053835}, author = {Kendra Jason and Christy L Erving} } @article {12248, title = {Intersectional Discrimination and Change in Blood Pressure Control Among Older Adults: The Health and Retirement Study.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {375-382}, abstract = {

BACKGROUND: Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished.

METHODS: Participants were 14 582 noninstitutionalized individuals (59\% women) in the Health and Retirement Study aged at least 51 years (76\% non-Hispanic White, 15\% non-Hispanic Black, 9\% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008-2014).

RESULTS: There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95\% confidence interval [CI]: 1.08-1.36) but not women (OR: 0.98, 95\% CI: 0.86-1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95\% CI: 1.03-2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95\% CI: 0.70-1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination-antihypertensive use associations: 0.85, 95\% CI: 0.77-0.94).

CONCLUSIONS: Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.

}, keywords = {cardiovascular, Health Disparities, Risk Factors, Socioeconomic issues}, issn = {1758-535X}, doi = {10.1093/gerona/glab234}, author = {Kendra D Sims and Smit, Ellen and G David Batty and Hystad, Perry W and Michelle C Odden} } @article {12073, title = {Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis.}, journal = {The International Journal of Aging and Human Development}, volume = {95}, year = {2022}, pages = {267-285}, abstract = {

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged >=50) from the Health and Retirement Study in 2014-2015 were included ( = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52\% of the sample) had no/minimal discrimination; Class 2 (21.89\%) experienced primarily ageism; class 3 (8.81\%) reported discrimination based on age/gender/national origin/race; class 4 (7.99\%) attributed discrimination to financial/other reasons; class 5 (5.87\%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92\%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.

}, keywords = {Discrimination, Intersectionality, Latent Class Analysis}, issn = {1541-3535}, doi = {10.1177/00914150211066560}, author = {Lu, Peiyi and Kong, Dexia and Shelley, Mack and Joan Davitt} } @article {https://doi.org/10.1002/gps.5774, title = {The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up}, journal = {International Journal of Geriatric Psychiatry}, volume = {37}, year = {2022}, abstract = {Objectives Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories. Methods Using 8,376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents. Results Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet these effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages. Conclusions Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.}, keywords = {Cognitive decline, race, socioeconomic status, trajectory}, doi = {10.1002/gps.5774}, author = {Zeng, Yue and Sang Lum, Terry Yat and Chen, Yu-Chih} } @article {10.1093/geroni/igac059.1203, title = {INTRODUCING THE CENTENARIANS IN THE HEALTH AND RETIREMENT STUDY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {304-304}, abstract = {The Health and Retirement Study (HRS) is a nationally representative sample of older adults, and data are available for 15 waves. This presentation presents an overview of the oldest cohort of the HRS (the AHEAD sample) as they become centenarians. Basic characteristics of these centenarians and near centenarians (98 years and older, N = 516) indicate that they are primarily female (77 percent), White (82 percent) with on average 10.6 years of education. The average age was 84.2 years at baseline and 98.3 years at wave 14. We analyze data by comparing centenarian survivors to nonsurvivors, by following them longitudinally, and by comparing different cohorts of centenarians over historical time. Results indicate that centenarians continue to enjoy life, and they have special survivorship characteristics. Newer cohorts, however, show a more compromised quality of life. The results are relevant to family members of oldest-old adults and to community service providers.}, issn = {2399-5300}, doi = {10.1093/geroni/igac059.1203}, author = {Martin, Peter and Lee, Gina and Arieli, Rotem and Ryou, Yeon Ji} } @article {13141, title = {Investigating Racial and Ethnic Disparities in the Provision of Workplace Accommodations in the United States}, year = {2022}, institution = {University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {This study used data from a nationally representative survey that follows people 50 and older over time (the Health and Retirement Study) to test whether the receipt of workplace accommodations by persons with work limitations varies by race/ethnicity. Workplace accommodations can include changes to time (allowing more breaks, allowing different arrival or departure times, or shortening the workday), provision of equipment/assistance (getting someone to help, getting special equipment, arranging special transportation), and changes to work (changing the job, helping to learn new job skills). We found that 85\% of persons with work limitations identified a need for workplace accommodations, but only 32\% actually received accommodations. While our preliminary analyses suggested some differences by race/ethnicity in the likelihood of receiving accommodations, when we also considered other factors (age, gender, education, organizational size, and physical nature of an occupation), these differences by race did not hold. Organizational size was a critical factor, however, as persons working for organizations that employed 100 or more people were significantly more likely to receive accommodations. This finding suggests that smaller employers may benefit from training or other supports to increase the availability of workplace accommodations. Workers with disabilities might also benefit from increased education offered by vocational rehabilitation agencies, workforce development programs, and other similar organizations on how to make requests for and implement reasonable accommodations.}, keywords = {Racial and ethnic disparities, United States, workplace accommodations}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp442.pdf}, author = {Debra L. Brucker and Megan Henly and Andrew Houtenville} } @mastersthesis {12425, title = {Involuntary Delayed Retirement and Mental Health of Older Adults Following the Great Recession}, year = {2022}, school = {University of Calgary}, address = {Calgary, Alberta}, abstract = {This thesis examines whether involuntary delayed retirement (IDR) is associated with multiple measures of mental health in working older adults (age 65+) in the United States following the Great Recession. In addition, two other related aims are also addressed in this thesis: 1) whether IDR is associated with multiple measures of mental health through a lower sense of control, and 2) whether a sense of control buffers the association between IDR and multiple mental health measures. Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012 (N=947). IDR was measured as wanting to stop working but not being able to due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in and anger-out, and life satisfaction. Using Stata 16.0, primary analyses were conducted with ordinary least squares (OLS) regression. The bootstrapping approach to testing mediation was followed for testing whether the sense of control mediated each association between IDR and the mental health outcomes. Interactions were tested to assess whether the sense of control moderated the relationship between IDR and the mental health outcomes. Results showed that older adults who worked after retirement age (age 65+) often experienced IDR. Furthermore, the results showed a lack of overall association between IDR and multiple mental health outcomes, but also demonstrated indirect relationships between IDR and depression, anxiety, anger-out, and life satisfaction through a sense of control. In addition, the sense of control did not act as a buffering agent in the relationship between IDR and mental health. While there is no overall association, there is an indirect deleterious effect, which suggests that IDR may have additional beneficial effects that should be investigated in future research. The findings also suggest that a sense of control is an essential mental health resource for older adults who work past retirement age. Mental health researchers, therefore, should pay more attention to a sense of control because the sense of control will help older adults maintain positive mental health even if they are required to work past retirement age.}, keywords = {Great Recession, involuntary delayed retirement, Mental Health}, url = {http://hdl.handle.net/1880/114643}, author = {Raihan, Mohammad Mojammel Hussain} } @article {11216, title = {Identifying cohabiting couples in administrative data: evidence from Medicare address data}, journal = {Health Services and Outcomes Research Methodology}, volume = {21}, year = {2021}, pages = {238-247}, abstract = {Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011{\textendash}2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.}, keywords = {Cohabitation, Couples, Marriage, Medicare}, isbn = {1572-9400}, doi = {10.1007/s10742-020-00229-1}, author = {Matta, Sasmira and Joanne W. Hsu and Theodore J Iwashyna and Micah Y. Baum and Kenneth M. Langa and Lauren Hersch Nicholas} } @article {11786, title = {Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study.}, journal = {Ear and Hearing}, volume = {43}, year = {2021}, pages = {487-494}, abstract = {

OBJECTIVES: Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare.

DESIGN: Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status.

RESULTS: A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury.

CONCLUSIONS: The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.

}, keywords = {Fall injury, Falls, Hearing aids}, issn = {1538-4667}, doi = {10.1097/AUD.0000000000001111}, author = {Riska, Kristal M and Peskoe, Sarah B and Kuchibhatla, Maragatha and Gordee, Alexander and Pavon, Juliessa M and Kim, Se Eun and Jessica S West and Smith, Sherri L} } @article {11543, title = {The impact of late-career job loss and genetic risk on body mass index: Evidence from variance polygenic scores.}, journal = {Scientific Reports}, volume = {11}, year = {2021}, pages = {7647}, abstract = {

Unemployment shocks from the COVID-19 pandemic have reignited concerns over the long-term effects of job loss on population health. Past research has highlighted the corrosive effects of unemployment on health and health behaviors. This study examines whether the effects of job loss on changes in body mass index (BMI) are moderated by genetic predisposition using data from the U.S. Health and Retirement Study (HRS). To improve detection of gene-by-environment (G {\texttimes} E) interplay, we interacted layoffs from business closures-a plausibly exogenous environmental exposure-with whole-genome polygenic scores (PGSs) that capture genetic contributions to both the population mean (mPGS) and variance (vPGS) of BMI. Results show evidence of genetic moderation using a vPGS (as opposed to an mPGS) and indicate genome-wide summary measures of phenotypic plasticity may further our understanding of how environmental stimuli modify the distribution of complex traits in a population.

}, keywords = {Body Mass Index, Job loss, polygenic score}, issn = {2045-2322}, doi = {10.1038/s41598-021-86716-y}, author = {Lauren L Schmitz and Goodwin, Julia and Miao, Jiacheng and Lu, Qiongshi and Dalton C Conley} } @article {https://doi.org/10.1111/1475-6773.13783, title = {Impact of Medicare Eligibility on Informal Caregiving for Surgery and Stroke}, journal = {Health Services Research}, volume = {56}, year = {2021}, pages = {61-62}, abstract = {Research Objective Over 40 million older Americans rely on informal care (unpaid assistance for personal care such and instrumental support, including toileting, bathing, and shopping). Prior work illustrates 68{\textendash}230\% greater spending on post-acute care after surgery for Medicare beneficiaries compared to older commercial insurance enrollees. Such enhanced access to post-acute care may reduce the need for family and friend caregiving support for rehabilitation following acute medical events. While use of informal care is substantial among older Americans, little is known about informal support for patients after acute medical events, and how formal post-acute care influences its use. Study Design We used 1998 to 2018 Health and Retirement Study (HRS) data to assess changes in weekly hours of informal care received by individuals experiencing acute events before and after Medicare eligibility. We created two similar cohorts of individuals near the Medicare eligibility age: pre-Medicare, or individuals ages 59{\textendash}66 and not covered by Medicare; and Medicare, or individuals ages 67{\textendash}74. We used a threshold of 67, rather than 65, for the Medicare cohort to account for the two-year lookback period used in HRS survey questions. The cohorts were matched using inverse probability treatment weights. A regression discontinuity design assessed three types of caregiving {\textendash} the proportion of respondents receiving care, intensity of care among care recipients, and care intensity among all respondents {\textendash} before and after Medicare eligibility. We estimated generalized linear models with a log link and gamma distribution that regressed informal care on Medicare status, a centered age variable, and an interaction between Medicare status and centered age. Sensitivity analyses included stratification by surgery type and by sex. Population Studied 4264 Health and Retirement Study participants near the age of Medicare eligibility in one of three self-reported acute medical cohorts: stroke, heart surgery, or joint surgery. Principal Findings Among near-retirement individuals, 2031 (47.6\%) had a stroke, 1038 (24.3\%) underwent heart surgery, and 1038 (28.0\%) underwent joint surgery. Of the 937 (22.3\%) of patients who reported receiving care from an informal caregiver, average care measured 34.0 (SD: 49.2) weekly hours. Mean (SD) weekly informal caregiving hours were 7.5 (27.0) overall, and 12.1 (34.7), 3.8 (18.5), and 2.9 (14.1) for stroke, heart surgery, and joint surgery patients, respectively. In adjusted analyses, the proportion of stroke patients receiving informal care decreased from 39.5\% to 28.6\% (or by 28\%) and the average weekly amount of care decreased from 21.0 to 10.3 hours (or 51\%) after Medicare enrollment. Non-significant decreases were observed for the other medical cohorts. There was a non-significant average decrease of 22.8 hours (or 40\%) in the intensity of care received by men after one of three events. Conclusions Access to Medicare coverage was associated with a 51\% reduction in informal care received by older Medicare stroke patients, potentially by increasing access to post-acute services. Implications for Policy or Practice Post-acute care is increasingly targeted for cost savings under Medicare policies, which may restrict access to post-acute care and rehabilitation, impacting demand for informal care for older adults with stroke.}, keywords = {Eligibility Determination, Informal caregiving, Medicare, Stroke, Surgery}, doi = {10.1111/1475-6773.13783}, author = {DeRoo, Ana and Ha, Jinkyung and Norcott, Alexandra and Regenbogen, Scott and Geoffrey J Hoffman} } @article {11349, title = {The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans.}, journal = {Journal of Aging and Health}, volume = {33}, year = {2021}, pages = {237-248}, abstract = {

We examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences. The Health and Retirement Study (2006-2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents{\textquoteright} first report of resilience. Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life. Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. We discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.

}, keywords = {latent growth curves, life course}, issn = {1552-6887}, doi = {10.1177/0898264320975231}, author = {Urena, Stephanie and Miles G Taylor and Dawn C Carr} } @article {11467, title = {The Impact of State Income Tax Breaks for the Elderly on Savings and Income Security}, year = {2021}, institution = {Retirement \& Disability Research Center, Center for Financial Security, University of Wisconsin-Madison}, address = {Madison, WI}, abstract = {This first study provides the causal effects of the state retirement income exemption policies on saving for retirement and long-term impact on income in retirement, which have been understudied. Using the Social Security W2 earnings records linked to restricted Health and Retirement Data (HRS) data, I find that a 26\% decline in savings into retirement plan accounts in post-policy periods. Workers in states with exemption offers were also less likely to save compared to those worked in states without exemption. The fall in household income (both before and after-tax) in retirement further implies that seniors in exemption states were not better off than their counter-part states. Hence, states might consider rethinking the effectiveness of these policies.}, keywords = {event study, income in retirement, savings for retirement, state retirement income tax exemption, two-ways fixed effects}, url = {https://cfsrdrc.wisc.edu/files/working-papers/Fellow_Dao_Final_508.pdf}, author = {Ngoc Dao} } @article {11215, title = {The Importance of Engaging in Physical Activity in Older Adulthood for Transitions between Cognitive Status Categories and Death: A Coordinated Analysis of Fourteen Longitudinal Studies.}, journal = {The Journals of Gerontology: Series A }, volume = {76}, year = {2021}, pages = {1661-1667}, abstract = {

BACKGROUND: Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories.

METHODS: Applying a coordinated analysis approach, this project independently analyzed fourteen longitudinal studies (NTotal = 52,039; mean baseline age across studies= 69.9-81.73) from North America and Europe using multi-state survival models to estimate the impact of engaging in PA on cognitive status transitions (non-impaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs.

RESULTS: Controlling for baseline age, sex, education and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from non-impaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (e.g., decreased risk of transitioning from mild to severe cognitive impairment; increased likelihood of transitioning backward from severe to mild cognitive impairment), though between-study heterogeneity suggests a less robust association.

CONCLUSIONS: These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

}, keywords = {cognitive aging, Exercise, Longevity, Successful aging}, issn = {1758-535X}, doi = {10.1093/gerona/glaa268}, author = {Yoneda, Tomiko and Nathan A Lewis and Knight, Jamie E and Rush, Jonathan and Vendittelli, Rebecca and Kleineidam, Luca and Hyun, Jinshil and Andrea M Piccinin and Scott M Hofer and Emiel O Hoogendijk and Derby, Carol A and Scherer, Martin and Steffi G Riedel-Heller and Wagner, Michael and van den Hout, Ardo and Wang, Wenyu and David A Bennett and Muniz-Terrera, Graciela} } @article {11396, title = {The Importance of Improving Educational Attainment for Dementia Prevalence Trends from 2000-2014, among Older non-Hispanic Black and White Americans.}, journal = {The Journals of Gerontology, Series B}, volume = {76}, year = {2021}, pages = {1870-1879}, abstract = {

OBJECTIVES: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess 1) how the trends in dementia prevalence may have differed across age and race groups and 2) the role of changing educational attainment in understanding these trends.

METHOD: This paper estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.

RESULTS: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.

DISCUSSION: This study shows the importance of improvement in educational attainment in the early part of the 20 th century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.

}, keywords = {Cognitive health, Educational attainment}, issn = {1758-5368}, doi = {10.1093/geronb/gbab015}, author = {Mark D Hayward and Mateo P Farina and Yuan S Zhang and Jung K Kim and Eileen M. Crimmins} } @mastersthesis {11537, title = {THE IMPORTANCE OF LIFESTYLE FACTORS ON DEVELOPING DEMENTIA AMONG ELDERLY PEOPLE IN THE USA}, volume = {B.A.}, year = {2021}, school = {University of Groningen}, address = {Groningen, Netherlands}, abstract = {Dementia is a disease without a cure, and due to the increasingly aging population in the US, it can become a bigger burden on society as a whole. Dementia is most often happening during the later stages of a person{\textquoteright}s life and is linked to genetics, family history, and other factors. Some negative/positive factors relating to the likelihood of developing dementia can be prevented/encouraged to reduce the number of dementia cases in society. This research aims to measure and analyze to what extent smoking, alcohol consumption, physical activity, and BMI influences developing dementia for the elderly of > 65 years old controlling for age, gender, and years of education. To address this research question, a Binary Logistic regression will be done from the Health and Retirement Study (HRS) accompanied to this; a literature review will be done to look into the effects of these factors. The results imply that smoking is not related to developing dementia while the literature suggests a relationship, but this relationship fades after quitting smoking for a longer time. Alcohol consumption has a positive effect on light- and moderate-drinkers compared to non-drinkers but negatively affects heavy-drinkers compared to non-drinkers; this corresponds to the literature. Physical activity has a very positive effect of not developing dementia, according to the data and literature. Finally, a higher BMI is associated with a lower risk of developing dementia for people > 65 but the risk is higher for people below that age. Dementia cases can be curbed if certain interventions like quitting smoking or encouraging physical activity are implemented.}, keywords = {Dementia, lifestyles}, url = {https://frw.studenttheses.ub.rug.nl/id/eprint/3430}, author = {Scholing, Vincent} } @article {11375, title = {Improving the Measurement of Retirement Income of the Aged Population}, number = {116}, year = {2021}, institution = {Office of Retirement and Disability Policy, Social Security Administration}, address = {Washington, D.C.}, abstract = {Research has shown that survey-reported income measures, particularly pension and retirement income, suffer from reporting errors, which lead to biased estimates of income and poverty of the aged population. Two of the Social Security Administration{\textquoteright}s main publications{\textemdash}Income of the Population 55 or Older and the Income of the Aged Chartbook{\textemdash}are published biennially and are based exclusively on publicly available data from the U.S. Census Bureau. In this paper, we use data from the Census{\textquoteright} 2016 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) merged with administrative data{\textemdash}Internal Revenue Service (IRS) tax records and Social Security earnings and benefit records{\textemdash}to examine whether and to what extent using these additional data improves income estimates. We also compare those estimates with public-use data from the 2016 Health and Retirement Study (HRS), which has the reputation of being a reliable source of income measures for the aged population. We find that for the population aged 65 or older, supplementing the CPS ASEC with IRS and Social Security administrative data results in a higher estimate of pension income{\textquoteright}s share of aggregate income, less estimated reliance on Social Security, and a lower estimated rate of poverty. Furthermore, we find that the HRS provides better estimates of the income of the aged population than the public-use CPS data.}, keywords = {Income, Measurement error}, url = {https://www.ssa.gov/policy/docs/workingpapers/wp116.html}, author = {Irena Dushi and Trenkamp, Brad} } @article {11605, title = {The incidence of the healthcare costs of chronic conditions.}, journal = {International Journal of Health Economics and Management}, volume = {21}, year = {2021}, pages = {473-493}, abstract = {

Who pays for~the costs of chronic conditions? In this paper, we examine whether 50-64-year old workers covered by employer-sponsored insurance bear healthcare costs~of chronic conditions in the form of lower wages. Using a difference-in-differences approach with data from the Health and Retirement Study, we find that workers with chronic diseases receive significantly lower wages than healthy workers when they are covered by employer-sponsored insurance. Our findings suggest that higher healthcare costs of chronic conditions can explain~the substantial part of the wage gap between workers with and without chronic diseases.

}, keywords = {Chronic disease, Compensating wage differential, Employer-sponsored health insurance, Wage}, issn = {2199-9031}, doi = {10.1007/s10754-021-09305-6}, author = {Lee, Kyung Min and Jeung, Chanup} } @article {11421, title = {Increasing Education-Based Disparities in Healthy Life Expectancy Among U.S. Non-Hispanic Whites, 2000-2010.}, journal = {The Journals of Gerontology, Series B}, volume = {76}, year = {2021}, pages = {319-329}, abstract = {

OBJECTIVES: To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century.

METHODS: This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).

RESULTS: Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages.

DISCUSSION: Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.

}, keywords = {Disability, Education, Healthy life expectancy, Mortality}, issn = {1758-5368}, doi = {10.1093/geronb/gbz145}, author = {Cantu, Phillip A and Connor M Sheehan and Sasson, Isaac and Mark D Hayward} } @article {12026, title = {Increasing Medicaid{\textquoteright}s Stagnant Asset Test For People Eligible For Medicare And Medicaid Will Help Vulnerable Seniors.}, journal = {Health Affairs}, volume = {40}, year = {2021}, pages = {1943-1952}, abstract = {

Low-income Medicare beneficiaries rely on Medicaid for supplemental coverage but must meet income and asset tests to qualify. We examined states{\textquoteright} income and asset tests for full-benefit Medicaid during the period 2006-18 and examined how alternative asset tests would affect eligibility for community-dwelling Medicare beneficiaries ages sixty-five and older. Most states have not updated the dollar limit of Medicaid{\textquoteright}s asset test since 1989, making the asset test increasingly restrictive in inflation-adjusted terms. We estimated that increasing Medicaid{\textquoteright}s asset limit by the Consumer Price Index, to Medicare Savings Program levels, or to $10,000 for individuals and $20,000 for couples would increase Medicaid eligibility by 1.7~percent, 4.4~percent, and 7.5~percent, respectively. Simplifying Medicaid{\textquoteright}s asset test to focus only on certain high-value assets would increase eligibility by 20.5~percent. Increasing asset limits would lessen restrictions on Medicaid eligibility that arise from stagnant asset tests, broadening eligibility for certain low-income Medicare beneficiaries and allowing them to retain higher, yet still modest, savings.

}, keywords = {Eligibility Determination, Medicaid, Medicare}, issn = {1544-5208}, doi = {10.1377/hlthaff.2021.00841}, author = {Cornelio, Noelle and Melissa McInerney and Jennifer M Mellor and Roberts, Eric T and Lindsay M Sabik} } @article {12027, title = { Inflammatory Disease Not Associated With Increased Alzheimer{\textquoteright}s Disease Risk}, year = {2021}, publisher = {Rheumatology Network}, keywords = {Alzheimer, Inflammation}, url = {https://www.rheumatologynetwork.com/view/inflammatory-disease-not-associated-with-increased-alzheimer-s-disease-risk}, author = {Dykes, Lana} } @mastersthesis {11780, title = {THE INFLUENCE OF SELF-PERCEPTIONS OF AGING ON COGNITIVE FUNCTIONING IN OLDER ADULT DYADS}, volume = {M.S.}, year = {2021}, school = {University of Missouri-Columbia}, address = {Columbia, MO}, abstract = {Older adults who report negative self-perceptions of aging (SPA) perform worse on memory tests and perceive their memory abilities to be worse than their counterparts who report positive SPA. Research suggests that romantic partners influence one another{\textquoteright}s experience and appraisal of aging. Thus, this study examined whether individuals{\textquoteright} SPA impacted their own and their partner{\textquoteright}s memory longitudinally. Using three waves of data from the Health and Retirement Study (HRS), we conducted actor-partner interdependence models with 933 married or cohabiting couples aged 50 to 88 to determine whether positive and negative dimensions of SPA influenced change in episodic memory (i.e., immediate and delayed recall) and self-rated memory over eight years. Partners{\textquoteright} SPA were positively correlated at baseline (positive = .393, p < .001; negative = .441, p < .001), however, we did not find evidence that SPA was associated with change in episodic or self-rated memory in either the actor or the partner. These findings indicate that individuals{\textquoteright} SPA is related to their partners{\textquoteright}, but researchers should continue to investigate the degree to which social influences of SPA impact cognitive functioning in older adulthood.}, keywords = {Aging, cognitive function, Self-perception}, url = {https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/85861/SkoblowHamamoriResearch.pdf?sequence=1}, author = {Skoblow, Hanamori F} } @article {su132413957, title = {The Influencing Mechanism of Social Effort-Reward Imbalance on Life Satisfaction among Aging Workforces in the United States: A Longitudinal Study}, journal = {Sustainability}, volume = {13}, year = {2021}, pages = {13957}, abstract = {Improving life satisfaction is consistent with the United Nations (UN) sustainable development goals. Although there are many studies examining life satisfaction, research on the influencing mechanisms remains a hot topic and scholars hope to explore more aspects that improve life satisfaction. The purpose was to explore how the relationship between social effort-reward imbalance and life satisfaction are mediated by positive and negative affect. We collected longitudinal data from 909 respondents participating in the 2008 and 2012 wave of the Health and Retirement Study (HRS). We used the first-order difference method and structural equation modeling (SEM) analysis to evaluate the validity of the proposed hypotheses. Our results demonstrated that social effort-reward imbalance was positively related to negative affect, and negatively related to positive affect. Positive affect was positively related to life satisfaction, while negative affect was negatively related to life satisfaction. The findings also indicated that positive and negative affect completely mediated the relationship between social effort-reward imbalance and life satisfaction. This study has made a contribution to the research on the influencing mechanism of life satisfaction from the aspects of theory and practice. Longitudinal data ensured that the conclusions were more reliable so that the study could provide useful suggestions for improving life satisfaction.}, keywords = {Aging Workforce, Life Satisfaction, Negative affect, Positive affect, social effort-reward imbalance}, issn = {2071-1050}, doi = {10.3390/su132413957}, author = {Lin, Xinqi and Gao, Yongchuang} } @article {11659, title = {Inheritance and Stockholding: The Role of Expectations}, journal = {Review of Economics}, volume = {72}, year = {2021}, pages = {1{\textendash}28}, abstract = {This paper uses data from the Health and Retirement Study to investigate the role of inheritances for stockholding. Individual heir fixed-effects estimates show that an inheritance receipt increases subsequent stock market participation. The respective magnitude of this shift is higher for large and fully anticipated receipts, whereas it seems to be largest for fully but larger-than-expected transfers. Generally, our effects are driven by households entering the stock market. Also, a less pre-inheritance liquidity constrained household shows higher post-inheritance stock ownership probability. This suggests, inheritance size as well as receipt and size anticipation are determinants for stockholding. In the context of stock market participation, our results highlight considerable heir and transfer heterogeneity which can have important implications for bequest taxation and economic welfare. By means of the intergenerational transmission of inequality and socio-economic status via the {\textquoteleft}wealth channel{\textquoteright}, households not only benefit from transfer receipt but also from later capital gains, due to stock market participation.}, keywords = {Expectations, Inheritance, investor behavior, Portfolio choice}, doi = {doi:10.1515/roe-2021-0009}, author = {Luik, Marc-Andr{\'e} and Salland, Jan} } @article {11412, title = {Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study}, journal = {Sleep Medicine}, volume = {80}, year = {2021}, pages = {158-166}, abstract = {ObjectiveTo evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.MethodsSecondary analyses were performed on 9,518 elderly participants (>=65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006-2014) were associated with time-to-onset of [1] physician-diagnosed {\textquotedblleft}memory-related disease{\textquotedblright}, {\textquotedblleft}Alzheimer{\textquoteright}s disease{\textquotedblright} and/or {\textquotedblleft}dementia, senility or any other serious memory impairment{\textquotedblright} and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.ResultsIn fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006-2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41-72\% increased risks of physician-diagnosed memory problems and 45-58\% increased risks of dementia diagnosis based on HRS criteria.ConclusionsWhen severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools.}, keywords = {Aging, Alzheimer{\textquoteright}s disease, Dementia, insomnia, Neurodegenerative, Sleep}, isbn = {1389-9457}, doi = {10.1016/j.sleep.2021.01.038}, author = {Beydoun, Hind A. and Beydoun, May A. and Weiss, Jordan and Hossain, Sharmin and Huang, Shuyan and Alemu, Brook T. and Alan B Zonderman} } @article {11808, title = {Insomnia symptoms and incident heart failure: a population-based cohort study.}, journal = {European Heart Journal}, volume = {42}, year = {2021}, pages = {4169-4176}, abstract = {

AIMS: Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF.

METHODS AND RESULTS: Data were obtained from the Health and Retirement Study in the US for a population-representative sample of 12,761 middle-aged and older adults (age >= 50 years; mean [SD] age, 66.7 [9.4] years; 57.7\% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discrete-time survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. At baseline, 38.4\% of the respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 1,730 respondents developed incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95\% CI: 1.08-1.38), two (HR=1.45; 95\% CI: 1.21-1.72), three (HR=1.66; 95\% CI: 1.37-2.02), or four (HR=1.80; 95\% CI: 1.25-2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents that had trouble initiating sleep (HR=1.17; 95\%CI: 1.01-1.36), maintaining sleep (HR=1.14; 95\% CI: 1.01-1.28), early-morning awakening (HR=1.20; 95\% CI: 1.02-1.43), or non-restorative sleep (HR=1.25; 95\% CI: 1.06-1.46) had a higher hazard of incident HF than asymptomatic respondents.

CONCLUSION: Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence.

}, keywords = {Heart Failure, insomnia symptoms, Marginal structural models, risk factor, Sleep disturbance}, issn = {1522-9645}, doi = {10.1093/eurheartj/ehab500}, author = {Mahmood, Asos and Ray, Meredith and Dobalian, Aram and Kenneth D. Ward and Ahn, SangNam} } @article {11606, title = {Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?}, journal = {Sleep}, volume = {44}, year = {2021}, pages = {A212 - A212}, abstract = {Alzheimer{\textquoteright}s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations.Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., {\textquotedblleft}baseline{\textquotedblright}) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values.Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed.Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD.Support (if any):}, keywords = {Cognition, Depressive symptoms, insomnia, vascular disease}, isbn = {0161-8105}, doi = {10.1093/sleep/zsab072.535}, author = {Afsara B. Zaheed and Adam P Spira and Ronald D Chervin and Laura B Zahodne} } @mastersthesis {11939, title = {Integrating Genetics into Economics}, year = {2021}, school = {Erasmus University}, address = {Rotterdam, Netherlands}, abstract = {The massive increase in sample size of genetic cohorts, combined with an increase in the collection of data on social-scientific outcomes in these datasets, has made it possible to study many socio-economically relevant individual characteristics from a genetics perspective. In economics, the subfield that studies the genetic architecture of socioeconomic outcomes and preferences is often called genoeconomics. Ultimately, genoeconomics can help economics in four different ways: genes can be used as measures of previous latent variables, genes can uncover biological mechanisms, genes can be used as control variables or instrumental variables, and genes can be used to target policy interventions. In this thesis, I develop and compare some methods that can be used in genoeconomics, and I show through empirical studies how genetically informed study designs can give new insights to economists. The methods developed and compared in this thesis foster the use of genes as instrumental variables and help further the understanding of genetic relationships across socio-economically relevant characteristics. The main empirical applications in this thesis concern smoking behaviour, entrepreneurship, and the structure of the brain. This first chapter provides an overview of the thesis, including a discussion of the research questions it addresses and the implications resulting from the answers to these questions.}, keywords = {Economics, Entrepreneurship, Genetics, Mental Health, Polygenic risk scores}, isbn = {978-90-5892-596-1}, url = {https://repub.eur.nl/pub/135159/122919-binnenwerk.pdf}, author = {Eric Slob} } @article {11389, title = {Intended Bequests and Housing Equity in Older Age}, number = {WP$\#$2021-2}, year = {2021}, institution = {Center for Retirement Research at Boston College}, address = {Boston, MA}, abstract = {This paper examines how homeownership evolves in old age and around the time of death, using detailed data from the Health and Retirement Study to assess the extent to which housing wealth held by older Americans might be used to complement Social Security in the provision of retirement income. Critical components of the analysis include the use of rich information on medical diagnoses, functional status, and bequest intentions in a competing-risks proportional hazard model of the likelihood of making a tenure transition out of homeownership, where death is the competing risk. The paper found that: The age profile of homeownership falls to under 10 percent among the oldest old, which in past studies has been a sufficient statistic for life-cycle behavior.For a baseline sample of homeowners, roughly half transition to renting before death; the other half die as homeowners.Health shock and bequest intentions play important roles in explaining why the elderly fail to spend housing wealth via tenure transitions. The policy implications of the findings are: Along with entitlements to Social Security and employer-provided pensions, housing is the most important asset in elderly portfolios, so that housing might supplement the retirement income of future retirees.The annual flow of housing bequests is about 4 percent of the aggregate housing value held by older Americans.About 80 percent of aggregate housing wealth of those 62 and older may be available to support consumption in retirement net of intended bequests. }, keywords = {Bequests, Homeownership}, url = {https://crr.bc.edu/working-papers/intended-bequests-and-housing-equity-in-older-age/}, author = {Gary V. Engelhardt and Michael D. Eriksen} } @article {11408, title = {Interaction between physical activity and polygenic score on type 2 diabetes mellitus in older Black and White participants from the Health and Retirement Study.}, journal = {The Journals of Gerontology: Series A }, volume = {76}, year = {2021}, pages = {1214-1221}, abstract = {

This study investigated the association of lifestyle factors and polygenic risk scores (PGS), and their interaction, on type 2 diabetes mellitus (T2D). We examined data from the United States Health and Retirement Study, a prospective longitudinal cohort of >=50-year-old adults containing nationally representative samples of Black and White Americans with pre-calculated PGS for T2D (N=14,001). Predicted prevalence and incidence of T2D were calculated with logistic regression models. We calculated differences in T2D prevalence and incidence by PGS percentiles and for interaction variables using nonparametric bootstrap method. Black participants had approximately twice the prevalence of Whites (26.2\% vs. 14.2\%), with a larger difference between the 90 th and 10 th PGS percentile from age 50-80 years. Significant interaction (Pinteraction=0.0096) was detected between PGS and physical activity among Whites. Among Whites in the 90 th PGS percentile, T2D prevalence for moderate physical activity was 17.0\% (95\%CI:14.8,19.6), 6.8\% lower compared to no/some physical activity (23.8\%, 95\%CI:20.4,27.5). T2D prevalence was similar (~10\%) for both groups in the 10 th PGS percentile. Incident T2D in Whites followed a similar pattern (Pinteraction=0.0325). No significant interactions with PGS were detected among Black participants. Interaction of different genetic risk profiles with lifestyle factors may inform understanding of varying inventions{\textquoteright} efficacy for different groups of people, potentially improving clinical and prevention interventions.

}, keywords = {Physical activity, Polygenic risk score, Racial differences, type 2 diabetes}, issn = {1758-535X}, doi = {10.1093/gerona/glab025}, author = {Wu, Yan Yan and Mika D. Thompson and Youkhana, Fadi and Catherine M. Pirkle} } @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 {11218, title = {Internet Adoption in Older Adults: Findings from the Health and Retirement Study.}, journal = {Cyberpsychol, Behavior, and Social Networking}, volume = {24}, year = {2021}, pages = {101-107}, abstract = {

Being able to use the Internet is becoming increasingly important in today{\textquoteright}s digitized society. Evidence suggests that older adults are at risk of being left behind by technological developments. We examined Internet adoption in older adults in relation to sociodemographic, health, cognitive, social, and personality factors. We used data from the Health and Retirement Study ( = 5,949; 61 percent women; age: = 72 years, standard deviation [] = 7; range = 50-105). Internet use was examined over an 8-year period. Predictors were assessed at baseline. We used a Cox proportional hazards model to examine how predictors were related to Internet adoption during the study period. Overall, 1,296 out of 5,949 participants (22 percent) reported starting to use the Internet during the study period. Our findings revealed that younger age, higher education, higher income, living with a partner, and better cognitive performance were associated with a higher likelihood of Internet adoption, whereas being Black was associated with a lower likelihood. Openness was associated with a higher likelihood of Internet adoption over the study period. Our findings add to the literature on the role of sociodemographic, cognitive, and health factors in older adults{\textquoteright} Internet use. In addition, we show that personality also predicts older adults{\textquoteright} Internet use.

}, keywords = {cognitive function, Internet use, Personality, Successful aging, Technology}, issn = {2152-2723}, doi = {10.1089/cyber.2019.0736}, author = {Macdonald, Birthe and H{\"u}l{\"u}r, Gizem} } @mastersthesis {12522, title = {Interpersonal Discrimination and Older Latinx Adults in the United States}, volume = {Ph.D.}, year = {2021}, school = {University of South Carolina}, address = {Columbia, SC}, abstract = {Discrimination is a chronic source of stress among Latinx adults in the United States (Lopez et al. 2017; Williams 2012). Limited research, however, considers differences within ethnicity-nativity, the influence of important psychosocial mechanisms such as sense of control, and the ways interpersonal discrimination may extend beyond the individual, known as vicarious effects (Wofford et al. 2019). For my chapters, public data comes from the Health and Retirement Study (HRS), a nationally representative longitudinal study of Americans aged 50 and older. My three dissertation chapters proceed in the following manner: Chapter 1 provides information to better understand Latinx adults beyond the monolithic categorization by examining experiences of interpersonal discrimination for US-born Mexican adults, US-born Latinx adults of other ethnicities, foreign-born Mexican adults, and foreign-born Latinx adults of other ethnicities. This fills a research gap by providing more detailed information on how racialized stress, via interpersonal discrimination measures, vary by ethnicity and nativity for older Latinx adults. For Chapter 2, I contribute to a better understanding of psychosocial resources, specifically sense of control (i.e., perceived constraints and mastery), which may explain the impact of discrimination on mental health (mediation) and/or protect against the adverse effects of interpersonal discrimination on depressive symptoms (moderation). I also stratify by ethnicity to better assess how these measures of sense of control might work differently across groups. This contributes to a broader understanding of mechanisms that might buffer the adverse consequences of discrimination on mental health, beyond previously researched social support measures. Finally, Chapter 3 contributes to the family literature by examining Latinx marriages. Specifically, I considered the way spouse{\textquoteright}s experiences of interpersonal discrimination influences the depressive symptoms of their partner. Understanding dyadic relationships for older Latinx marriages is especially important as limited information considers older Latinx adults and their families. Using the stress process and linked lives theory, actor effects were found, but no partner effects were found{\textemdash}this may be explained by the familioso framework. Future research within discrimination, health, and family literature should continue to consider the specific processes influencing the wellbeing of Latinx individuals.}, keywords = {Depressive symtomology, Discrimination-health, Dyatic data, Interpersonal discrimination, Latinx families}, url = {www.proquest.com/dissertations-theses/interpersonal-discrimination-older-latinx-adults/docview/2672314531/se-2?accountid=14667}, author = {Dues, Adrianne} } @article {11558, title = {Interplay between stress-related genes may influence Alzheimer{\textquoteright}s disease development: The results of genetic interaction analyses of human data.}, journal = {Mechanisms of Ageing and Development}, volume = {196}, year = {2021}, pages = {111477}, abstract = {

Emerging evidence from experimental and clinical research suggests that stress-related genes may play key roles in AD development. The fact that genome-wide association studies were not able to detect a contribution of such genes to AD indicates the possibility that these genes may influence AD non-linearly, through interactions of their products. In this paper, we selected two stress-related genes (GCN2/EIF2AK4 and APP) based on recent findings from experimental studies which suggest that the interplay between these genes might influence AD in humans. To test this hypothesis, we evaluated the effects of interactions between SNPs in these two genes on AD occurrence, using the Health and Retirement Study data on white indidividuals. We found several interacting SNP-pairs whose associations with AD remained statistically significant after correction for multiple testing. These findings emphasize the importance of nonlinear mechanisms of polygenic AD regulation that cannot be detected in traditional association studies. To estimate collective effects of multiple interacting SNP-pairs on AD, we constructed a new composite index, called Interaction Polygenic Risk Score, and showed that its association with AD is highly statistically significant. These results open a new avenue in the analyses of mechanisms of complex multigenic AD regulation.

}, keywords = {Alzheimer{\textquoteright}s disease, Genetic interactions, Integrated stress response, Polygenic risk score}, issn = {1872-6216}, doi = {10.1016/j.mad.2021.111477}, author = {Anatoliy Yashin and Wu, Deqing and Konstantin G Arbeev and Bagley, Olivia and Akushevich, Igor and Duan, Matt and Arseniy P Yashkin and Svetlana Ukraintseva} } @conference {11534, title = {Intersectional Discrimination and Change in Blood Pressure Control among Older Adults: The Health and Retirement Study}, booktitle = {OHSU-PSU School of Public Health Annual Conference}, year = {2021}, abstract = {Background: The association of intersectional discrimination (e.g., ageism in conjunction with classism) and blood pressure control in diverse older populations remains unestablished. Methods: Participants were 14582 non-institutionalized individuals (59\% women) in the Health and Retirement Study aged at least 51 years at baseline (76\% Non-Hispanic White, 15\% Non-Hispanic Black, 9\% Hispanic/Latinx). Discrimination measures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as ascribing everyday discrimination to more than one reason), and the sum of discrimination over the lifespan. We assessed whether discrimination was independently associated with change in measured hypertension status (N=14582) and concurrent medication use among reported hypertensives (N=9086) over a four-year period (2008-2014). Results: There was no association between the frequency of everyday discrimination and change in measured hypertension in men or women. Lifetime discrimination was associated with a higher odds of hypertension four years later among men (OR: 1.21, 95\% CI: 1.08, 1.36) but not women (OR: 1.00, 95\% CI: 0.87, 1.15). Also among men, ascribing everyday discrimination to at least two reasons was associated with a 1.50 (95\% CI: 1.07, 2.19)-fold odds of hypertension than reporting no everyday discrimination; intersectional discrimination was not associated with developing hypertension among women (OR: 0.96, 95\% CI: 0.73, 1.26). All three discriminatory measures were associated with lower likelihood of reported antihypertensive medication use, without apparent gender differences. Conclusions: Experiences of lifetime as well as intersectional everyday discrimination may elevate hypertensive risk among older men, and decrease the likelihood of antihypertensive medication use among older adults overall.}, keywords = {Blood pressure, intersectional discrimination}, url = {https://pdxscholar.library.pdx.edu/publichealthpdx/2021/Presentations/12/}, author = {Kendra D Sims} } @article {11733, title = {Intersectional trends in employment quality in older adults in the United States}, journal = {SSM - Population Health}, volume = {15}, year = {2021}, pages = {100868}, abstract = {Americans{\textquoteright} working lives have become more precarious over the past several decades. Worsening employment quality has been linked to poorer physical and mental health and may disproportionately impact marginalized working populations. We examined differences in the quality and character of worker-employer relationships among older workers in the United States (US) across intersecting gender-racial/ethnic-educational subgroups. Using longitudinal data on employment stability, material rewards, workers{\textquoteright} rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (1992{\textendash}2016), we used principal components analysis to construct an employment quality (EQ) score. We estimated intersectional differences in EQ, overall and over time, using generalized estimating equations. Overall, EQ was greatest for white men with college degrees and poorest for Latinx women with < high school degrees. Over time, EQ tended to remain unchanged or slightly worsen across intersectional strata; the greatest EQ reduction was for Latinx women with college degrees, while the greatest improvement was for white women with high school degrees. There are enduring and growing inequities in EQ for older marginalized adults in the US, which may contribute to growing health inequities.}, keywords = {employment quality, Inequities, Intersectionality, Precarious employment}, isbn = {2352-8273}, doi = {10.1016/j.ssmph.2021.100868}, author = {Sarah B. Andrea and Eisenberg-Guyot, Jerzy and Peckham, Trevor and Vanessa M Oddo and Hajat, Anjum} } @article {angrisani_samek_kapteyn_2021, title = {Introduction to the Special Issue on New Longitudinal Data for Retirement Analysis and Policy}, journal = {Journal of Pension Economics and Finance}, year = {2021}, pages = {1{\textendash}5}, abstract = {The number of data sources available for academic research on retirement economics and policy has increased rapidly in the past two decades. Data quality and comparability across studies have also improved considerably, with survey questionnaires progressively converging towards common ways of eliciting the same measurable concepts. Probability-based Internet panels have become a more accepted and recognized tool to obtain research data, allowing for fast, flexible, and cost-effective data collection compared to more traditional modes such as in-person and phone interviews. In an era of big data, academic research has also increasingly been able to access administrative records (e.g., Kost{\o}l and Mogstad, 2014; Cesarini et al., 2016), private-sector financial records (e.g., Gelman et al., 2014), and administrative data married with surveys (Ameriks et al., 2020), to answer questions that could not be successfully tackled otherwise.}, keywords = {Longitudinal data, Methodology}, doi = {10.1017/S1474747221000044}, author = {Marco Angrisani and Samek, Anya and Arie Kapteyn} } @article {11738, title = {Investigating Racial/Ethnic Disparities in the Association Between AHEI-2010 and Change in Cystatin C in a Representative Sample of Older Americans}, journal = {Current Developments in Nutrition}, volume = {5}, year = {2021}, pages = {1015}, abstract = {Cystatin C (Cys C) is a promising biomarker for early-stage chronic kidney disease. Dietary intake plays an essential role in the prevention of kidney function decline, which has yet to be examined in relation to changes in Cys C among older adults. Our objective was to test whether scores on the Alternative Healthy Eating Index-2010 (AHEI-2010) were associated with change in Cys C from 2012{\textendash}2016 and if this varied by race/ethnicity.Observations were drawn from the Health and Retirement Study. Blood spot collection and examination occurred in 2012 and 2016, participant attributes were measured in 2012, and dietary assessment was conducted by a validated dietary frequency questionnaire in 2013. The sample was restricted to respondents aged >=65 years who were White (n = 789), Black (n = 108), or Hispanic (n = 61) and had biomarkers measured in 2012 and 2016 (n = 958). Serum Cys C (mg/L) was constructed to be equivalent to the 1999{\textendash}2002 NHANES scale. Dietary quality was measured using AHEI-2010. Autoregressive linear modeling adjusting for covariates and sampling design was used to examine the associations of interest.Mean serum Cys C was 1.20 {\textpm} 0.44 mg/L (SD) in 2012 and 1.25 {\textpm} 0.45 mg/L in 2016, and mean AHEI-2010 score was 58.11 {\textpm} 11.0. Greater AHEI-2010 was associated with lower serum Cys C level at baseline (b = -.004, SE = .013, P = .002) and less rapid increase in the Cys C level from 2012{\textendash}2016 (b = -.003, SE = .012, P = .024). The association between AHEI-2010 and change in serum Cys C was significantly different for Whites and Hispanics (b = .128, SE = .031, P \< .001), but null when comparing Whites and Blacks. AHEI-2010 was negatively associated with change in Cys C for Whites, and positively associated with change in Cys C among Hispanics. Stratified analyses suggested that AHEI-2010 was not significantly different for Whites and Hispanics. Hispanics had significantly lower household income, assets, and educational attainment than Whites, and greater levels of food insecurity.Our results indicate that dietary quality has a divergent association with change in serum Cys C for White and Hispanic older adults. These results suggest the need for examination of how disparities in socioeconomic status may influence the effect of dietary intake on kidney function for older adults from different racial/ethnic backgrounds.No funding.}, keywords = {Cystatin C, Racial Disparities, renal function}, isbn = {2475-2991}, doi = {10.1093/cdn/nzab053_008}, author = {Nicholas J Bishop and Zhu, Jie} } @article {bishop_zuniga_2020, title = {Investigating walnut consumption and cognitive trajectories in a representative sample of older US adults}, journal = {Public Health Nutrition}, volume = {24}, year = {2021}, pages = {1741-1752}, abstract = {Objective: Existing research suggests walnut intake may be associated with better cognitive function in older adults, yet few studies utilise longitudinal data from observational studies of ageing populations. Our objective was to estimate the association between whole walnut intake and cognitive change in a representative sample of older Americans. Design: Secondary analysis of the Health and Retirement Study and Health Care and Nutrition Study. Walnut consumption was defined as a categorical measure (none, low intake (0{\textperiodcentered}01{\textendash}0{\textperiodcentered}08 1 oz. servings per day) and moderate intake (>0{\textperiodcentered}08 1 oz. servings per day)) and cognitive function was measured using the Telephone Interview for Cognitive Status. Latent growth modelling estimated the association between walnut consumption and trajectories of cognitive status over a 4-year observational period. Sensitivity analyses assessing non-random dropout and Monte Carlo power analyses were conducted to contextualise results. Setting: The USA. Participants: A sample of 3632 US adults aged 65 years and older. Results: Those reporting any walnut consumption had greater cognitive scores at baseline than those not consuming walnuts (low walnut consumption, b = 1{\textperiodcentered}53, se = 0{\textperiodcentered}21, P < 0{\textperiodcentered}001; moderate walnut consumption, b = 2{\textperiodcentered}22, se = 0{\textperiodcentered}27, P < 0{\textperiodcentered}001), but walnut consumption was not associated with cognitive change. Walnut consumption was positively associated with socioeconomic status and health behaviours as well as intake of nutrients identified to have neuroprotective benefits. Conclusions: We identified an association between walnut consumption and cognitive function in older adults, although we did not find that walnut consumption was protective against age-related cognitive decline.}, keywords = {Cognitive decline, Walnuts}, doi = {10.1017/S1368980020001287}, author = {Nicholas J Bishop and Krystle E Zuniga} } @article {10642, title = {Identifying Moderators in the Link Between Workplace Discrimination and Health/Well-Being}, journal = {Frontiers}, year = {2020}, type = {Journal}, abstract = {The stress that arises from workplace discrimination can have a large impact on an employee{\textquoteright}s work attitude, their work and life satisfaction, and oftentimes whether or not they stay in a job. Workplace discrimination can also have a considerable influence on employees{\textquoteright} short- and long-term health. However, less is known about the factors that might mitigate or exacerbate the effects of discrimination on health. The current study focused not only on the links between workplace discrimination and health, and but also on the effects of potential moderators of the discrimination-health link (i.e., perceived control, Big Five personality traits, optimism, and coworker/supervisor support). People with high neuroticism, high extraversion and high agreeableness were more negatively affected by workplace discrimination than those low on neuroticism, extraversion, and agreeableness. Perceived control was found to be a protective factor, such that those high in perceived control had fewer chronic illnesses in the context of high levels of workplace discrimination.}, keywords = {Health and well-being, Personality, workplace discrimination, workplace support}, doi = {10.3389/fpsyg.2020.00458}, url = {https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00458/full}, author = {Yue Ethel Xu and William J. Chopik} } @article {10972, title = {The Illusory Benefit of Working Longer on Financial Preparedness for Retirement}, number = {2}, year = {2020}, institution = {The New School for Social Research}, address = {New York City}, abstract = {Older workers with insufficient savings are advised to delay retirement. Using Health and Retirement Study data, we compare outcomes of those who delay retirement, a possibly select group, with the predictions of a typical spreadsheet model. Work to age 70 is associated with an 18 percentage-point increase in the share financially prepared for retirement, compared with a predicted 46 percentage points because most older workers claim Social Security and retirement wealth barely increases. Drawing down retirement wealth while working makes sense for most, because earnings are lower than post-retirement income, in part because many older workers voluntarily work part time. }, keywords = {older worker labor supply, Retirement income, Social Security claiming}, url = {https://www.economicpolicyresearch.org/images/docs/research/retirement_security/The_Illusory_Benefits_of_Working_Longer_Working_Paper_2020.pdf}, author = {Teresa Ghilarducci and Papadopoulos, Michael and Anthony Webb} } @article {11373, title = {The Impact of Growing Health and Mortality Inequalities on Lifetime Social Security Payouts}, number = {MRDRC WP 2020-412}, year = {2020}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {The prevalence of obesity, diabetes, and other health problems has increased in recent decades in the United States, and there is a growing gap between the health and longevity of individuals with high socioeconomic status (SES) and low SES. These trends likely have implications for Social Security{\textquoteright}s financial position in the coming decades. Because high-SES individuals tend to receive higher annual benefits and live longer, increases in health and mortality inequalities may result in increases in aggregate Social Security payouts. This paper uses data from the Health and Retirement Study, and a microsimulation model of health, mortality, and Social Security benefits, to forecast lifetime Social Security benefits of the 1934 to 1959 birth cohorts in the U.S. We compare alternative assumptions about the future course of mortality. We find that accounting for health and mortality inequalities is important. In a baseline model that ignores trends in mortality inequalities, we estimate that lifetime Social Security benefits would grow by 26\% in real terms between the 1934 and 1959 birth cohorts due to increasing benefit levels and improvements in average mortality. When we account for mortality inequalities, we find an increase of 28\% to 38\% in average lifetime benefits, depending on the assumptions of the model. We also forecast lifetime benefits using the alternative assumption that improvements in population mortality will slow for younger birth cohorts.}, keywords = {health, mortality inequalities, Social Security}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp412.pdf}, author = {P{\'e}ter Hudomiet and Michael D Hurd and Susann Rohwedder} } @article {11346, title = {The Impact of Health on Wealth: Empirical Evidence}, number = {2020-19}, year = {2020}, institution = {University of Connecticut}, address = {Storrs, CT}, abstract = {This paper empirically evaluates the impact of health on wealth. Using the frailty index as a measure of health and carefully accounting for the dynamic relationship between frailty and wealth, I find that suffering one more health deficit leads, on average, to a 2.45 percent decline in the household net worth of individuals between age 50 and 100. The household net worth of individuals with no college degree, poor health, and over the age of 70 is significantly negatively affected by poor health. The results pass the tests of instrument validity and are consistent across several alternative definitions of wealth. Using financial net worth as a definition of wealth, I find that the average impact of frailty on wealth is the largest, while it is the smallest when wealth is defined to include only housing net worth.}, keywords = {health, Wealth}, url = {https://media.economics.uconn.edu/working/2020-19.pdf}, author = {Ghimire, Umesh} } @article {10954, title = {Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning}, journal = {Journal of General internal Medicine}, year = {2020}, abstract = {Background Limitations in instrumental activities of daily living (IADL) hinder a person{\textquoteright}s ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. Objective To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. Design A retrospective cohort study of the population-based Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. Subjects Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. Main Measures The main outcome was 30-day all-cause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. Key Results The overall 30-day readmission rate in the study was 16.4\%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmission (26\% readmitted). Multivariable regression analyses showed that ADL limitations were associated with 1.17 (1.06{\textendash}1.29) times higher risk of readmission even after adjusting for other patient covariates. Risk prediction was modest though for even the best model (AUC = 0.612). Conclusions IADL limitations are key predictors of 30-day readmission as demonstrated using several machine learning methods. Routine assessment of functional abilities in hospital settings could help identify those most at risk.}, keywords = {Activities of Daily Living, Health Services Research, multimorbidity, Patient Readmission, supervised machine learning}, isbn = {1525-1497}, doi = {https://doi.org/10.1007/s11606-020-05982-0}, author = {Nicholas K Schiltz and Dolansky, Mary A. and David F Warner and Kurt C Stange and Gravenstein, Stefan and Siran M Koroukian} } @mastersthesis {11385, title = {The impact of multimorbidity and financial resources on psychological well-being in later life}, volume = {Doctor of Philosophy}, year = {2020}, school = {Iowa State University}, address = {Ames, IA}, abstract = {The purpose of this dissertation is to examine the impact of multimorbidity and financial resources on psychological well-being in later life. Three research studies were conducted using data from the Health and Retirement Study (Studies 1 and 2) and the Georgia Centenarian Study (Study 3). Study 1 examined the longitudinal effects of multimorbidity on initial levels of wealth and depressive symptoms and the change in wealth and depressive symptoms over four time points. The growth curve analysis revealed that older adults presenting multimorbidity or higher number of chronic diseases and illnesses had significantly lower levels of initial wealth and higher levels of initial depressive symptoms. In addition, multimorbidity had a negative association with the linear change in wealth and a positive association with the linear change in depressive symptoms. The results indicate that older adults with a higher number of chronic diseases and illnesses experienced a linear decline in wealth and a linear increase in depressive symptoms. Study 2 examined the effects of multimorbidity and financial resources on depressive symptoms from an individual differences perspective through the five factor personality model. Direct and moderating effects of personality traits were examined. The results indicate that older adults with higher levels of neuroticism, openness to experience, and agreeableness, as well as lower levels of extraversion and conscientiousness reported higher levels of multimorbidity. Older adults with more chronic diseases and illnesses reported less wealth and more depressive symptoms. Also, older adults who reported less wealth reported more depressive symptoms. Furthermore, significant indirect effects were found. Multimorbidity had a positive indirect effect on depressive symptoms through wealth. Neuroticism, openness to experience, and agreeableness had a negative indirect effect on depressive symptoms through multimorbidity. Extraversion and conscientiousness had a positive indirect effect on wealth through multimorbidity. This indicates that older adults with higher levels of neuroticism, openness to experience, and agreeableness reported more chronic illness/diseases, which in turn negatively related to wealth. Lastly, three significant interactions were found. Neuroticism moderated the association of multimorbidity with depressive symptoms and extraversion moderated the association of multimorbidity with wealth. Furthermore, age moderated the association between multimorbidity with wealth. Study 3 examined the distal and proximal effects of multimorbidity and financial resources on the psychological well-being of centenarians through the developmental adaptation model. The results indicate that for centenarians, multimorbidity and financial resources did not significantly impact their psychological well-being. However, their perception of financial adequacy had a significant impact on their experience of negative emotions. In addition, years of education had a stronger impact on perceptions of financial adequacy. The findings from the three studies provide support to previous literature and contribute to the literature on the importance of examining the impact of multimorbidity and financial resources on psychological well-being in later life. }, keywords = {Finances, multimorbidity, Well-being}, url = {https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=9346\&context=etd$\#$page=80}, author = {Kim, Joseph} } @article {10928, title = {The Impact of Region and Urbanicity on the Discrimination-Cognitive Health Link Among Older Blacks}, journal = {Research in Human Development}, volume = {17}, year = {2020}, pages = {4 - 19}, abstract = {Little research has examined how the link between discrimination and cognitive health varies by where people live. This study investigates how living in non-urban versus urban areas in different regions in the United States moderates the discrimination-cognitive health link among older non-Hispanic Blacks. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS; N = 2,347). Regression analyses indicate that experiencing more everyday discrimination is significantly associated with lower episodic memory when living in urban areas. Among non-Hispanic Blacks, the discrimination-episodic memory link does not significantly vary across U.S. regional contexts. Findings highlight variation in the association between everyday discrimination and cognitive health by where older non-Hispanic Blacks live. Results suggest the importance of socio-environmental factors in shaping how stressful experiences such as discrimination are linked to cognitive health in later life.}, keywords = {Cognitive health, Discrimination, non-urban versus urban areas}, isbn = {1542-7609}, doi = {10.1080/15427609.2020.1746614}, author = {Kimson E Johnson and Sol, Ketlyne and Sprague, Briana N. and Tamara J. Cadet and Mu{\~n}oz, Elizabeth and Noah J Webster} } @article {11083, title = {The Impact of Rising Household Debt Among Older Americans}, journal = {EBRI Issue Brief}, volume = {502}, year = {2020}, publisher = {Employee Benefit Research Institute}, chapter = {22}, address = {Washington, D.C.}, abstract = {As older households transition into retirement, their labor income, as well as their ability to accumulate more income-producing assets, declines and they will need to primarily live off their retirement plans and Social Security income. Carrying debt through retirement affects retirees{\textquoteright} financial security as they have more expenses to cover with limited resources. As such, having debt at older ages can affect the timing of retirement and Social Security claiming. This in particular is important as Baby Boomers continue to enter retirement in large numbers and, according to many studies, are known not to be well prepared financially for retirement. }, keywords = {household debt, Older Americans}, url = {https://www.ebri.org/content/the-impact-of-rising-household-debt-among-older-americans}, author = {Zahra Ebrahimi} } @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} } @article {10965, title = {Impact of Social, Contextual, and Behavioral Factors on Health Status Among Asian Populations Across the United States, China, and Korea...2020 AOTA Annual Conference \& Expo}, journal = {American Journal of Occupational Therapy}, volume = {74}, year = {2020}, abstract = {PURPOSE: Although cross-national comparisons for patterns of aging populations are feasible due to the existing national micro-data, few studies have attempted to examine different social, cultural, and policy contexts that influence aging across countries in Asian populations. This study aims to examine the social, contextual, and behavioral factors that influence functional status across the three Asian populations. DESIGN: A secondary data analysis was performed on three national surveys: the 2012 Health and Retirement Study, the 2012 China Health and Retirement Longitudinal Study, and the 2012 Korean Longitudinal Study of Aging. METHOD: We retrieved a representative sample of 211 American Asian adults, 13,649 Chinese adults, and 7,486 Korean adults from the national aging surveys. Survey participants were population-based national samples of individuals over 50 years old and lived in community settings. Hierarchical regression models were utilized to compare health status and examine the influence of social-contextual factors on health status across the American Asian, Chinese, and Korean adults. The self-rated health question (1-very good to 5-very bad) was the dependent variable and was identified in all three surveys as a common metric for health status (Cieza et al., 2015; Hong et al., 2018). Social-contextual factors were used as independent variables, including: age, sex, living arrangement, employment status, self-rated health, body mass index (kg/m2), cognitive status (CESD depression score, orientation, and serial 7{\textquoteright}s test score), chronic conditions (stroke, arthritis, diabetes, hypertension, cancer, heart problem), number of people in house, number of living parents, children, siblings, children living in the same city, weekly contact with children, weekly religious participation, and financial transfer from/to children. The regression coefficients (β) on the study variables in regression model were examined to compare the effects of family and environmental factors on health status across countries. RESULTS: The mean age of the sample was 63.8 years (SD=9.5). The majority of the sample lived with a spouse/partner (81.6\%), female (52.8\%), and employed (53.8\%). The unadjusted self-rated health status scores revealed that American Asian had significantly better health status (Mean=2.5, SD=0.06) than Korean (Mean=3.7, SD=0.01) and Chinese adults (Mean=3.9, SD=0.01). Health status orders did not change even after accounting for the social-contextual factors. Age, depression scores, chronic conditions, and receipt of financial assistance from children were significantly associated with poor health status (p<0.05). Factors significantly associated with good health (p<0.05) are: higher education attainment, current employment, active lifestyle, higher cognitive function, social participation, and giving financial support to their children. CONCLUSION: Study findings that the American Asian adults are healthier than the Korean and Chinese adults. We speculate that the majority of the differences across the three countries may be due to differences in the rate of the aging populations or different cultural aspects for the aging populations. Policy makers and clinicians would need to investigate the negative driving factors on health status in China and Korea or adapt the US health policies to improve healthy aging among the adults in the two countries.}, keywords = {Asians, CHARLS, Congresses and Conferences, Functional status, KLoSA, Social determinants of health}, isbn = {0272-9490}, doi = {https://doi.org/10.5014/ajot.2020.74S1-PO3606}, author = {Ickpyo Hong and Pryor, Loree and Kitchens, Riqiea} } @article {9724, title = {The Impact of Stressful Life Events on the Incidence of Type 2 Diabetes in U.S. Adults from the Health and Retirement Study.}, journal = {The Journals of Gerontology: Series B}, volume = {75}, year = {2020}, pages = {640-649}, abstract = {

Objectives: We evaluated the association between cumulative stressful life events (SLE) and type of stress (lifetime vs. recent) and incident diabetes (T2DM) in middle-aged U.S. adults.

Methods: Data from the 2006-2014 waves of the Health and Retirement Study (HRS) were analyzed (n = 7956). Stress-related differences in age at T2DM diagnosis were estimated using Cox proportional hazards models.

Results: The adjusted risk of T2DM significantly increased by six percent per unit increase in cumulative SLE (95\% CI = 1.03, 1.11), by five percent per unit increase in lifetime stress (95\% CI = 1.00, 1.09), and by 23\% per unit increase in recent stress (95\% CI = 1.12, 1.36). Each level of cumulative SLE (one, two, three, and > four events) and recent stress (one and > two events) compared to no stress was significantly associated with an increased risk of T2DM. Each level of lifetime stress compared to no stress was significantly associated with an elevated risk of T2DM except for three events.

Discussion: Cumulative SLE and type of stress were associated with incident T2DM in middle-aged adults. Reducing the direct effect of stress with management interventions may reduce the indirect effect of developing T2DM and warrants further investigation.

}, keywords = {Depressive symptoms, Diabetes, Health Factors, Stress}, issn = {1758-5368}, doi = {10.1093/geronb/gby040}, author = {Betsy E Smith and Toni Miles and Elkins, Jennifer and Jennifer L. Barkin and Mark H. Ebell and Amara E. Ezeamama} } @article {10703, title = {The Impact of Varying Levels of Advance Care Planning Engagement on Perceptions of the End-of-Life Experience Among Caregivers of Deceased Patients With Cancer}, journal = {American Journal of Hospice and Palliative Medicine}, year = {2020}, note = {PMID: 32281390}, type = {Journal}, abstract = {Context:Advance care planning (ACP) is used to prepare patients and caregivers for future {\textquotedblleft}in the moment{\textquotedblright} decisions at the end-of-life. Patients with cancer generally do not engage in all 3 components of ACP (documented living will, health-care surrogate, end-of-life discussions); however, little is known about the impact of these varying levels of ACP engagement on caregivers postdeath.Objective:To examine the relationship between varying levels of ACP engagement and caregivers{\textquoteright} perceptions of cancer decedents{\textquoteright} end-of-life experiences.Methods:A secondary analysis of the 2002 to 2014 waves of the Health and Retirement Study data using structural equation modeling was conducted. Five levels of ACP engagement were defined: full (discussions/documents), augmented discussions, documents only, discussions only, and no engagement.Results:Among the 2172 cancer death cases, the analyzed sample included 983 cases where end-of-life decisions occurred. Compared to no ACP, all levels of ACP were significantly associated with caregivers{\textquoteright} positive perceptions of cancer decedents{\textquoteright} end-of-life experiences (P <= .001), controlling for sex, race, and Hispanic ethnicity (R 2 = .21). However, the relative impact of each level of ACP engagement was not equal; full engagement (β = .61) was associated with a greater impact compared to each of the partial levels of engagement (augmented discussions [β = .33], documents only [β = .17], discussions only [β = .17]).Conclusion:Partial ACP engagement, not just nonengagement, serves as an important clinically modifiable target to improve the end-of-life care experience among patients with cancer and the perceptions of those experiences among bereaved caregivers.}, keywords = {Advance care planning, advance directive, Bereavement, Cancer, caregiver, end-of-life}, doi = {10.1177/1049909120917899}, url = {https://www.ncbi.nlm.nih.gov/pubmed/32281390}, author = {Kristin Levoy and Harleah Buck and Victoria Behar-Zusman} } @article {10916, title = {The Implications of Providing Grandchild Care for Grandparents{\textquoteright} Marital Quality}, journal = {Journal of Family Issues}, year = {2020}, abstract = {This study distinguished among types of grandchild care (i.e., co-residence, high and low levels of babysitting, and no care), and examined their associations with grandparents? marital quality. The sample consisted of 7,267 married grandparents aged 40 years and over from the 2008, 2010, and 2012 waves of the Health and Retirement Study. Providing grandchild care generally undermined grandparents? marital quality; however, different types of grandchild care affected different aspects of marital quality. The negative effects of providing grandchild care were more pronounced among grandmothers than grandfathers. Grandmothers providing high-level babysitting care were at especially higher risk of experiencing marital strain among the caregiver groups. Findings suggest that providing grandchild care appears to be more of a stressor than a source of reward with respect to shaping grandparents? marital quality. Sensitivity to such impact on marital quality may be usefully incorporated into developing supports and services meant for grandparent caregivers.}, keywords = {Child Care, dyadic relationship/quality/satisfaction, gender and family, intergenerational, quantitative}, isbn = {0192-513X}, doi = {10.1177/0192513X20934845}, author = {Wang, Shuangshuang and Jan E Mutchler} } @article {11205, title = {Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia.}, journal = {Neuroepidemiology}, year = {2020}, abstract = {

INTRODUCTION: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches.

METHODS: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study.

RESULTS: Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment.

DISCUSSION/CONCLUSIONS: Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.

}, keywords = {Algorithms, Dementia, Diagnosis, Medicare, Sensitivity and Specificity}, issn = {1423-0208}, doi = {10.1159/000510753}, author = {Melinda C Power and Kan Z Gianattasio and Ciarleglio, Adam} } @article {10993, title = {The Importance of Gradual Retirement in America Today}, journal = {Public Policy \& Aging Report}, volume = {30}, year = {2020}, month = {2020}, pages = {107 - 112}, keywords = {bridge jobs, economics of aging, gradual retirement}, isbn = {1055-3037}, doi = {https://doi.org/10.1093/ppar/praa013}, author = {Kevin E. Cahill and Joseph F. Quinn} } @article {11177, title = {Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study.}, journal = {American Journal of Industrial Medicine}, year = {2020}, abstract = {

BACKGROUND: Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD).

METHODS: The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort{\textquoteright}s baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death.

RESULTS: SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash.

CONCLUSIONS: Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.

}, keywords = {COPD, exposure, longitudinal, Occupation}, issn = {1097-0274}, doi = {10.1002/ajim.23196}, author = {Silver, Sharon R and Alarcon, Walter A and Li, Jia} } @article {11194, title = {Income Dynamics and Consumption Insurance}, year = {2020}, institution = {University of Pennsylvania}, abstract = {An accurate quantitative analysis using lifecycle incomplete markets models requires that they match both the total amount of insurance available to households in the data and the empirical importance of the sources of insurance such as, e.g., household saving and borrowing or the tax and transfer system. The prominent empirical benchmark estimates of the extent and sources of insurance provided in Blundell, Pistaferri and Preston (American Economic Review, 2008) imply that the currently used models poorly fit these data. We show that this is because the income process used as an input in the incomplete markets models and when constructing the empirical benchmark estimates of insurance abstracts from the irregular nature of income observations at the start and end of family income spells. When ignored, this feature of the income data induces a large bias in the empirical measures of the degree and sources of insurance and results in a misleading assessment of the models{\textquoteright} performance. The empirical measures of insurance accounting for the bias imply a limited role of assets and taxes and transfers in insuring permanent shocks to household budgets.}, keywords = {consumption, Income and wealth, Insurance}, url = {https://www.sas.upenn.edu/~manovski/papers/Inc_Dyn_Cons_Ins.pdf}, author = {Dmytro Hryshko and Iourii Manovskii} } @article {11267, title = {Income Security and Financial Wellbeing of Older Workers Transitioning into Retirement }, year = {2020}, note = {Research Grant from Institute of Consumer Money Management}, institution = {North Carolina State University}, address = {Raleigh, NC}, abstract = {This report begins with a discussion of the literature on income replacement and income security as older workers transition into retirement. In addition, literature on the financial distress and financial literacy of elderly households is reviewed. Section III describes our data sources and dataset construction. Section IV presents descriptive statistics on income replacement of recent retirees while Section V examines the characteristics of subgroups experiencing large income changes. Finally, Section VI shows regression analysis of the factors associated with income changes and studies the link between income changes and financial distress. Appendix A and Appendix B offers description of our samples of North Carolina public workers and HRS respondents in greater detail. Appendix C includes tables on sample characteristics and regression analysis of additional outcomes. Appendix D records the survey questions we use to create key variables for our North Carolina dataset.}, keywords = {income changes, pension benefits, Retirement}, url = {https://siyanliu.wordpress.ncsu.edu/files/2020/11/Liu_Siyan_ICMM_Report.pdf}, author = {Robert Clark and Liu, Siyan} } @conference {11020, title = {Income-poor but Asset-rich: Effect of housing wealth on older adults{\textquoteright} healthcare utilization}, year = {2020}, publisher = {IZA Institute of Labor Economics}, organization = {IZA Institute of Labor Economics}, abstract = {Do wealthier individuals use more healthcare services than those less affluent? We investigate this question by exploiting the booms and busts in the U.S. housing market {\textendash} a natural experiment that generated considerable gains and losses for homeowners. We estimate the effect of wealth on older adults{\textquoteright} healthcare utilization using the Instrumental Variables (IVs) approach with the region - year variations in house prices and households{\textquoteright} loan-to-value (LTV) ratios to construct an instrument. As a robustness check for count-valued outcomes, we employ a new method of identification using heteroskedasticity (Lewbel, 2012). This method may be used to estimate a count model with endogenous regressors, where external instruments are not available. Using data from the 1996-2014 Health and Retirement Study (HRS), we find that an increase in wealth lowers the probability of hospital admissions, visits to doctors, prescription drug use, outpatient surgery and the use of special facilities or services. On the other hand, an increase in wealth leads to a higher probability of using dental services. At the intensive margin, the number of doctor visits decreases in response to positive wealth shock, but there is no significant effect on the number of nights in hospital. Overall, we find consistent evidence that wealthier individuals demand fewer health services but they have more out-of-pocket health expenditures compared to less wealthy individuals.}, keywords = {healthcare utilization, Housing wealth, Identification}, url = {http://conference.iza.org/conference_files/UniDuisburg_2020/tran_m29963.pdf}, author = {Tran, My and Gannon, Brenda and Rose, Christiern} } @article {10809, title = {Incorporating Long-Term Services and Supports in Health Care Proposals: Cost and Distributional Considerations}, year = {2020}, institution = {Urban Institute }, address = {Washington, D.C.}, abstract = {Recent health care reform proposals have included coverage for long-term services and supports (LTSS), reflecting a fundamental change in the way many policymakers discuss health care. To inform broader discussions of these health care reform proposals, we project costs and distributional effects for three stylized proposals for public LTSS benefits. Each proposal would significantly expand the public role in financing LTSS relative to current law. All proposals would have broad eligibility criteria and generous benefit packages, consistent with recent proposals for single-payer health care plans, and would address family burdens and care inadequacies under current law. Our stylized scenarios are intended to represent some proposals{\textquoteright} intentions without exactly matching any specific proposal. The three public LTSS benefit options are as follows:  Option 1 (Base): Expanded access to home- and community-based services based on Health Insurance Portability and Accountability Act standards. This option would use Health Insurance Portability and Accountability Act definitions of disability for eligibility and provide a broad package of home- and community-based services. It would increase total LTSS spending by nearly $240 billion and federal spending by $355 billion. It would also greatly expand formal service use, reduce state Medicaid responsibilities, and alleviate family cost-sharing burdens.  Option 2: Expanded access to home- and community-based services with an institutional benefit. This second option would build on the first reform option, using the same definition of disability and providing the same home- and community-based services, but would also include institutional care benefits. This option would increase total LTSS spending by about $255 billion and federal spending by $450 billion; this difference in cost from option 1 largely owes to further reduced state burdens.  Option 3: Expanded access to home- and community-based services based on less strict standards. This option would use a broader disability definition and thus cover significantly more people. We project that it could increase total spending by $321 billion and federal costs by almost $526 billion. Families across the income distribution would benefit from expanded LTSS under all three options; people with the lowest incomes would receive the greatest benefits, and those in the middle of the income distribution would experience relief from cost sharing given their greater exposure to high out-of-pocket LTSS costs. All families would thus receive protection from a risk for which few are now covered.Given the lack of precedent for these proposals, we present ranges for our projections to underscore their uncertainty and dependence on assumptions.}, keywords = {health care reform, Long-term services and supports}, url = {https://www.urban.org/sites/default/files/publication/102311/incorporating-long-term-services-and-supports-in-health-care-proposals.pdf}, author = {Melissa Favreault} } @article {10995, title = {Increases in BMI and Chronic Pain for US Adults in Midlife, 1992 to 2016}, journal = {SSM - Population Health}, year = {2020}, abstract = {Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20\% of the upward trend in mild/moderate nonlimiting pain and 32\% of the trend in severe and/or limiting pain for women, and 10\% and 19\% of the trends respectively for men.}, keywords = {activity limitations, Obesity, pain, Trends}, isbn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2020.100644}, author = {Andrew C. Stokes and Xie, Wubin and Lundberg, Dielle J. and Hempstead, Katherine and Zajacova, Anna and Zachary Zimmer and Dana A Glei and Meara, Ellen and Samuel H. Preston} } @article {10873, title = {Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability}, journal = {Annals of Behavioral Medicine}, volume = {54}, year = {2020}, pages = {455 - 469}, abstract = {Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability.We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability.The U.S. sample included 3,991 couples drawn from nine waves (1998{\textendash}2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner{\textquoteright}s baseline depressive symptoms, and each partner{\textquoteright}s number of chronic conditions across waves.Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels.Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.}, keywords = {Chronic illness, Disability, multimorbidity, Spouses}, isbn = {0883-6612}, doi = {10.1093/abm/kaz061}, author = {Courtney A Polenick and Kira S. Birditt and Turkelson, Angela and Helen C Kales} } @article {Kang:2020:1087-3244:159, title = {The Influence of Cognitive Impairment on Health Behaviors among Older Adults}, journal = {American Journal of Health Behavior}, volume = {44}, year = {2020}, pages = {159-168}, abstract = {Objectives: Previous research on cognitive impairment and health behaviors has focused largely on how health behaviors affect cognition; rarely has it examined whether cognitive impairment affects health behaviors. The purpose of this study was to examine the impact of cognitive impairment on engagement in health behaviors among older adults. Methods: The study sample included 19,644 adults aged 50 or older from the Health and Retirement Study 1995-2012 surveys. We used mixed-effects logistic regression to analyze the influence of cognitive impairment, measured using the Telephone Interview for Cognitive Status, on the engagement of health behaviors including physical activity, smoking, and drinking. Results: Cognitive impairment without dementia [CIND] (OR = .84, 95\% CI = .80-.89) and dementia (OR = .68, 95\% CI = .61-.75) were associated with a lower likelihood of engaging in regular vigorous physical activity during longitudinal follow-up, after adjusting for covariates. CIND or dementia was not significantly associated with the likelihood of smoking or alcohol consumption. Conclusions: CIND and dementia are risk factors for physical inactivity among older adults. Promotion of regular physical activity should be an essential component of health promotion programs for persons with cognitive impairment.}, keywords = {Cognition, health}, issn = {1087-3244}, doi = {doi:10.5993/AJHB.44.2.4}, url = {https://www.ingentaconnect.com/content/png/ajhb/2020/00000044/00000002/art00004}, author = {Kang, Sung-wan and Xiang, Xiaoling} } @article {11078, title = {The Influence of Early-life Economic Shocks on Long-term Outcomes: Evidence from the U.S. Great Depression}, number = {2020-11}, year = {2020}, institution = {The University of Sydney}, address = {Sydney}, abstract = {We show that health and productivity around retirement age, and earnings over the life cycle, vary with exposure to economic conditions in early life. Using state-yearlevel variation from the most severe and prolonged economic downturn in American history{\textemdash}the Great Depression{\textemdash}combined with restricted micro-data from the Health and Retirement Study, we find that changes in macroeconomic indicators before age 6 are associated with changes in economic well-being, earnings, metabolic syndrome, and physical limitations decades later. We also document large declines in long-term mortality. Results are not driven by endogenous fertility responses throughout the 1930s. Our results help inform the design of retirement and healthcare systems and the long-term costs of business cycles. }, keywords = {Aging, Human capital, Poverty, Unemployment}, url = {http://econ-wpseries.com/2020/202011.pdf}, author = {Duque, Valentina and Lauren L Schmitz} } @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 {10175, title = {Influence of senior housing types on cognitive decline and nursing home admission among lower-income older adults.}, journal = {Aging \& Mental Health}, volume = {24}, year = {2020}, pages = {1579-1588}, type = {Journal}, abstract = {Focusing on unique ageing populations in subsidized senior housing for lower-income older adults, this study contributes to literature on housing and aging; provides initial understanding of existing housing types; and explores the extent to which living in different housing types may influence changes in cognitive function and likelihood of nursing home admission. Data came from seven waves (2002-2014) of the Health and Retirement Study. A latent-class clustering approach was used to identify senior-housing types among lower-income older people; We identified four discernible housing types among lower-income older adults: (1) High physical \& Low service, (2) Low physical \& Low service, (3) High physical \& High service, and (4) Medium physical \& High service. Individuals in Medium physical \& High service and High physical \& Low service types were likely to have higher cognitive-function levels at baseline ( = 0.58, < .001; 0.58, < .001) and slower rates of decline over time ( = 0.42, < .001; = 0.32, < .01). Older adults in High physical \& High service are significantly less likely to be admitted to a nursing home (OR = 0.55, < .00). The mismatch between health needs and lack of service and support suggests that current residents in each housing type relocate, based on knowledge of subsidized housing or availability. Future studies should examine possible mismatches between health needs and housing environment.}, keywords = {Cognitive Ability, Financial Health, Nursing homes}, issn = {1364-6915}, doi = {10.1080/13607863.2019.1650888}, author = {So Jung Park and BoRin Kim and Kwon, Eunsun and Kown, Goeun} } @article {11164, title = {The Influence of the BDNFVal66Met Polymorphism on the Association of Regular Physical Activity With Cognition Among Individuals With Diabetes.}, journal = {Biological Research for Nursing}, year = {2020}, abstract = {

INTRODUCTION: Diabetes is associated with cognitive dysfunction that comes with substantial lifetime consequences, such as interference with diabetes self-management and reduced quality of life. Although regular physical activity has been consistently shown to enhance cognitive function among healthy subjects, significant interpersonal differences in exercise-induced cognitive outcomes have been reported among (BDNF) Val/Val vs. Met carriers. However, the evidence on how the Val66Met variant influences the relationship between regular physical activity and cognition among individuals with diabetes is currently lacking.

METHODS: A total of 3,040 individuals with diabetes were included in this analysis using data from the Health and Retirement Study. Associations among moderate and vigorous physical activities (MVPA) and measures of cognitive function were evaluated using multivariable linear regression models within each stratum of the Val66Met genotypes.

RESULTS: MVPA was more strongly associated with total cognitive score, mental status, and words recall among Met/Met carriers, compared to Val/Val and Val/Met carriers.

CONCLUSIONS: This study provided preliminary findings on how variants may modulate the exercise-induced cognitive benefits among mid-aged and older adults with diabetes. Given the limitations of the current study, it is necessary for randomized controlled trials to stratify by genotypes to more conclusively determine whether Met carriers benefit more from increased physical activity. In addition, future research is needed to examine how the interplay of Val66Met variants, DNA methylation, and physical activity may have an impact on cognitive function among adults with diabetes.

}, keywords = {Brain-Derived Neurotrophic Factor, Cognition, Diabetes Mellitus, Exercise, Gene-Environment Interaction}, issn = {1552-4175}, doi = {10.1177/1099800420966648}, author = {Liu, Tingting and Canon, McKenzie D and Shen, Luqi and Marples, Benjamin A and Colton, Joseph P and Lo, Wen-Juo and Gray, Michelle and Li, Changwei} } @article {11257, title = {The Interaction of Health, Genetics, and Occupational Demands in SSDI Determinations}, number = {NB20-11}, year = {2020}, institution = {National Bureau of Economic Research, Retirement and Disability Research Center}, address = {Cambridge, MA}, abstract = {Evaluations of Social Security Disability Insurance (SSDI) applications are based not only on poor health, but in many cases, consider the vocational factors of age, education and work experience to determine whether individuals can work. SSDI determinations based on these factors have grown threefold since 1985 (Michaud, Nelson, and Wiczer 2016). Yet little is known about the relationship between SSDI activity and the ability to meet occupational requirements (Rutledge, Zulkarnain, and King 2019). Moreover, there is strong evidence that morbidity and mortality are distributed unequally across occupations (Marmot et al. 1991), perhaps because differential work environments may exacerbate disability but also because individual-level underlying health is unlikely to be randomly distributed across occupations (Mackenbach et al. 2017). Together, these phenomena result in complex relationships of SSDI determinants with both the independent and joint effects of health and occupational demands. Disentangling the contributions of these forces is challenging, because selection into occupations by health is often unobserved and because data on occupational demands for employment histories is limited. We propose to triangulate between these factors by using a rich set of data linkages from the Health and Retirement Study, including linkage to the Social Security Administration (SSA) disability application file (831 file), and the Department of Labor{\textquoteright}s O*Net job classification system.}, keywords = {Genetics, health, Occupation, SSDI}, url = {https://www.nber.org/programs-projects/projects-and-centers/retirement-and-disability-research-center/center-papers/nb20-11}, author = {Harrati, Amal and Lauren L Schmitz} } @article {10926, title = {Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study}, journal = {Research in Human Development}, volume = {17}, year = {2020}, month = {2020/01/02}, pages = {41 - 56}, abstract = {Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.}, keywords = {Chronic disease, Cognition, Financial hardship}, isbn = {1542-7609}, doi = {10.1080/15427609.2020.1746159}, author = {Byrd, DeAnnah R. and Gonzales, Ernest and Beatty Moody, Danielle L. and Gillian L Marshall and Laura B Zahodne and Roland J. Thorpe Jr. and Keith E Whitfield} } @article {10913, title = {Inter-Cohort Variations in the Education-Health Gradient: Socio-Historical Changes in Early-Life Selection Mechanisms in the U.S.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2020}, abstract = {

OBJECTIVES: Most prior studies on cohort-specific changes in the education gradient relative to health treat the distribution of education within a particular cohort as a "starting place" for understanding later life health disparities. This premise has obfuscated the role that socio-historical changes in early-life selection mechanisms play in the widening of education-based inequalities in functional limitations across birth cohorts.

METHOD: Drawing from the Health and Retirement Survey (1992-2016; n=20,920), this study employs inverse probability weight (IPW) to account for early-life selection mechanisms that are likely to impact both educational attainment and functional limitations. IPW adjusted generalized linear mixed effects models were used to estimate the total effect of education on functional limitations across birth cohorts (born 1924-1959).

RESULTS: A significant linear decline in the negative effects of childhood socioeconomic disadvantage on education (β =0.005, p<0.01) over birth year was documented. By contrast, the same variable{\textquoteright}s negative effect on functional health increased significantly (β =0.006, p<0.001) across cohorts. Adjustment for childhood socioeconomic status did yield narrower education-based inequalities in functional limitations, but the difference between IPW adjusted and unadjusted results was not statistically significant. The pattern of significant widening of education-based inequalities (β =-0.05, p<0.001) in functional limitations across birth cohorts was maintained.

DISCUSSION: This study underscores the role that socio-historical changes in early-life selection mechanisms play in modifying patterns of education-based inequalities in health across cohorts.

}, keywords = {Childhood, Educational Status, health disparity, Older adult, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa100}, author = {Bhatta, Tirth R} } @article {10981, title = {Intercohort Variations in the Education{\textendash}Health Gradient: Sociohistorical Changes in Early-Life Selection Mechanisms in the United States}, journal = {The Journals of Gerontology: Series B}, year = {2020}, month = {2020}, abstract = {Most prior studies on cohort-specific changes in the education gradient relative to health treat the distribution of education within a particular cohort as a {\textquotedblleft}starting place{\textquotedblright} for understanding later-life health disparities. This premise has obfuscated the role that sociohistorical changes in early-life selection mechanisms play in the widening of education-based inequalities in functional limitations across birth cohorts.Drawing from the Health and Retirement Survey (1992{\textendash}2016; n = 20,920), this study employs inverse probability weight (IPW) to account for early-life selection mechanisms that are likely to affect both educational attainment and functional limitations. IPW-adjusted generalized linear mixed-effects models were used to estimate the total effect of education on functional limitations across birth cohorts (born 1924{\textendash}1959).A significant linear decline in the negative effects of childhood socioeconomic disadvantage on education (β = 0.005, p \< .01) over the birth year was documented. By contrast, the same variable{\textquoteright}s negative effect on functional health increased significantly (β = 0.006, p \< .001) across cohorts. Adjustment for childhood socioeconomic status did yield narrower education-based inequalities in functional limitations, but the difference between IPW-adjusted and unadjusted results was not statistically significant. The pattern of significant widening of education-based inequalities (β = -0.05, p \< .001) in functional limitations across birth cohorts was maintained.This study underscores the role that sociohistorical changes in early-life selection mechanisms play in modifying patterns of education-based inequalities in health across cohorts.}, keywords = {Cohort Analysis, Functional limitations, life course}, isbn = {1079-5014}, doi = {https://doi.org/10.1093/geronb/gbaa100}, author = {Bhatta, Tirth R} } @article {10973, title = {Intergenerational Altruism and Retirement Transfers: Evidence from the Social Security Notch}, journal = {The Journal of Human Resources}, year = {2020}, abstract = {I contribute new evidence on altruistic preferences in intergenerational transfers using variation in Social Security benefits induced by an inflation-indexing mistake. The instrument is most relevant for those with low education, so I focus on this group. I find support for pure altruism because individuals who received additional Social Security benefits passed on 15.4 percent to children via inter vivos transfers without receiving any additional care in return. On the contrary, children reduce caregiving monotonically with increases in parental Social Security benefits. Adult female children appear to be the most affected as they both receive monetary transfers and reduce caregiving.}, keywords = {Altruism, Caregiving, Intergenerational transfers, Social Security}, doi = {10.3368/jhr.58.1.0419-10140R3}, author = {Mukherjee, Anita} } @mastersthesis {10925, title = {Intergenerational Relationships and Sleep in Aging Families}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Massachusetts, Boston}, address = {Boston}, abstract = {Sleep is a fundamental health behavior that has implications for physical and psychological well-being across the life course. As people age, they have increased concerns about sleep. This dissertation comprises three studies that provide complementary perspectives on how intergenerational relationships are associated with sleep for older adults. Using 2006, 2010, and 2014 waves data of the Health and Retirement Study, Study 1 examined the bidirectional link between parent-child relationship quality and insomnia among U.S. older adults (N = 3,567). Results from autoregressive cross-lagged panel models showed that negative parent-child relationship quality at earlier waves was indirectly associated with older parents{\textquoteright} insomnia in later waves through depressive symptoms. Older parents{\textquoteright} insomnia at earlier waves was related to more depressive symptoms in later waves, which further led to more strained parent-child relationship quality. Study 2 investigated the psychological mechanisms linking parent-child relationships and sleep among U.S. older adults. This study used self-reported sleep quality and actigraph-measured sleep characteristics from the second wave of the National Social Life, Health, and Project (N = 548). Results from structural equation modeling showed that parents{\textquoteright} closeness with their children was associated with better objective sleep characteristics, and more frequent contact with their children was related to fewer insomnia symptoms. Moreover, less closeness with children was related to more insomnia via depressive symptoms among older adults. Study 3 drew data from the 2014 China Longitudinal Ageing Social Survey and analyzed older parents{\textquoteright} (N = 8,450) reports on their sleep quality and relationships with each of their children. Results from logistic regression models showed that living alone, greater variation in children{\textquoteright}s financial transfers and emotional closeness, and more instrumental support from children were associated with higher risk of sleep difficulty for Chinese older parents with multiple children. Greater instrumental support from offspring was associated with a higher risk of sleep difficulty for parents from one-child families. Focusing on an increasingly important public health issue, this research adds to the scientific knowledge of how intergenerational relationships are associated with sleep in later life. Findings from three studies highlights the importance of parent-child relationships for sleep health in multigenerational families.}, keywords = {insomnia, Parent-Child Relations, Sleep}, url = {https://scholarworks.umb.edu/doctoral_dissertations/557/}, author = {Wang, Haowei} } @article {10.1093/geronb/gby156, title = {Inter-Individual Variability in Trajectories of Functional Limitations by Race/Gender}, journal = {The Journals of Gerontology: Series B}, volume = {75}, year = {2020}, month = {01}, pages = {1082-1092}, abstract = {Several theories emphasize that systematic interindividual divergence is a key feature of cohort aging and evidence for accumulative social inequality over the life course. While many have documented widening health gaps with age between subgroups, such divergence is only one aspect of the broader social inequality based on race and gender. This article examines patterns of interindividual variability in trajectories of functional limitations within each race/gender.Using data from the Health and Retirement Study (HRS){\textquoteright}s HRS cohort (born 1931{\textendash}1941), I estimate growth curves of functional limitations with Level 2 heteroscedasticity, allowing interindividual variability to differ across 4 groups: white men, black men, white women, and black women. I examine race/gender differences in the age-based pattern of interindividual variability using an interquartile range of estimated individual trajectories.Black men, white women, and black women have greater interindividual variability in functional limitations than do white men. Interindividual variability increases systematically with age at similar rates for all groups but black women.Functional limitations become more heterogeneous with age for the entire cohort and for white men, white women, and black men. Future research should identify life-course processes that generate the race and gender patterning of interindividual variability in late-life health.}, keywords = {Differential aging, Health inequalities, Heteroscedasticity}, issn = {1079-5014}, doi = {10.1093/geronb/gby156}, author = {Lin, Jielu} } @article {11304, title = {Intersectional Discrimination Attributions and Health Outcome among American Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {871}, abstract = {Discrimination has been consistently documented to relate to adverse health outcomes. However, most existing research focused on a single discrimination attribution (e.g. ageism). Few studies considered multifaceted discrimination attributions. Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged \>50) from the Health and Retirement Study in 2014-2015 were included in the analysis (n=6,286). Their experiences and self-perceived reasons (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) for everyday discrimination were examined. Latent class analysis was employed to ascertain the profiles of subgroups characterized by their intersectional discrimination attributions. Regression models examined the correlates of the class memberships and the associations with health outcomes. Six classes were identified: class 1 (54.52\% of the sample) had no/minimal discrimination experience; Class 2 (21.89\%) experienced primarily ageism; class 3 (8.81\%) reported discrimination based on age/gender/national origin/race; class 4 (7.99\%) attributed discrimination to financial/other reasons; class 5 (5.87\%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92\%) perceived discrimination from almost every aspect. Intersectional discrimination attributions were associated with poorer self-rated health, and greater levels of depressive symptoms and loneliness. The associations between intersectional discrimination and cognition were not statistically significant. This study found multiple marginalized identities co-occur and compound to contribute to perceived everyday discrimination among American older adults. Those experiencing discrimination due to multiple reasons warrant particular attention. Results underscore the utility of an intersectional approach in understanding discrimination in later life.}, keywords = {health outcomes, intersectional discrimination}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.3222}, author = {Lu, Peiyi and Kong, Dexia and Shelley, Mack and Joan Davitt} } @article {9581, title = {Investigating predictors of cognitive decline using machine learning.}, journal = {Journals of Gerontology, Series B: Psychological Sciences \& Social Sciences}, year = {2020}, abstract = {

Objectives: Genetic risks for cognitive decline are not modifiable; however their relative importance compared to modifiable factors is unclear. We used machine learning to evaluate modifiable and genetic risk factors for Alzheimer{\textquoteright}s disease(AD), to predict cognitive decline.

Methods: Health and Retirement Study participants, aged 65-90, with DNA and >2 cognitive evaluations, were included (n=7,142). Predictors included age, body mass index, gender, education, APOE ε4, CVD, hypertension, diabetes, stroke, neighborhood socio-economic status(NSES), and AD risk genes. Latent class trajectory analyses of cognitive scores determined the form and number of classes. Random Forests (RF) classification investigated predictors of cognitive trajectories. Performance metrics (accuracy, sensitivity and specificity) were reported.

Results: Three classes were identified. Discriminating highest from lowest classes produced the best RF performance: accuracy=78\%(1.0\%), sensitivity=75\%(1.0\%) and specificity=81\%(1.0\%). Top ranked predictors were education, age, gender, stroke, NSES, and diabetes, APOE ε4 carrier status and BMI. When discriminating high from medium classes, top predictors were education, age, gender, stroke, diabetes, NSES and BMI. When discriminating medium from the low classes, education, NSES, age, diabetes and stroke were top predictors.

Discussion: The combination of latent trajectories and RF classification techniques suggested that non-genetic factors contribute more to cognitive decline than genetic factors. Education was the most relevant predictor for discrimination.

}, keywords = {Alzheimer{\textquoteright}s disease, Cognitive Ability, Machine learning}, issn = {1758-5368}, doi = {10.1093/geronb/gby054}, author = {Casanova, Ramon and Saldana, Santiago and Michael W Lutz and Brenda L Plassman and Kuchibhatla, Maragatha and Kathleen M Hayden} } @mastersthesis {11093, title = {An Investigation of the Consequences and Costs Associated with Bereavement: Findings from the Health and Retirement Study (2004-2014)}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Georgia}, address = {Athens, GA}, abstract = {The loss of a loved one adversely affects the bereaved. Previous research reports that loss increases the risk of mortality, physical and mental health problems, and healthcare utilization. Using data from the 2004 to 2014 waves of the Health and Retirement Study (HRS), we estimated the risk for mortality, the number of years of healthy life lost, and the increase in medical expenditures associated with an increasing exposure to bereavement. HRS enrolls a representative sample of adults in the United States aged 50 years and older. Population sample weights are available in HRS allowing for estimates of population-level burden. The exposure to loss was defined as the total number of losses of both parents and spouses. Analyses included (1) Cox proportional hazards models (mortality risk) with an attributable fraction calculation; (2) linear regression models (years of healthy life lost) with an outcome combining survival adjusted by the self-reported measure of health combined with US Census data to estimate the annual years lost; and (3) a cost prediction model to estimate HRS respondent medical expenditures based on reported healthcare utilization, with propensity-score matching and regression models to estimate the increase in medical expenditures. Key findings from the analyses showed a persistent increase in mortality associated with an increase in the number of losses experienced by an individual. This increase in the mortality hazard was between 33\% and 49\% and may account for roughly one-third of the population burden of mortality. An estimated total of 3.6 million years of healthy life are lost annually due to bereavement with the majority of the burden experienced by persons 50 to 65 years of age. Any physical activity significantly reduces the impact of bereavement, especially as the number of losses accumulates. Over a two-year period, an exposure to loss generates increased healthcare utilization estimated to be roughly $2500 per bereaved individual. Our results add to a growing body of research concerning the impact of bereavement on health and well-being. These may be the first estimate of the population-level burden that an increasing exposure to loss places on adults in the US.}, keywords = {Bereavement, Loss, Mortality, Population-level health}, isbn = {9798645490010}, author = {Ingels, Justin B.} } @article {11084, title = {IRA Withdrawal Patterns in Times of Crisis}, journal = {EBRI Issue Brief}, volume = {510}, year = {2020}, publisher = {Employee Benefit Research Institute}, chapter = {18}, address = {Washington, D.C.}, abstract = {One of the provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act that affects retirees is the waiver of required minimum distributions (RMDs) for 2020. The waiver, which applies to all 401(k) and individual retirement account (IRA) owners, provides flexibility so that retirees can avoid liquidating assets at low prices and preserve their assets. In this Issue Brief, we explore historical IRA withdrawal patterns of older Americans, including those taking only RMDs and those taking distributions that exceed the RMD level. We look at prior crises, such as the Great Recession of 2008{\textendash}2009, to see how withdrawal patterns were affected by both financial hardships and RMD waivers during that time. }, keywords = {CARES Act, IRA withdrawal behavior}, url = {https://www.ebri.org/content/ira-withdrawal-patterns-in-times-of-crisis}, author = {Zahra Ebrahimi} } @article {9972, title = {Isolation, not loneliness or cynical hostility, predicts cognitive decline in older Americans.}, journal = {Journal of Aging and Health}, year = {2020}, abstract = {

OBJECTIVE: To jointly examine isolation, loneliness, and cynical hostility as risk factors for cognitive decline in older adults.

METHOD: Data came from the 2006 to 2012 waves of the Health and Retirement Study (HRS), a longitudinal study of U.S. older adults (age ⩾ 65 years, n = 6,654). Measures included frequency of contact with social network (objective isolation), the Hughes Loneliness Scale (loneliness), a modified version of the Cook-Medley Hostility Inventory (cynical hostility), and a modified version of the Telephone Interview for Cognitive Status (cognitive function). Multilevel modeling (random slope + intercept) was used to examine the association between these factors and trajectories of cognitive function.

RESULTS AND DISCUSSION: After controlling for demographic characteristics, self-reported health, and functional limitations, loneliness (β = -.34, 95\% confidence interval [CI] = [-0.56, -0.11), and cynical hostility (β = -.14, 95\% CI = [-0.24, -0.04) correlated with lower cognitive function, but none predicted change in cognitive function. Objective social isolation was associated with lower cognitive function (β = -.27, 95\% CI = [-0.41, -0.12]) and steeper decline in cognitive function (β = -.09, 95\% CI = [-0.16, -0.01]).

}, keywords = {Cognition \& Reasoning, Depressive symptoms, Loneliness, Risk Factors}, issn = {1552-6887}, doi = {10.1177/0898264318800587}, author = {Sarah C. Griffin and Briana Mezuk and Williams, Allison Baylor and Paul B. Perrin and Bruce D. Rybarczyk} } @mastersthesis {10299, title = {The Impact of Adult Children{\textquoteright}s Education on Elderly Parents{\textquoteright} Health and Old-Age Support: Evidence from the United States and China}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-05-03}, pages = {120}, school = {Columbia University}, type = {phd}, abstract = {The aim of this dissertation is to study the effect of adult children{\textquoteright}s education on the health and economic wellbeing of their parents in old age. This dissertation contributes to the field of human capital theory through enhancing the understanding of the connections between adult children and parents in old age. It studies large nationally representative data sets in the US and China. The findings highlight the potential importance of pathways through which children{\textquoteright}s human capital affects parents in later life and suggest that offspring{\textquoteright}s human capital (education) is important for parental health and old-age support. This research has important implications for the amelioration of health disparities related to intergenerational inequality in both the U.S and China.}, keywords = {0351:Gerontology, 0452:Social work, Aging, Education, Gerontology, Human capital, Inter-generational relationship, Social Sciences, Social work}, isbn = {9781392078761}, url = {https://academiccommons.columbia.edu/doi/10.7916/d8-hfpz-rr25}, author = {Nan Jiang} } @article {10075, title = {Impact of Diabetes and Disease Duration on Work Status Among U.S. Older Adults.}, journal = {J Aging Health}, volume = {32}, year = {2019}, chapter = {432-440}, abstract = {

OBJECTIVES: To examine the effects of diabetes and disease duration on work status over a 9-year period.

METHOD: Multinomial logistic regression models examined the probability of retirement and disability impeding work, using data from the Health and Retirement Study ( n = 5,576).

RESULTS: Among participants who had retired in 2012, almost 14\% had incident diabetes (4.91 mean years with diabetes, 95\% confidence interval [CI] = [4.67, 5.15]). Approximately 22\% of participants who reported a disability impeded labor force participation had prevalent diabetes (17.1 mean years with diabetes, 95\%CI = [16.41, 17.71]). Only prevalent diabetes that indicated longer disease duration was associated with disability (relative risk ratio [RRR] = 1.83, 95\% CI = [1.30, 2.57]). There was evidence of effect modification among Hispanics only ( p = .02).

DISCUSSION: Diabetes increased risk of exiting the workforce due to disability, and mean disease duration was associated with changes. Disease management and workplace interventions may enable older adults to continue being productive should they choose to remain in the workforce.

}, keywords = {Aging Workforce, Diabetes, Disability, Retirement}, issn = {1552-6887}, doi = {10.1177/0898264318822897}, url = {https://pubmed.ncbi.nlm.nih.gov/30767603/}, author = {Mutambudzi, Miriam and C{\'e}sar Gonz{\'a}lez-Gonz{\'a}lez and Rebeca Wong} } @article {6520, title = {The Impact of Employment on Parental Coresidence}, journal = {Real Estate Economics}, volume = {47}, year = {2019}, pages = {1055-1088}, type = {Journal}, abstract = {We examine the extent to which parents use housing and shared living arrangements as a form of risk-sharing for their adult children, using detailed data on children and parents in the Health and Retirement Study for 1998 2012. On average, a young man moving from full-time to nonemployment raises the likelihood of coresiding with a parent by 1.5 percentage points; moving from full-time employment to being part-time employed raises the likelihood of coresiding with a parent by 2 percentage points. The implied elasticity of parental coresidence with respect to the son{\textquoteright}s income is -1.1; for daughters, the elasticity is -0.5.}, keywords = {Adult children, Employment and Labor Force, Other}, doi = {10.1111/1540-6229.12152}, url = {http://dx.doi.org/10.1111/1540-6229.12152}, author = {Gary V. Engelhardt and Michael D. Eriksen and Nadia Greenhalgh-Stanley} } @article {doi:10.1177/0019793919891973, title = {The Impact of Income-Related Medicare Part B Premiums on Labor Supply}, journal = {ILR Review: The Journal of Work and Policy}, year = {2019}, pages = {0019793919891973}, abstract = {The 2003 Medicare Modernization Act introduced income-related premiums on Medicare coverage for professional services (Part B) for the first time. Beginning in 2007, higher-income households were required to pay higher premiums for Part B coverage, which raises the price of Medicare relative to employer-sponsored health insurance for these households. The authors exploit this exogenous change in Medicare policy to examine the impact of Part B premiums on the labor supply decisions of older adults. They find that higher Medicare premiums delay retirement. Findings have important implications for Medicare policy and labor markets.}, keywords = {Labor, Labor Dynamics, Medicare, Medicare Part B}, doi = {10.1177/0019793919891973}, url = {https://doi.org/10.1177/0019793919891973}, author = {Padmaja Ayyagari and Frank A Sloan} } @mastersthesis {10235, title = {The Impact of Medicare Part D on Mortality and Financial Stability}, volume = {Doctor of Philosophy}, year = {2019}, month = {2019}, pages = {168}, school = {University of Kentucky}, address = {Lexington, United States}, abstract = {Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I also find potential for improvement in enrollment for difficult-to-reach groups. Next, Chapter 2 examines the impact of Medicare Part D on mortality. Although I do not find an impact on the life expectancy of respondents as a whole, I do find a significant positive effect for black respondents, indicating that Medicare Part D may have mattered more for disadvantaged groups. The largest impact is for black men, who have an additional 9 percentage point chance of living to age 73 for an additional 8 years of coverage (significant at the 5\% level). When looking only at cardiovascular mortality, which is more likely to be influenced by drug coverage, I find improvements in life expectancy for the total population, with stronger effects for minorities and men. Overall, my findings suggest that Medicare Part D did move the needle on its goal: to improve the health of those who, without government intervention, had the most difficulty paying for prescription drugs. Chapter 3 looks at the impact of Medicare Part D prescription drug coverage on cost-related medication adherence, food insecurity, and finances among seniors. It would be reasonable to assume that Medicare Part D, which led to near-universal drug coverage among senior citizens, could allow seniors to shift money previously spent on drug expenditures to other areas. The strongest effect of Medicare Part D is on cost-related medication nonadherence, leading to a 21\% decrease for an additional 8 years of Medicare Part D coverage. The impact is even stronger for the black male population (30\%). I fail to reject the null hypothesis that Medicare Part D did not reduce food insecurity or household debt. Overall, Medicare Part D appears to have improved the financial stability of seniors.}, keywords = {Economics, Health Economics, Health Insurance, Life Expectancy, Medicare Part D, Public Economics, Racial Disparities}, doi = {https://doi.org/10.13023/etd.2019.325}, url = {https://uknowledge.uky.edu/economics_etds/45/}, author = {Toran, Katherine} } @mastersthesis {https://open.bu.edu/handle/2144/36153, title = {The impact of productive and leisure activities on cognitive health in later life}, volume = {Doctor of Philosophy}, year = {2019}, month = {2019}, pages = {147}, school = {Boston University}, address = {Boston, MA}, abstract = {BACKGROUND AND OBJECTIVES: Cognitive decline in old age brings challenges such as economic and caregiving burden, loss of independence, and other health consequences (Alzheimer{\textquoteright}s Association, 2018). The productive aging literature has advanced a number of ideas about how to stay healthy in later life (Hooyman \& Kiyak, 2018; Morrow-Howell, Gonzales, Matz-Costa, \& Greenfield, 2015). However, existing literature has: tended to focus on productive and leisure activities during limited spans of time; not explored how the productive/leisure activity{\textendash}cognitive health relationship differs by the social determinants of health such as gender or race/ethnicity; and has not considered how these activities are collectively associated with cognition among older adults in the United States. Thus, using longitudinal data from a national cohort of older adults, this dissertation focuses on the following research questions: (1) Are the previous and ongoing cognitive, physical, and social complexities of work associated with cognitive health in later life? (2-a) Are the ongoing cognitive, physical, and social complexities of work and volunteering associated with cognitive health in later life? (2-b) Are the ongoing cognitive, physical, and social complexities of work, volunteering, and leisure activities associated with cognitive health in later life? For each question, the dissertation will explore whether associations vary by key social determinants of health. RESEARCH DESIGN: Using a nationally representative sample of older adults (51+) in the Health and Retirement Study (HRS; 2004{\textendash}2014), growth curve modeling is applied. The samples for research questions 1, 2-a, and 2-b include the following respondents, respectively: the Early Baby Boomer cohort, the HRS core survey respondents, and the HRS core respondents who provided information on leisure activity in the HRS Consumption and Activities Mail Survey (CAMS). CONTRIBUTIONS: Consistent with the Social Work Grand Challenge of advancing long and productive lives by focusing on cognitive aging, this study provides insight into cognitive aging research, interventions, and policy from a behavioral and social science perspective. Overall, this study adds to the discussion about policies and services to support older adults in maintaining active lifestyles and to promote healthy cognitive aging among older adults in the United States.}, keywords = {Cognition, Cognitive health, Leisure, Retirement}, url = {https://open.bu.edu/handle/2144/36153}, author = {Lee, Yeonjung} } @mastersthesis {10312, title = {The Impact of Retirement Savings Methods on Retiree Satisfaction}, volume = {Master of Public Policy}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-05-03}, pages = {51}, school = {Georgetown University}, type = {phd}, abstract = {This paper examines the relationship between sources of retirement income and self-reported retirement satisfaction, as well as the role of financial behavior in retirement savings decisions. The changing landscape of private retirement savings, especially the shift from defined-benefit pensions to defined-contribution plans and IRAs, raises the question of which savings method is associated with the best outcomes. Data from the Health and Retirement Survey show retirees who rely on income from employer-sponsored retirement plans report higher retirement satisfaction than those who depend on Social Security benefits, who in turn report higher satisfaction than those who rely on IRAs. Meanwhile, satisfaction among retirees who participate in defined-benefit pensions exceeds that of those who own defined-contribution plans. Data from the Survey of Consumer Finance additionally indicate that those with worse saving habits and greater aversion to financial risk tend to be less likely to participate in defined-contribution plans and tend to have lower retirement incomes.}, keywords = {0630:Public policy, Defined-benefit, Defined-contribution, Pension, Public Policy, Retirement, Satisfaction, Savings, Social Sciences}, isbn = {9781392076569}, url = {https://repository.library.georgetown.edu/handle/10822/1055075}, author = {Albanese,Joseph J., Jr.} } @article {9913, title = {Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults}, journal = {Journal of the American Medical Directors Association}, volume = {20}, year = {2019}, pages = {730-735}, type = {Journal}, abstract = {Objectives: Impairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. Design: Longitudinal panel. Setting: Detailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. Participants: A nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. Measures: Ability to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. Results: The presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95\% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/Implications: Our findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others.}, keywords = {Activities of Daily Living, Caregiving, Cognitive Ability, Disabilities}, issn = {15258610}, doi = {10.1016/j.jamda.2018.10.014}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1525861018305875https://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/plain}, author = {Ryan P McGrath and Brian C Clark and Erlandson, Kristine M. and Stephen D. Herrmann and Brenda Vincent and Orman T Hall and Kyle J Hackney} } @conference {10626, title = { Inattentive Households and Consumption Declines during Retirement}, booktitle = {21st Annual SSA Research Consortium Meeting}, year = {2019}, address = {Washington, D.C.}, abstract = {There is little agreement on the question of whether U.S. households are well-prepared for retirement. We revisit this debate using the Consumption and Activities Mail Survey (CAMS) linked to the Health and Retirement Study (HRS) to better understand the dynamics of pre- and post-retirement consumption. We first develop a dynamic model with home production that captures conventional reasons why consumption may decline during retirement: Time preference rates, a decline in work-related expenses, health shocks, and changes in home production. We also consider an additional factor{\textemdash}inattention{\textemdash}that allows for a gradual adjustment to new economic conditions. Even after retirement, households may not realize how much they need for both current and future expenses. Dividing the sample into terciles based on retirement adequacy, we find that differences in consumption paths diverge not immediately at retirement, but over a lengthy period of time; by 10 years post-retirement, those poorly prepared for retirement experienced a drop in consumption roughly one-third greater than those best prepared. This differential decline does not appear to be explained by health status, family size, marital status, time preference, risk aversion, or home production such as cooking at home or shopping for bargains. Instead, these patterns are most consistent with a model of household inattention. }, keywords = {consumption decline, inattentive households}, author = {Sheng Guo and Jonathan S Skinner and Stephen P. Zeldes} } @article {11347, title = {Incentives for Home- and Community-Based Care Under the Affordable Care Act: Implications for SSI Receipt}, year = {2019}, institution = {University of Wisconsin-Madison}, abstract = {One in three 65-year-olds will require long term care at some point in their lives. Most nursing home stays cost over $3,500 a month, an expense that eventually exhausts the financial resources of most families. Medicaid currently covers these expenses for 6 out of 10 nursing home residents. Not all those who require care need enough help to justify moving into a nursing home, but in many states Medicaid will not pay for care received at home. In these states, moving into a nursing home is the only way to get help paying for care. The Balancing Incentives Program (BIP), which is part of the Affordable Care Act, encouraged states that spend most of their Medicaid dollars on nursing home care to adopt programs and practices that extend coverage for care while living at homes, living with relatives, or living in assisted living facilities. In participating states, the BIP may have enabled some elderly to return to home and community settings or prevented them from needing to move into nursing homes. When living outside of a nursing home, low income elderly may also be eligible for Supplemental Security Income (SSI) payments. SSI is income assistance available to financially needy elderly, disabled and blind persons living in the community. People living in nursing homes are generally not eligible for SSI. Our project will examine whether and how the BIP changed living arrangements and receipt of SSI. It is a first step towards understanding whether the BIP improved the lives and well-being of economically-disadvantaged elderly adults. If changes in living arrangements are found, future work will examine the impact on the health of those affected and on relatives who may be providing or coordinating their care.}, keywords = {Affordable Care Act, CMS, SSA, SSI}, url = {https://cfsrdrc.wisc.edu/publications/working-paper/wi19-08}, author = {Mary K. Hamman and Helppie-McFall, Brooke and Daniela Hochfellner} } @article {10362, title = {Income and Wealth Disparities Continue through Old Age}, number = {GAO-19-587}, year = {2019}, month = {08/2019}, institution = {U.S. Government Accountability Office}, abstract = {Income and wealth inequality in the United States have increased over the last several decades. We looked at whether these trends continue for older Americans as they age. We compared income and wealth for all older households from 1989 through 2016 and found households in the top 20\% saw disproportionately greater gains than other households. We also looked at income and wealth for a group of older Americans as they aged. We found disparities in income decreased, possibly due to the transition from working to retirement. Disparities in wealth increased, perhaps because of significant differences in the size of some assets, such as home equity. }, keywords = {Wealth Inequality}, url = {https://www.gao.gov/products/GAO-19-587}, author = {U.S. Government Accountability Office} } @article {Xu2019, title = {Individualized prediction of depressive disorder in the elderly: A multitask deep learning approach}, journal = {International Journal of Medical Informatics}, volume = {132}, year = {2019}, note = {cited By 0}, abstract = {Introduction: Depressive disorder is one of the major public health problems among the elderly. An effective depression risk prediction model can provide insights on the disease progression and potentially inform timely targeted interventions. Therefore, research on predicting the onset of depressive disorder for elderly adults considering the sequential progression patterns is critically needed. Objective: This research aims to develop a state-of-the-art deep learning model for the individualized prediction of depressive disorder with a 22-year longitudinal survey data among elderly people in the United States. Methods: We obtain the 22-year longitudinal survey data from the University of Michigan Health and Retirement Study, which consists of information on 20,000 elderly people in the United States from 1992 to 2014. To capture temporal and high-order interactions among risk factors, the proposed deep learning model utilizes a recurrent neural network framework with a multitask structure. The C-statistic and the mean absolute error are used to evaluate the prediction accuracy of the proposed model and a set of baseline models. Results: The experiments with the 22-year longitudinal survey data indicate that (a) machine learning models can provide an accurate prediction of the onset of depressive disorder for elderly individuals; (b) the temporal patterns of risk factors are associated with the onset of depressive disorder; and (c) the proposed multitask deep learning model exhibits superior performance as compared with baseline models. Conclusion: The results demonstrate the capability of deep learning-based prediction models in capturing temporal and high-order interactions among risk factors, which are usually ignored by traditional regression models. This research sheds light on the use of machine learning models to predict the onset of depressive disorder among elderly people. Practically, the proposed methods can be implemented as a decision support system to help clinicians make decisions and inform actionable intervention strategies for elderly people.}, keywords = {deep learning, depression, Prediction}, doi = {10.1016/j.ijmedinf.2019.103973}, url = {https://www.ncbi.nlm.nih.gov/pubmed/31569007}, author = {Xu, Z. and Qingpeng Zhang and Wentian Li and Li, Mingyang and Yip, P.S.F.} } @article {10125, title = {Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education.}, journal = {International Journal of Geriatric Psychiatry}, year = {2019}, abstract = {

OBJECTIVES: To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.

METHODS: We identified the prevalence of depressive symptoms among U.S.-born adults ages >=50 years in the 1998-2014 waves of the Health and Retirement Study (n=16,022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus non-rural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.

RESULTS: In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR=1.20; 95\% CI: 1.12, 1.29; marginal predicted probability 10.5\% for rural and 8.9\% for non-rural childhood residence). Adjusting for U.S. Census birth region and parental education attenuated this association (OR=1.07; 95\% CI: 0.99, 1.15; marginal predicted probability 9.9\% for rural and 9.3\% for non-rural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR=0.94; 95\% CI: 0.87, 1.01; marginal predicted probability 9.2\% for rural and 9.8\% for non-rural).

CONCLUSIONS: Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.

}, keywords = {Depressive symptoms, Education, Place of residence, Rural Settings}, issn = {1099-1166}, doi = {10.1002/gps.5176}, author = {Audrey R Murchland and Chloe W Eng and Joan A Casey and Jacqueline M Torres and Elizabeth R Mayeda} } @article {9946, title = {Inflammatory mechanisms underlying the effects of everyday discrimination on age-related memory decline.}, journal = {Brain, Behavior \& Immunity}, volume = {75}, year = {2019}, month = {2019 Jan}, pages = {149-154}, abstract = {

BACKGROUND/OBJECTIVES: Previous research suggests that everyday discrimination is associated with worse episodic memory and partially mediates Black-White disparities in memory aging. The biological mechanisms underlying the link between everyday discrimination and memory are unclear but may involve inflammatory processes. This study aimed to determine whether systemic inflammation, indexed by blood levels of C-reactive protein (CRP), mediates associations between everyday discrimination and episodic memory over 6 years.

DESIGN: A longitudinal mediation model quantified associations between baseline everyday discrimination, 4-year change in CRP, and 6-year change in episodic memory.

SETTING: The Health and Retirement Study (HRS).

PARTICIPANTS: 12,624 HRS participants aged 51 and older.

MEASUREMENTS: Everyday Discrimination Scale, high-sensitivity CRP assays of dried blood spots, composite scores of immediate and delayed recall of a word list.

RESULTS: Black participants reported greater everyday discrimination. Greater discrimination was associated with lower baseline memory and faster memory decline. Higher CRP at baseline partially mediated the negative association between discrimination and baseline memory, but CRP change did not mediate the association between discrimination and memory decline.

CONCLUSION: This U.S.-representative longitudinal study provides evidence for deleterious effects of discrimination on subsequent episodic memory. The fact that elevated CRP only partially explained the concurrent association between discrimination and memory highlights the need for more comprehensive investigations of biological mechanisms underlying the link between social stress and age-related memory decline in order to better characterize potential intervention targets to reduce racial inequalities in memory aging.

}, keywords = {Ageism, C-reactive protein, Discrimination, Inflammation, Memory}, issn = {1090-2139}, doi = {10.1016/j.bbi.2018.10.002}, author = {Laura B Zahodne and A Zarina Kraal and Sharifian, Neika and Afsara B. Zaheed and Sol, Ketlyne} } @article {11685, title = {The Influence of Cognitive Function on Balance, Mobility, and Falls in Older Cancer Survivors}, journal = {Rehabilitation Oncology}, volume = {37}, year = {2019}, pages = {77{\textendash}82}, abstract = {Introduction: Older cancer survivors fall more often, as disease-associated sequelae such as impaired cognitive function contribute to a higher falls risk. Cognitive dysfunction may contribute to falls and mobility; however, this relationship is not well described. The purpose of this study was to examine associations between cognitive function, gait speed, balance, and falls in older cancer survivors. Methods: A cross-sectional analysis of 573 older cancer survivors was conducted from the 2010 Health and Retirement Study wave. Groups were assigned on the basis of falls history: Falls (N = 222) or No Falls (N = 351). Groupwise comparisons on demographic, cognitive, and physical mobility variables were completed. Linear regression analyses were performed to examine associations between cognitive function (recall, orientation, executive function), gait speed, tandem balance, and falls in the sample and by group. Results: Significant between-group differences existed in demographic, cognitive function, falls, and mobility variables. Falls were inversely associated with executive function (β = -0.18, P < .05). Delayed recall was linearly associated with tandem stance in the whole sample (β = 0.11, P < .05). Falls history was able to detect differing relationships between gait speed and each of the cognitive processes (β = 0.11-0.17 for fallers; β = 0.11-0.22 for nonfallers), indicating the underlying influence of cognition on mobility in cancer survivors. Discussion: Different cognitive processes influence falls, balance, and mobility in the older cancer survivor, especially those with a history of falling. Assessments of balance and falls should include screening more than orientation to detect cognitive impairments that impact mobility and falls.}, keywords = {balance, Cancer Survivors, Cognition, Falls, mobility}, doi = {10.1097/01.REO.0000000000000128}, author = {Blackwood, Jennifer} } @article {9518, title = {The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment.}, journal = {Journal of Aging \& Health}, volume = {31}, year = {2019}, abstract = {

OBJECTIVE: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity.

METHOD: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death.

RESULTS: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity.

DISCUSSION: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.

}, keywords = {Cognitive Ability, Comorbidity, Mortality, NDI}, issn = {1552-6887}, doi = {10.1177/0898264317751946}, author = {Nicholas K Schiltz and David F Warner and Kathleen A Smyth and Gravenstein, Stefan and Kurt C Stange and Siran M Koroukian} } @article {13079, title = {Informing Educational Interventions using Genome-Wide Data, 2016-2019}, year = {2019}, institution = {Barcelona Computing Center}, address = {Catalonia, Spain}, keywords = {Economics, ECONOMICS OF EDUCATION, Epidemiology}, url = {https://t2-4.by-covid.bsc.es/jspui/handle/123456789/59600}, author = {N Davies} } @mastersthesis {10598, title = {INSIGHT INTO NICOTINE AND ALCOHOL USE THROUGH GENETIC ASSOCIATION METAANALYSES}, volume = {Doctor of Philosophy}, year = {2019}, month = {12/2019}, school = {University of Minnesota}, type = {Dissertation}, address = {minneapolis}, abstract = {Since the Surgeon General{\textquoteright}s report in 1964, cigarette use has been declining in the US and in most high-income countries across the rest of the world (Antman, Arnett, Jessup, \& Sherwin, 2014; Spanagel, 2017) (M. Ng et al., 2014) (Jha \& Peto, 2014). There have been multiple studies of cigarette smoking as the primary risk factor for many diseases including lung cancer and heart disease, contributing to 5 million deaths globally (Jha \& Peto, 2014). The risk of cigarette smoking is not limited to regular smokers alone, a higher risk of cancer and cardiovascular disease also exists for intermittent smokers (Schane, Ling, \& Glantz, 2010). Moreover, the effects of secondhand smoke are also a public health concern since mere exposure has been linked to an increased risk in lung cancer and stroke (Kim, Ko, Kwon, \& Lee, 2018). Children are particularly vulnerable because they breathe at a faster rate than adults and secondhand smoke has been associated with increased rates of bacterial infections, acute respiratory illness and rates of hospitalization of asthma attacks (Cao, Yang, Gan, \& Lu, 2015; Z. Wang et al., 2015). The only other substance to approximate the public health burden of tobacco use is alcohol use. There are an estimated 2.4 billion people across the globe who use alcohol (Gowing et al., 2015; Griswold et al., 2018; Jha \& Peto, 2014). Alcohol use has been clearly linked to risk for a wide variety of diseases (e.g., liver cirrhosis), but also to unintentional injuries such as traffic accidents and falls (Griswold et al., 2018; Rehm, 2011). Twin studies routinely find that nicotine and alcohol use are heritable (Polderman et al., 2015) with ~50\% of the phenotypic variance being accounted for by additive genetic effects. Despite this substantial heritability, prior to 2019 only a handful of specific genetic variants or genomic regions have been reliably found to be associated with substance use or dependence. The decreasing cost of array genotyping and genome sequencing since the mid-2000s (Mardis, 2011) has led to a marked increase in the number of studies that use these technologies to study genetic associations for complex traits and disease. The standard analytical approach for gene-disease mapping has become the genome-wide association study (GWAS). Very simply, GWAS is a series of correlations between individuals{\textquoteright} genotypes, most commonly single-nucleotide polymorphisms (SNPs), with the phenotype of interest. GWAS and GWAS meta-analyses have successfully found several functional, and potentially causal variants associated with substance dependence (Laura J. Bierut et al., 2010; Hancock et al., 2018; Walters et al., 2018). However, these variants account for a tiny fraction of the phenotypic variation, prompting the conclusion that behavioral phenotypes are highly polygenic; many variants, each of small effect, work in conjunction to influence the phenotype. In fact, the effect of any single variant is so small that very large study samples are necessary to detect them (Visscher et al., 2017). Alcohol and nicotine dependence are clinically relevant phenotypes and tend to have higher heritability estimates than measures of consumption (Verhulst, Neale, \& Kendler, 2015; Vink, Willemsen, \& Boomsma, 2005) which would make them more ideal GWAS candidate phenotypes. However, there is substantial difficulty in achieving the desired sample size in substance abuse as cases would require clinical diagnosis and further work would be needed to find a suitable control (Dick, Meyers, Rose, Kaprio, \& Kendler, 2011). It is more practical to work with simple substance use phenotypes that are regularly collected in biomedical studies using short survey questions ({\textquotedblleft}Do you smoke regularly?{\textquotedblright} or {\textquotedblleft}How many drinks per week do you typically consume?{\textquotedblright}) and are common in medical records as part of regular health check-ups or hospital intakes. There have been GWAS meta-analyses of alcohol and nicotine use that have found several significant loci (Schumann et al., 2016; Tobacco and Genetics Consortium, 2010) and we aim to increase the sample size further in order to capture more substance use associated variants. In the first chapter, we used GWAS meta-analysis to discover common variants (variants with allele frequency > 0.1\%) that are associated with alcohol and nicotine use. It is the largest GWAS meta-analysis of alcohol and nicotine use to date combining summary statistics from over 30 GWASs and reached over 1.2 million participants of European descent. For nicotine use, we examined cigarette smoking from initiation to cessation. The four phenotypes are {\textbullet} Smoking Initiation: Binary phenotype on whether the participants have ever been a regular smoker (also commonly defined as having smoked more than 100 cigarettes). 2 coded as regular smoker and 1 as never a regular smoker. {\textbullet} Age of initiation: Quantitative phenotype on when the participants started regularly smoking. Individuals who are not regular smokers were set to missing. {\textbullet} Cigarettes per Day: Binned phenotype (1-5) on how many cigarettes smoked per day. Individuals who are not regular smokers were set to missing. {\textbullet} Smoking cessation: Binary phenotype on whether the participants is a current or former regular smoker. 2 coded as current and 1 as former. Individuals who are not regular smokers were set to missing. We had one alcohol use phenotype which measures heaviness of use. {\textbullet} Drinks per week: Quantitative phenotype on how many alcoholic drinks per week they consume. Studies were asked to left-anchor and log transform this phenotype. We discovered 566 conditionally independent variants in 406 loci associated with nicotine and alcohol use. Using these results, we performed cell, tissue, gene-set, and pathway enrichment analyses on each set of meta-analysis results to understand the specific biological mechanisms of those traits. An advantage to including both alcohol and nicotine use phenotypes is that we can jointly explore the results for any common variants that may contribute to a more general substance use factor. Alcohol and nicotine use are highly comorbid behaviors (Meyerhoff et al., 2006) so there may be common variants that are affecting both substances pleiotropically. We examined the genetic correlations between the phenotypes and did a pleiotropy analysis to see if any genes overlap across the five traits. Lastly, to see the utility of these results, we calculated polygenic risk scores (PRS) with the meta-analyses results and it significantly predicted the same phenotypes in two other independent samples. Previous large-scale GWAS meta-analysis of alcohol and nicotine use have found several significant loci (Schumann et al., 2016; Tobacco and Genetics Consortium, 2010) but the heritability derived from these SNPs are far from the heritability estimated from twin studies. SNPbased heritability from published GWAS meta-analysis results are generally under 10\% (Zheng et al., 2017), much less than the 30-60\% (Grant et al., 2009; Polderman et al., 2015; Verhulst et al., 2015; Vink et al., 2005) typically found in twin studies. The discrepancy between heritabilities estimated from twin studies and genotyped variants has been termed the {\textquotedblleft}missing heritability{\textquotedblright} (Eichler et al., 2010; Gibson, 2012; Maher, 2008). One hypothesis is the effect of each individual variant is much smaller than previous expectations and we may need hundreds of thousands of individuals to detect them. Another common hypothesis concerns the genetic architecture underlying the trait where rare variants with large effects are what{\textquoteright}s contributing to the missing heritability. There are examples of highly penetrant mendelian diseases that are due to low frequency variants such as cystic fibrosis, therefore, it stands to reason that the same may be true for behavioral traits as well. From an evolutionary theory perspective, if the variant has a large deleterious effect then it is expected to be selected against in a population and thus exists at a lower frequency (Gibson, 2012). In the second chapter, we performed exome meta-analysis in parallel to the first chapter in order to find rare variants that may be associated specifically with nicotine use. We examined 4 nicotine use phenotypes: {\textbullet} Smoking Initiation: Binary phenotype on whether the participants have ever been a regular smoker (also commonly defined as having smoked more than 100 cigarettes). 2 coded as regular smoker and 1 as never a regular smoker. {\textbullet} Cigarettes per day (CPD; quantitative trait) average number of cigarettes smoked per day by ever smokers. {\textbullet} Pack-years (quantitative trait; Packs per day x Years smoked, with a pack defined as 20 cigarettes); years smoked is typically formed from age at smoking initiation to current age for current smokers or age at cessation for former smokers. {\textbullet} Smoking cessation: Binary phenotype on whether the participants is a current or former regular smoker. 2 coded as current and 1 as former. Individuals who are not regular smokers were set to missing. The exome-metanalysis was done simultaneously as the GWAS meta-analysis and found 40 common loci (also implicated in the GWAS meta-analysis) associated with nicotine use but no conclusive rare variant associations. We also checked for conditionally independent rare variants within previously associated loci and found one low-frequency variant (allele frequency~1\%). In order to characterize these loci, we queried the GWAS catalogue, QTL in GTEx V7, Brain xQT, and BRAINEAC and also performed pathway enrichment analysis. Lastly, we used mendelian randomization with our results and some key phenotypes associated with smoking. We found causal associations between smoking initiation and educational attainment. In order to understand the mechanisms of these addictions, there have been many animal studies, most commonly mice, that model drug addiction from use to relapse (Lynch, Nicholson, Dance, Morgan, \& Foley, 2010). The biology and chemistry of alcohol and nicotine have been studied extensively (Benowitz, Hukkanen, \& Jacob, 2009; Cederbaum, 2012; Edenberg, 2007), yet there are still gaps in the knowledge of how and why there are individual differences in the metabolism of these substances. The underlying biology of substance metabolism may be common amongst mammalian species, but human-specific traits and behaviors are much harder to model and replicate in mice. A common method to measure these underlying mechanisms in humans is to examine endophenotypes that are associated with the complex phenotype of interest. Endophenotypes are stable, simple, and heritable traits within individuals that are useful as measures associated with a more complex phenotype; some examples of endophenotypes are biomarkers such as cotinine and brain-based measures like electroencephalography. These endophenotypes are viewed as measures that are closer to acute underlying biological pathways or cognitive processes which may be expressed as part of the heterogeneity of a complex phenotype. There have been studies linking alcohol use disorder and various brain-based endophenotype in the literature (Carlson, Iacono, \& McGue, 2002; Malone, Iacono, \& McGUE, 2001). In the third chapter, we associated the results from the imputed GWAS meta-analyses to these endophenotypes in order to understand its connection to substance use. None of the associations were significant after correcting for multiple tests.}, keywords = {alcohol, Nicotine}, url = {https://conservancy.umn.edu/bitstream/handle/11299/211777/Liu_umn_0130E_20936.pdf?sequence=1}, author = {Mengzhen, Liu} } @article {10077, title = {Insomnia symptoms predict both future hypertension and depression.}, journal = {Preventative Medicine}, volume = {123}, year = {2019}, pages = {41-47}, abstract = {The prevalence of hypertension and depression is high in older populations. Moreover, their comorbidity may significantly increase morbidity and mortality. However, the risk factors contributing to both health conditions are not well understood. Older individuals are prone to insomnia; thus we hypothesized that having more insomnia symptoms increases risk for incident hypertension and depression over time. The sample consisted of a longitudinal population-based study of community-dwelling older individuals, from the 2008-2016 waves of the Health and Retirement Study, sampled across the United States. A total of 18,123 subjects, aged 50+, were stratified into three age groups, ages 50-60, 61-74, and 75 and older years. Subjects were excluded for reporting baseline hypertension or depression at the first wave 2008. Center for Epidemiologic Studies-Depression (CES-D) score >= 4 was the cutoff for elevated depressive symptomatology. Subjective insomnia symptoms were evaluated. Cox proportional hazards regression revealed that SBP (1.02[1.01, 1.02]) and more insomnia symptoms (1.11[1.01, 1.21]) were significant predictors of hypertension for all age groups. For depression, only insomnia symptoms were significant predictors (9.91[6.37, 15.41]). Kaplan-Meier curves revealed that 9.2\% of the overall cohort had both hypertension and depression within 8 years and more insomnia symptoms predicted greater incidences of both conditions (p-values <0.001). In this older prospective cohort, insomnia symptoms are consistent predictors of future hypertension and depression in all age groups, who were not hypertensive and depressed at baseline. Insomnia may contribute to the etiology and comorbidity of hypertension and depression in older individuals.}, keywords = {Blood pressure, Depressive symptoms, Sleep}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2019.02.001}, author = {Dong, Yutong and Frances Margaret Yang} } @article {9764, title = {Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.}, journal = {Western Journal of Nursing Research}, volume = {41}, year = {2019}, pages = {685-703}, abstract = {Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients{\textquoteright} odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients{\textquoteright} bed days decreased (4.69 vs. 2.54) while caregivers{\textquoteright} bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.}, keywords = {Activities of Daily Living, Caregiving, Marriage, Physical Ability}, issn = {1552-8456}, doi = {10.1177/0193945918781057}, author = {Geoffrey J Hoffman and Sarah A. Burgard and Carolyn A Mendez-Luck and Joseph E Gaugler} } @article {9770, title = {Internet Use and Preventive Health Behaviors Among Couples in Later Life: Evidence from the Health and Retirement Study.}, journal = {Gerontologist}, year = {2019}, abstract = {

Background and Objectives: The aim of this study was to examine the link between internet use and preventive health behaviors. We focused on couples to examine whether there were cross-partner associations between internet use and preventive health behaviors.

Research Design and Methods: The data for this study came from the 2010 and 2012 waves of the Health and Retirement Study and the sample consisted of 5,143 pairs of coupled-individuals. Preventive health behaviors included cancer screenings (mammogram and prostate tests), cholesterol tests, and flu shots. Logistic multilevel actor-partner interdependence models were employed to test the study hypotheses.

Results: Internet use was associated with a higher likelihood of receiving prostate exams and cholesterol tests for husbands, net of demographic and health characteristics, and insurance status. We found that wives{\textquoteright} internet use was associated with a higher likelihood of receiving flu shots and prostate exams for husbands, but husbands{\textquoteright} internet use was not associated with wives{\textquoteright} preventive health behaviors.

Discussion and Implications: Research linking internet use and preventive health behaviors is important because such behaviors are associated not only with health of the older population but also with substantial reductions in health care expenditures. Our findings suggested that internet use of older adults is associated with their own preventive health behaviors, as well as their spouses{\textquoteright} preventive health behaviors. Interventions and programs to facilitate older adults{\textquoteright} preventive health behaviors should consider couple-based approaches.

}, keywords = {Health Behavior, Internet usage, Marriage, Preventative Care}, issn = {1758-5341}, doi = {10.1093/geront/gny044}, author = {Nam, Sangbo and Sae Hwang Han and Megan Gilligan} } @article {10375, title = {Interpreting Subjective and Objective Measures of Job Resources: The Importance of Sociodemographic Context.}, journal = {International Journal of Environmental Research and Public Health}, volume = {16}, year = {2019}, month = {2019 08 23}, abstract = {

Salutary retirement policy depends on a clear understanding of factors in the workplace that contribute to work ability at older ages. Research in occupational health typically uses either self-reported or objective ratings of the work environment to assess workplace determinants of health and work ability. This study assessed whether individual characteristics and work-related demands were differentially associated with (1) self-reported ratings of job resources from older workers in the Health and Retirement Study, and (2) corresponding objective ratings of job resources from the Occupational Information Network (O*NET). Results from regression and relative weights analyses showed that self-reported ratings were associated with self-reported job demands and personal resources, whereas corresponding O*NET ratings were associated with differences in gender, race, or socioeconomic standing. As a result, subjective ratings may not capture important aspects of aging workers{\textquoteright} sociodemographic background that influence work ability, occupational sorting, opportunities for advancement, and ultimately the job resources available to them. Future studies should consider including both subjective and objective measures to capture individual and societal level processes that drive the relationship between work, health, and aging.

}, keywords = {Job resources, sociodemographics}, issn = {1660-4601}, doi = {10.3390/ijerph16173058}, url = {https://www.ncbi.nlm.nih.gov/pubmed/31443601}, author = {Lauren L Schmitz and Courtney L McCluney and Amanda Sonnega and Margaret T Hicken} } @article {9637, title = {Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation.}, journal = {Research on Aging}, volume = {41}, year = {2019}, pages = {31-53}, abstract = {This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults{\textquoteright} health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites.}, keywords = {Moves, Protective factors, Social Support, Volunteerism}, issn = {1552-7573}, doi = {10.1177/0164027518773125}, author = {Guillermo Ernest Gonzales and Shen, Huei-Wern and Tam E Perry and Wang, Yi} } @article {9473, title = {{\textquoteright}It is nothing more than a senior moment{\textquoteright}: The moderating role of subjective age in the effect of change in memory on self-rated memory.}, journal = {Aging \& Mental Health}, volume = {23}, year = {2019}, pages = {272-276}, abstract = {

OBJECTIVE: The association between memory performance and self-rated memory is yet to be understood. More specifically, little is known about the factors that lie at the base of self-evaluations of memory in relation to actual changes in memory. In this study, we suggest that subjective age modifies the effect of objective change in memory on self-rated memory.

METHOD: We used two waves of the Health and Retirement Study (N = 4624) to examine whether subjective age moderates the effect of experienced changes in memory between T1 and T2 on self-rated memory at T2.

RESULTS: Our results suggest that subjective age is a significant moderator of the effect of change in memory on self-rated memory. The effect is weaker among those with younger subjective age, and stronger for those with older subjective age.

CONCLUSION: While preserving a young subjective age is usually considered an adaptive strategy, it also has potential negative effects, masking changes in memory performance.

}, keywords = {Memory, Self-reported health, Subjective age}, issn = {1364-6915}, doi = {10.1080/13607863.2017.1399350}, author = {Dikla Segel-Karpas and Yuval Palgi} } @article {10071, title = {Is it possible to overcome the {\textquoteright}long arm{\textquoteright} of childhood socioeconomic disadvantage through upward socioeconomic mobility?}, journal = {Journal of Public Health (Oxf)}, year = {2019}, month = {2019 Feb 28}, abstract = {

OBJECTIVES: Socioeconomically disadvantaged children have worse adult health; we test if this {\textquoteright}long arm{\textquoteright} of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood.

METHODS: Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from median dichotomized childhood socioeconomic status (SES; childhood human and financial capital) and adult SES (wealth at age 67) from Health and Retirement Study respondents (N = 6669). Healthy ageing markers, in tertiles, were walking speed, peak expiratory flow (PEF), and grip strength measured in 2008 and 2010. Multinomial logistic regression models, weighted to be nationally representative, controlled for age, gender, race, birthplace, outcome year and childhood health and social capital.

RESULTS: Upwardly mobile individuals were as likely as the stable high SES group to be in the best health tertile for walking speed (OR = 0.81; 95\% CI: 0.63, 1.05; P = 0.114), PEF (OR = 0.97; 95\% CI: 0.78, 1.21; P = 0.810) and grip strength (OR = 0.97; 95\%CI: 0.74, 1.27; P = 0.980).

DISCUSSION: Findings suggest the {\textquoteright}long arm{\textquoteright} of childhood socioeconomic disadvantage can be overcome for these markers of healthy ageing through upward socioeconomic mobility.

}, keywords = {Childhood adversity, social mobility, Socioeconomic factors}, issn = {1741-3850}, doi = {10.1093/pubmed/fdz018}, author = {Anusha M Vable and Paola Gilsanz and Ichiro Kawachi} } @article {9540, title = {If My Blood Pressure Is High, Do I Take It to Heart? Behavioral Effects of Biomarker Collection in the Health and Retirement Study}, journal = {Demography}, volume = {55}, year = {2018}, pages = {403-434}, abstract = {Starting in 2006, respondents in the biennial U.S. Health and Retirement Study were asked to submit biomarkers every other wave and were notified of several results. Rates of undiagnosed high blood pressure and diabetes according to these biomarkers were 1.5 \% and 0.7 \%, respectively. An intent-to-treat analysis suggests that collection and notification had small effects on the average respondent and may have reduced health care utilization. Among respondents who received notification of potentially dangerous biomarker levels, subsequent rates of new diagnosis and associated pharmaceutical usage increased by 20 to 40 percentage points, an order of magnitude above baseline. High blood glucose A1C was associated with a 2.2 \% drop in weight and an increase in exercise among respondents without a previous diagnosis of diabetes. Notifications appear also to have altered health behaviors by spouses, suggesting household responses to health maintenance. Biomarker collection seems to have altered circumstances for an interesting minority of HRS respondents.}, keywords = {Biomarkers, Diabetes, Health Behavior, Survey Methodology}, issn = {0070-3370}, doi = {10.1007/s13524-018-0650-2}, author = {Ryan D. Edwards} } @article {9910, title = {If You{\textquoteright}re Over 50, Chances Are the Decision to Leave a Job Won{\textquoteright}t be Yours}, journal = {ProPublica}, year = {2018}, month = {12/28/2018}, address = {New York City}, keywords = {Ageism, Employment and Labor Force, News, Retirement Planning and Satisfaction}, url = {https://www.propublica.org/article/older-workers-united-states-pushed-out-of-work-forced-retirement}, author = {Gosselin, Peter} } @article {9273, title = {The impact of changes in episodic memory surrounding retirement on subsequent risk of disability, cardiovascular disease, and mortality}, journal = {Work, Aging and Retirement}, volume = {4}, year = {2018}, pages = {10{\textendash}20}, abstract = {Retirement is a key hallmark of life for many in modern society. The Baby Boom generation has resulted in increasing numbers of retirees. Given this trend, it is important to identify key factors that promote better health and longevity in the years following retirement. We used data from 4,266 participants of the Health and Retirement Study who retired over the course of the study to examine whether levels of episodic memory at retirement and rates of change before and after retirement would be associated with disability, cardiovascular disease, and mortality risk following retirement, above and beyond socio-demographics and known risk factors. Individuals who exhibited higher levels of episodic memory at the time of retirement and relative stability in episodic memory prior to and following retirement had a decreased likelihood for disability, cardiovascular disease incidence, and mortality following retirement. The effects of disability remained when controlling for socio-demographics and known risk factors, whereas the effects of level and change prior to retirement on cardiovascular disease incidence and mortality were no longer significant with the inclusion of known risk factors. Better episodic memory was consistently associated with lower risk of disability, cardiovascular disease, and mortality following retirement. Less decline or stability in episodic memory during the time prior to retirement was also associated with lower risk of disability and cardiovascular disease, but not with mortality risk, during the period after retirement. Our discussion focuses on the importance of maintaining episodic memory and possible mechanisms through which it affects health following retirement.}, keywords = {Cardiovascular disease, Cognitive Ability, Disabilities, Memory, Mortality}, issn = {2054-4642}, doi = {10.1093/workar/wax020}, url = {http://academic.oup.com/workar/article/doi/10.1093/workar/wax020/4085175/The-Impact-of-Changes-in-Episodic-Memoryhttp://academic.oup.com/workar/article-pdf/doi/10.1093/workar/wax020/19539531/wax020.pdf}, author = {Frank J Infurna and Andel, Ross} } @article {9727, title = {The Impact of Changes in Population Health and Mortality on Future Prevalence of Alzheimer{\textquoteright}s Disease and Other Dementias in the United States}, journal = {The Journals of Gerontology: Series B}, volume = {73}, year = {2018}, pages = {S38-S47}, abstract = {Objectives We assessed potential benefits for older Americans of reducing risk factors associated with dementia. Methods A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project dementia onset and mortality in risk reduction scenarios for diabetes, hypertension, and dementia. Results We found reducing incidence of diabetes by 50\% did not reduce number of years a person ages 51 or 52 lived with dementia and increased the population ages 65 and older in 2040 with dementia by about 115,000. Eliminating hypertension at middle and older ages increased life expectancy conditional on survival to age 65 by almost 1 year, however, it increased years living with dementia. Innovation in treatments that delay onset of dementia by 2 years increased longevity, reduced years with dementia, and decreased the population ages 65 and older in 2040 with dementia by 2.2 million. Conclusions Prevention of chronic disease may generate health and longevity benefits but does not reduce burden of dementia. A focus on treatments that provide even short delays in onset of dementia can have immediate impacts on longevity and quality of life and reduce the number of Americans with dementia over the next decades.}, keywords = {Alzheimer{\textquoteright}s disease, Dementia, Mortality, Population Health}, issn = {1079-5014}, doi = {10.1093/geronb/gbx147}, url = {https://academic.oup.com/psychsocgerontology/article/73/suppl_1/S38/4971567http://academic.oup.com/psychsocgerontology/article-pdf/73/suppl_1/S38/24626796/gbx147.pdf}, author = {Julie M Zissimopoulos and Tysinger, Bryan and Patricia A St Clair and Eileen M. Crimmins} } @book {9608, title = {Impact of Divorce on Retirement Security}, series = {Working Papers}, year = {2018}, pages = {66}, publisher = {RAND Corporation}, organization = {RAND Corporation}, abstract = {In this paper, we consider the implications of divorce on retirement security. We introduce a theory that highlights how specialization within a divorcing household and timing of divorce relative to planned timing of retirement savings can have a negative impact on retirement security. Using panel data from the Health and Retirement Study (HRS), we evaluate differences in accumulated total and liquid retirement wealth at retirement ages. We replicate past findings that find a negative relationship between ever-divorced individuals and asset accumulation, particularly for women. We find that the negative relationship in our sample between wealth and divorce without remarriage is worse for women who divorce in their 30s than for women who divorce in their 50s whereas for men the relationship is worse for men who divorce in their 50s compared to men who divorce in their 30s. Using the household nature of our data, we compare assets of households before a separation leading to a divorce to those of each individual after that separation. We find evidence of swapping and liquidation of retirement and housing assets: 51 percent of separating households with liquid pre-separation retirement assets will have at least one household member with zero liquid retirement assets after separation. Finally, we develop a methodology to evaluate whether near-retirement divorce impacts retirement decumulation. We conduct a differences-indifferences matching analysis that assigns individuals who eventually divorce within the HRS to similar, but non-divorcing, individuals at first interview. This analysis controls for observed differences between the average divorcee and the average continuously married person, as well as permanent unobserved differences. We find that separated women are more likely to delay Social Security retirement benefit claiming until age 65 or 66, but otherwise we find no significant evidence that divorce is associated with differential decumulation of liquid retirement assets. }, keywords = {Divorce, Marriage, Retirement Planning and Satisfaction, Savings}, doi = {10.7249/WR1201}, url = {https://www.rand.org/pubs/working_papers/WR1201.html}, author = {Hung, Angela and Knapp, David} } @article {9553, title = {Impact of In-Hospital Death on Spending for Bereaved Spouses.}, journal = {Health Services Research}, volume = {53}, year = {2018}, pages = {2696-2717}, abstract = {

OBJECTIVE: To examine how patients{\textquoteright} location of death relates to health care utilization and spending for surviving spouses.

DATA SOURCES/STUDY SETTING: Health and Retirement Study (HRS) 2000-2012 linked to the Dartmouth Atlas and Medicare claims data.

STUDY DESIGN: This was an observational study. We matched bereaved spouses whose spouses died in a hospital to those whose spouses died outside the hospital using propensity scores based on decedent and spouse demographic and clinical characteristics, care preferences, and regional practice patterns.

DATA COLLECTION/EXTRACTION METHODS: We identified 1,348 HRS decedents with surviving spouses. We linked HRS data from each dyad with Medicare claims and regional characteristics.

PRINCIPAL FINDINGS: In multivariable models, bereaved spouses of decedents who died in the hospital had $3,106 higher Medicare spending 12~months postdeath (p~=~.04) compared to those whose spouses died outside a hospital. Those surviving spouses were also significantly more likely to have an ED visit (OR = 1.5; p~<~.01) and hospital admission (OR~= 1.4; p~=~.02) in the year after their spouse{\textquoteright}s in-hospital death. Increased Medicare spending for surviving spouses persisted through the 24-month period postdeath ($5,310; p~=~.02).

CONCLUSIONS: Bereaved spouses of decedents who died in the hospital had significantly greater Medicare spending and health care utilization themselves after their spouses{\textquoteright} death.

}, keywords = {Bereavement, End of life decisions, Medicare linkage, Medicare/Medicaid/Health Insurance}, issn = {1475-6773}, doi = {10.1111/1475-6773.12841}, author = {Katherine A Ornstein and Melissa M Garrido and Albert L Siu and Bollens-Lund, Evan and Kenneth M. Langa and Amy Kelley} } @article {9633, title = {The Impact of Policy Incentives on Long-Term Care Insurance and Medicaid Costs: Does Underwriting Matter?}, journal = {Health Services Research}, volume = {53}, year = {2018}, pages = {3728-3749}, abstract = {

OBJECTIVE: To test whether underwriting modifies the effect of state-based incentives on individuals{\textquoteright} purchase of long-term care insurance.

DATA SOURCE: Health and Retirement Study (HRS), 1996-2012.

STUDY DESIGN: We estimated difference-in-difference regression models with an interaction of state policy indicators with individuals{\textquoteright} probabilities of being approved for long-term care insurance.

DATA EXTRACTION: We imputed probabilities of underwriting approval for respondents in the HRS using a model developed with underwriting decisions from two U.S. insurance firms. We measured the elasticity response to long-term care insurance price using changes in simulated after-tax price as an instrumental variable for premium price.

PRINCIPAL FINDINGS: Tax incentives and Partnership programs increased insurance purchase by 3.62 percentage points and 1.8 percentage points, respectively, among those with the lowest risk (highest approval probability). Neither had any statistically significant effects among the highest risk individuals.

CONCLUSIONS: We show that ignoring the effects of underwriting may lead to biased estimates of the potential state budget savings of long-term care insurance tax incentives. If the private market is to play a role in financing long-term care, policies need to address the underlying adverse selection problems.

}, keywords = {Long-term Care, Medicare/Medicaid/Health Insurance, Policy, Taxes}, issn = {1475-6773}, doi = {10.1111/1475-6773.12870}, author = {Portia Y. Cornell and David C Grabowski} } @article {9495, title = {Impact of volunteering on cognitive decline of the elderly}, journal = {The Journal of the Economics of Ageing}, volume = {12}, year = {2018}, pages = {46-60}, abstract = {Cognitive decline among the elderly imposes a large welfare and health care cost on the individual as well as society. Little however is known about factors that can mitigate cognitive decline. Using seven waves of the Health and Retirement Study and a fixed effects {\textendash} instrumental variable methodology, this study estimates the effects of volunteering on old age cognitive decline. Although cognitive decline is an inevitable aspect of aging, our results suggest that volunteering participation significantly forestalls its progress among individuals aged 60 years and older.}, keywords = {Cognitive Ability, Engagement, Social Support, Volunteerism}, issn = {2212828X}, doi = {10.1016/j.jeoa.2018.01.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2212828X17300646http://api.elsevier.com/content/article/PII:S2212828X17300646?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X17300646?httpAccept=text/plain}, author = {Gupta, Sumedha} } @article {10000, title = {The impacts of service related exposures on trajectories of mental health among aging veterans.}, journal = {Journals of Gerontology, Series B: Psychological Sciences \& Social Sciences}, volume = {73}, year = {2018}, pages = {e131-e142}, abstract = {Objectives: Drawing on life-course perspective and cumulative advantage theory, we examined whether service related exposures (SREs)-combat and exposure to death-have lasting impacts on depressive symptom and psychiatric problem trajectories of aging veterans. Methods: The Health and Retirement Study and linked 2013 Veterans Mail Survey were used to examine SREs and mental health among older veterans between 2002 and 2012 (N = 1,662). Latent growth curves were used to measure how individuals vary from average mental health trajectories based on SREs and other important covariates. Results: Exposure to death had a significant and lasting effect on depressive symptoms for veterans in late life but was reduced to nonsignificance when physical health trajectories were included. Combat and exposure to death had independent and robust impacts on psychiatric problems, which were robust in final models. Discussion: SREs presented varied and significant impacts, suggesting that combat does not work alone in driving poor mental health trajectories, and that exposure to death is a more robust risk marker for later outcomes.}, keywords = {Depressive symptoms, Health Trajectories, Veterans}, issn = {1758-5368}, doi = {10.1093/geronb/gbw149}, author = {Urena, Stephanie and Miles G Taylor and Ben Lennox Kail} } @article {11912, title = {Import Competition and Household Debt}, year = {2018}, institution = {Federal Reserve Bank of New York Staff Reports,}, abstract = {We analyze the effect of import competition on household balance sheets from 2000 to 2007 using individual data on consumer finances. We exploit variation in exposure to foreign competition using industry-level shipping costs and initial differences in regions{\textquoteright} industry specialization to study households use of credit markets in response to income shocks. We show that household debt increases significantly in regions where manufacturing industries are more exposed to import competition. A one standard deviation increase in exposure to import competition explains 30\% of the cross-regional variation in household leverage growth, and is mostly driven by home equity extraction. Using data on individual expectations, we find that households in affected areas underestimate the persistence of income shock and lever up in order to smooth consumption. Our results highlight the role played by mortgage markets in absorbing displacement shocks triggered by globalization.}, keywords = {competiition, Debt, Household, Household asset allocation}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2808981}, author = {Jean-Noel Barrot and Erik Loualiche and Matthew C. Plosser and Julien Sauvagnat} } @article {9933, title = {Importance of Recalibrating Models for Type 2 Diabetes Onset Prediction: Application of the Diabetes Population Risk Tool on the Health and Retirement Study.}, journal = {Conf Proc IEEE Eng Med Biol Soc}, volume = {2018}, year = {2018}, month = {2018 Jul}, pages = {5358-5361}, abstract = {A timely prediction of type 2 diabetes (T2D) onset is important for early intervention to prevent, or at least postpone, its incidence. Several models to predict T2D onset according to individual risk factors were proposed. However, their practical applicability is limited by the fact that they often perform suboptimally when applied to a different population. A solution to overcome this limitation is model recalibration, which consists in updating the model parameters. The aim of this work is to demonstrate the benefits of T2D predictive model recalibration. For the purpose, we considered as case study the Diabetes Population Risk Tool (DPoRT), originally tuned for the Canadian population, and we applied it to data collected in older Americans in the Health and Retirement Study (HRS). A subset of 30,274 subjects was extracted from HRS and divided into a training (N=24,219) and a test set (N=6,055) stratifying for sex and diabetes incidence. The DPoRT was recalibrated by re-estimating all model coefficients on the training set, and then assessed on the test set by comparing the performance of recalibrated vs original model. Model discriminatory ability and calibration were assessed by the concordance index (C-index) and the expected to observed event probability ratio (E/O), respectively. Results show that the recalibrated DPoRT presents similar discriminatory ability to the original model, with C-index equal to 0.68 vs. 0.67 in men, 0.73 vs. 0.73 in women, and better calibration than the original model, with E/O ratio equal to 0.75 vs. 4.57 in men, 0.81 vs. 2.53 in women. Results confirm that recalibration is a key step to be performed before the application of predictive models to different populations in order to guarantee an accurate prediction of diabetes incidence.}, keywords = {Diabetes}, issn = {1557-170X}, doi = {10.1109/EMBC.2018.8513554}, author = {Vettoretti, Martina and Longato, Enrico and Camillo, Barbara Di and Facchinetti, Andrea} } @article {9601, title = {In Debt and Approaching Retirement: Claim Social Security or Work Longer?}, journal = {AEA Papers and Proceedings}, volume = {108}, year = {2018}, month = {05/2018}, pages = {401-406}, chapter = {401}, abstract = {Over the past couple of decades, older Americans have become considerably more leveraged. This paper considers whether household debt affects the timing of retirement and Social Security benefit claiming. Using data from the Health and Retirement Study, we find that older adults with debt are more likely to work and less likely to receive Social Security benefits than those who are debt-free. Indebted adults are also more likely to delay fully retiring from the labor force and claiming their benefits. Among the sources of debt, mortgages have a stronger impact on older adults{\textquoteright} behavior than do other sources of debt. }, keywords = {Debt, Retirement Planning and Satisfaction, Social Security}, issn = {2574-0768}, url = {https://www.aeaweb.org/articles?id=10.1257/pandp.20181116}, author = {Barbara A Butrica and Nadia S. Karamcheva} } @article {9820, title = {Incidental Bequests and the Choice to Self-Insure Late-Life Risks}, journal = {American Economic Review}, volume = {108}, year = {2018}, month = {Jan-09-2018}, pages = {2513 - 2550}, abstract = {Despite facing significant uncertainty about their lifespans and health care costs, most retirees do not buy annuities or long-term care insurance. In this paper, I find that retirees{\textquoteright} saving and insurance choices are highly inconsistent with standard life-cycle models in which people care only about their own consumption but match well models in which bequests are luxury goods. Bequest motives tend to reduce the value of insurance by reducing the opportunity cost of precautionary saving. The results suggest that bequest motives significantly increase saving and significantly decrease purchases of long-term care insurance and annuities.}, keywords = {Annuitization, Healthcare, Insurance}, issn = {0002-8282}, doi = {10.1257/aer.20141651}, url = {https://pubs.aeaweb.org/doi/10.1257/aer.20141651https://pubs.aeaweb.org/doi/pdf/10.1257/aer.20141651}, author = {Lockwood, Lee M.} } @article {8552, title = {Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {901-912}, abstract = {

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

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

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

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

}, keywords = {Aged, Chronic disease, Data Accuracy, Epidemiologic Methods, Female, Health Surveys, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Self Report}, issn = {1758-5368}, doi = {10.1093/geronb/gbw063}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27260670}, author = {Christine T Cigolle and Corey L Nagel and Caroline S Blaum and Jersey Liang and Ana R Qui{\~n}ones} } @article {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 {9815, title = {Index or illusion: The case of frailty indices in the Health and Retirement Study.}, journal = {PLoS One}, volume = {13}, year = {2018}, month = {07/2018}, pages = {e0197859}, abstract = {

INTRODUCTION: Frailty is a geriatric syndrome that has been defined differently with various indices. Without a uniform definition, it remains unclear how to interpret and compare different frailty indices (FIs). With the advances in index mining, we find it necessary to review the implicit assumptions about the creation of FIs. We are concerned the processing of frailty data may introduce measurement error and bias. We aim to review the assumptions, interpretability and predictive power of FIs regarding mortality.

METHODS: Three FIs, the Functional Domains Model proposed by Strawbridge et al. (1998), the Burden Model by Rockwood et al. (2007) and the Biologic Syndrome Model by Fried et al. (2004), were directly compared using the data from the Health and Retirement Study (HRS), a longitudinal study since 1996 mainly following up Americans aged 50 years and over. The FIs were reproduced according to Cigolle et al. (2009) and interpreted with their input variables through forward-stepwise regression. Biases were the residuals of the FIs that could not be explained by own input variables. Any four of the input variables were used to create alternative indices. Discrete-time survival analysis was conducted to compare the predictive power of FIs, input variables and alternative indices on mortality.

RESULTS: We found frailty a syndrome not unique to the elderly. The FIs were produced with different degrees of bias. The FIs could not be fully interpreted with the theory-based input variables. The bias induced by the Biological Syndrome Model better predicted mortality than frailty status. A complicated FI, the Burden Model, could be simplified. The input variables better predicted mortality than the FIs. The continuous FIs predicted mortality better than the frailty statuses. At least 6865 alternative indices better predicted mortality than the FIs.

CONCLUSION: FIs have been used as outcome in clinical trials and need to be reviewed for adequacy based on our findings. The three FIs are not closely linked to the theories because of bias introduced by data manipulation and excessive numbers of input variables. We are developing new algorithms to develop and validate innovative indices.

}, keywords = {Frailty}, issn = {1932-6203}, doi = {10.1371/journal.pone.0197859}, author = {Yi-Sheng Chao and Hsing-Chien Wu and Chao-Jung Wu and Wei-Chih Chen} } @mastersthesis {10287, title = {Individual Characteristics Associated with Dementia Risk in Minority Populations}, volume = {Master of Arts in Social Gerontology}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-02-20}, pages = {86}, school = {University of Nebraska at Omaha}, type = {phd}, abstract = {U.S. minority populations are continuously growing. Concurrent with this growth is an increase in persons with cognitive impairment and dementia, especially in vulnerable populations. Despite this increase, there has been a comparative lack of minority focused research, especially in regards to comprehensive models which examine demographics, education, and health. This study utilized the ADAMS dataset (Health and Retirement Study) to investigate the predictive variables of age, sex, marital status, employment, education, and health within the context of ethnicity. Results showed that age, minority status, disability, lower education, cardiovascular disease, and increased number of comorbidities positively predicted development of both cognitive impairment not dementia and dementia. This evidence, in the context of ethnicity, and the burden of health, education, and demographics on minority persons, gives cause for increased support and development of culturally sensitive and focused programming to better serve minority populations.}, keywords = {ADAMS, Dementia, Ethnic studies, ethnicity, Gerontology, Health and environmental sciences, HRS, Minority, Public Health, Social Sciences}, isbn = {9780438864016}, author = {Sarah B Hubner} } @mastersthesis {10346, title = {Individual Predictors of Volunteering in Older Adults Using Structural Equation Modeling}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-02-21}, pages = {263}, school = {University of Nebraska at Omaha}, type = {phd}, abstract = {The purpose of this study was to evaluate the interplay of both personality and resource theories to explain volunteering outcomes in adults 65 years and older. Structural equation modeling tested Core 2010 data from the Health and Retirement Survey and the Leave Behind, Self-Administered Questionnaire. Personality theory was tested using measures of the Big Five personality domains. Resource theory which combines psychosocial theories using personal, social, and cultural constructs were tested. Results showed that of the Big Five personality domains Extraversion, both directly and indirectly, predicted volunteering. Extraversion also predicted social capital measures of frequency of Meeting with Friends and Email-Write Interactions, and to a lesser extent Religiosity (used as a proxy for cultural capital). Religiosity, measured as Church Attendance and indicators associated with Belief in God, directly predicted volunteering outcomes. Agreeableness predicted Religiosity. Open to New Experience was positively correlated with social capital involving Email-Write Interactions and inversely correlated with cultural capital (Religiosity). As expected, health and income directly predicted volunteering while age was inversely related to volunteering. Understanding the extent to which this new knowledge of how the interplay of social and cultural capital intervene between personality to predict volunteering outcomes may bode well for organizations seeking to engage older adults and/or grow their pool of volunteers. Future applied research testing how this interplay impacts volunteering outcomes could help volunteer organizations develop and promote best practices to enhance engaging older adults and recruiting and retention efforts.}, keywords = {0351:Gerontology, Aging, Behavior, Gerontology, SEM, Social Sciences, Volunteering}, isbn = {9780438863781}, author = {Baumel,Zolana Z.} } @article {9565, title = {Informal caregiving costs for CVD projected to double by 2035}, journal = {Healio}, year = {2018}, publisher = {Healio}, address = {Thorofare, New Jersey}, keywords = {Cardiovascular disease, Caregiving, Economics, News}, url = {https://www.healio.com/cardiology/chd-prevention/news/online/\%7B184a689e-3874-4e64-b563-6e7a3a66dfd7\%7D/informal-caregiving-costs-for-cvd-projected-to-double-by-2035} } @article {9787, title = {Innovations in Finance (A Special Report) - Experts{\textquoteright} Voices: Why Elder Financial Fraud Is Worse Than We Thought}, journal = {The Wall Street Journal}, year = {2018}, month = {06/20/2018}, pages = {R8}, edition = {Eastern}, address = {New York City}, author = {Olivia S. Mitchell} } @article {9556, title = {Integrative analysis of omics summary data reveals putative mechanisms underlying complex traits}, journal = {Nature Communications}, volume = {9}, year = {2018}, abstract = {The identification of genes and regulatory elements underlying the associations discovered by GWAS is essential to understanding the aetiology of complex traits (including diseases). Here, we demonstrate an analytical paradigm of prioritizing genes and regulatory elements at GWAS loci for follow-up functional studies. We perform an integrative analysis that uses summary-level SNP data from multi-omics studies to detect DNA methylation (DNAm) sites associated with gene expression and phenotype through shared genetic effects (i.e., pleiotropy). We identify pleiotropic associations between 7858 DNAm sites and 2733 genes. These DNAm sites are enriched in enhancers and promoters, and >40\% of them are mapped to distal genes. Further pleiotropic association analyses, which link both the methylome and transcriptome to 12 complex traits, identify 149 DNAm sites and 66 genes, indicating a plausible mechanism whereby the effect of a genetic variant on phenotype is mediated by genetic regulation of transcription through DNAm.}, keywords = {Complex Traits, Genetics, GWAS}, doi = {10.1038/s41467-018-03371-0}, url = {http://www.nature.com/articles/s41467-018-03371-0http://www.nature.com/articles/s41467-018-03371-0.pdfhttp://www.nature.com/articles/s41467-018-03371-0.pdfhttp://www.nature.com/articles/s41467-018-03371-0}, author = {Wu, Yang and Zeng, Jian and Zhang, Futao and Zhihong Zhu and Qi, Ting and Zheng, Zhili and Lloyd-Jones, Luke R. and Riccardo E Marioni and Nicholas G Martin and Grant W Montgomery and Ian J Deary and Naomi R. Wray and Peter M Visscher and McRae, Allan F. and Yang, Jian} } @mastersthesis {10240, title = {An Intersectional Perspective on the Relationships Among Social Status, Self-reported Discrimination, and Low-grade C-Reactive Protein in the Health and Retirement Study}, volume = {Doctor of Philosophy}, year = {2018}, month = {06/2018}, pages = {205}, school = {The Pennsylvania State University}, address = {State College, PA}, abstract = {A broad literature has documented social patterning of health, such that those with lower social status (e.g., racial minorities, women, and people of lower socioeconomic status) bear a disproportionate burden of morbidity and mortality relative to those with higher status. Disparities may be larger for some individuals, particularly those who are socially disadvantaged in more than one status. Variations in stress exposure, like experiences of discrimination, and resulting low-grade inflammation, may explain such disparities. A limited body of literature has examined the social distribution of low-grade inflammation, which is implicated in chronic diseases that are responsible for excess deaths in the United States. Limited work has examined how social statuses might interact to predict inflammatory markers like C-reactive protein (CRP), or tested psychosocial mechanisms responsible for the social distribution of CRP. The present study will examine the relationship between race, gender, and SES; everyday and lifetime discrimination exposure; and CRP. Aim 1 will test whether an interaction of race, gender, and SES are associated with CRP levels. Aim 2 will assess how race, gender, and SES shape exposure to lifetime and everyday discrimination, and whether this discrimination exposure mediates the relationship between race x gender x SES and CRP. Data were drawn from 5,486 respondents in the Health and Retirement Study, a nationally representative sample of midlife and older adults, to analyze the relationships between social status (e.g., race, gender, SES), everyday discrimination, lifetime discrimination, and CRP levels at baseline and after a four-year follow-up. Aim 1 study results demonstrate that race, gender, and SES interact to produce differential CRP levels at baseline and follow-up. The results suggest that there are incremental benefits for each additional level of SES for all race and gender groups except Black women. Significant three-way interactions of race, gender, and SES also indicate that Black women experience higher CRP levels with increases in SES, and that Black men with low SES are have the highest levels of CRP. Aim 2 study results show that everyday and lifetime discrimination exposure varies across social status groups. However, there were no significant interactions among race, gender, and SES on discrimination exposure. Further, results showed that both everyday and lifetime exposure to discrimination were significantly associated with CRP levels at baseline but not with change in CRP over four years. In clarifying the complexity inherent in disparities in low-grade inflammation, as well as potential psychosocial mechanisms responsible for these mechanisms, this work will contribute to a greater understanding of the factors underlying major causes of excess morbidity and mortality in the United States, and may identify potential intervention points for addressing health disparities.}, keywords = {C-reactive protein, developmental perspective, Gerontology, health, health discrimination, Intersectionality, Lifespan, Racial Disparities, social determinants, social status and health}, url = {https://etda.libraries.psu.edu/catalog/15539hrc117}, author = {Heather R. Farmer} } @article {9795, title = {Intersectionality and Stratification in the Labor Market}, journal = {Generations - Journal of the American Society on Aging}, volume = {42}, year = {2018}, pages = {34-40}, abstract = {Since the 1990s, women have made gains in education and work, but gender and racial stratification in health, work, and retirement create disparities in aging. This article explores the changing social and economic status of mature men, women, and women of color through a review of the health and aging literature, and analysis of the Health and Retirement Study. The article analyzes the ways women-black women in particular-are disadvantaged by racialized patriarchy, leading to strong dependence on government old-age programs.}, keywords = {Employment and Labor Force, Racial/ethnic differences, Women and Minorities}, url = {https://apps.webofknowledge.com/InboundService.do?customersID=Alerting\&mode=FullRecord\&IsProductCode=Yes\&product=WOS\&Init=Yes\&Func=Frame\&DestFail=http\%3A\%2F\%2Fwww.webofknowledge.com\&action=retrieve\&SrcApp=Alerting\&SrcAuth=Alerting\&SID=8CK2zTEgfWYafamBP8q\&}, author = {Moore, Kyle K. and Teresa Ghilarducci} } @article {9845, title = {It{\textquoteright}s better to be born rich than gifted}, journal = {The Washington Post}, year = {2018}, month = {10/9/2018}, address = {Washington, DC}, keywords = {Genetics, GWAS, News, Socioeconomic factors}, url = {https://www.washingtonpost.com/business/2018/10/09/its-better-be-born-rich-than-talented/?noredirect=on\&utm_term=.e6c0cc49f545}, author = {Van Dam, Andrew} } @article {10351, title = {Is It Time to Raise the Social Security Retirement Age?}, year = {2018}, month = {11/2018}, institution = {The Urban Institute}, abstract = {Social Security faces a long-term financing problem. The program now spends more than it collects each year, and Social Security{\textquoteright}s trustees project that it will be unable to pay full benefits beginning in 2034. Reducing the payment period by raising the age at which beneficiaries can begin collecting benefits would improve Social Security{\textquoteright}s finances. But some older people, especially those with limited education and incomes, could suffer financially if they had to wait longer to collect retirement benefits. This report examines how raising Social Security{\textquoteright}s early entitlement age (EEA), currently 62, might affect beneficiaries and discusses ways to protect adults who might not be able to work until qualifying for Social Security benefits.}, url = {https://www.urban.org/research/publication/it-time-raise-social-security-retirement-age}, author = {Richard W. Johnson} } @article {8855, title = {Identifying adults aging with disability using existing data: The case of the Health and Retirement Study.}, journal = {Disabil Health J}, volume = {10}, year = {2017}, month = {2017 Oct}, pages = {611-615}, abstract = {

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

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

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

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

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

}, keywords = {Activities of Daily Living, Adolescent, Age of Onset, Aged, Aged, 80 and over, Aging, Child, Child Health, Chronic disease, Disabled Persons, Female, health, Health Status, Health Surveys, Humans, Male, Middle Aged, Retirement, Self Report, Work}, issn = {1876-7583}, doi = {10.1016/j.dhjo.2016.12.016}, url = {https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1}, author = {Caitlin E. Coyle and Putnam, Michelle} } @article {8483, title = {Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.}, journal = {Health Serv Res}, volume = {52}, year = {2017}, month = {2017 02}, pages = {113-131}, abstract = {

OBJECTIVE: To create and test three prospective, increasingly restrictive definitions of serious illness.

DATA SOURCES: Health and Retirement Study, 2000-2012.

STUDY DESIGN: We evaluated subjects{\textquoteright} 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12~months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.

DATA COLLECTION: Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.

PRINCIPAL FINDINGS: One-year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.

CONCLUSIONS: Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Critical Illness, Early Diagnosis, Female, Health Care Costs, Hospitalization, Humans, Male, Medicare, Nursing homes, Prospective Studies, Quality Improvement, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12479}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26990009}, author = {Amy Kelley and Kenneth E Covinsky and Rebecca Jean Gorges and McKendrick, Karen and Bollens-Lund, Evan and R Sean Morrison and Christine S Ritchie} } @article {8697, title = {Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 03}, pages = {276-284}, abstract = {

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

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

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Health Behavior, Health Expenditures, Health Status, Humans, Machine learning, Male, Medicare, Retrospective Studies, Self Report, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000660}, author = {Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Avi Dor and Charles W Given and Kurt C Stange and Siran M Koroukian} } @article {9233, title = {The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review}, journal = {Respiratory Medicine}, volume = {129}, year = {2017}, month = {Jan-08-2017}, pages = {130-139}, abstract = {Objective To determine the characteristics of persons with cognitive impairment being able to self-manage in chronic obstructive pulmonary disease (COPD). Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance this systematic review examined all studies in English from 1st January 2000 to 20 February 2016, describing the relationship between cognition and COPD self-management domains in older community dwelling persons with dementia or cognitive impairment. Results Of 4474 studies identified, thirteen studies were eligible for inclusion. No studies differentiated populations into recognized dementia subtypes. Study aims were variable; most (n = 7) examined inhaler competency alone. Studies identified a link between worsening cognition and the need for assistance in activities of daily living. Only one study evaluated the impact of cognition on overall self-management and found no association between cognitive impairment and self-rated self-management. Mild degrees of cognitive impairment were associated with reduced symptom recall. Cognitive impairment in COPD was associated with high degrees of inhaler incompetency. Basic cognitive screening tests were able to predict inhaler incompetence with reduced overall cognitive function, dyspraxia, and/or executive function identified as predictors of incompetency. Conclusions Multiple measures of disability consistently demonstrated that cognitive impairment in COPD significantly increased the need for assistance in many aspects of daily living, treatment adherence, and effective self-management. Given the nature of neuropsychological deficits seen in COPD, dedicated screening tools are required. Future research should investigate the impact of cognitive dysfunction in COPD and identify how to support those that lack capacity to self-manage.}, keywords = {Cognitive Ability, COPD, Survey Methodology}, issn = {09546111}, doi = {10.1016/j.rmed.2017.06.006}, url = {http://www.sciencedirect.com/science/article/pii/S0954611117301725?_rdoc=1\&_fmt=high\&_origin=gateway\&_docanchor=\&md5=b8429449ccfc9c30159a5f9aeaa92ffb}, author = {Baird, Chelsea and Lovell, Janaka and Marilyn Johnson and Shiell, Kerrie and Ibrahim, Joseph E.} } @article {8820, title = {The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 01}, pages = {71-80}, abstract = {

BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals.

OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment.

MAIN MEASURES: Outcomes measured were readmissions <=30~days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents >=65~years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race.

KEY RESULTS: For pneumonia, >=3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); {\textquoteright}other{\textquoteright} patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496).

CONCLUSIONS: Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, Comorbidity, Disability Evaluation, Female, Heart Failure, Humans, Logistic Models, Male, Myocardial Infarction, Patient Readmission, Pneumonia, Retrospective Studies, Risk Adjustment, Social determinants of health}, issn = {1525-1497}, doi = {10.1007/s11606-016-3869-x}, url = {http://link.springer.com/10.1007/s11606-016-3869-xhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/article/10.1007/s11606-016-3869-x/fulltext.html}, author = {Meddings, Jennifer and Reichert, Heidi and Shawna N Smith and Theodore J Iwashyna and Kenneth M. Langa and Timothy P Hofer and Laurence F McMahon} } @article {9229, title = {The impact of health and education on future labour force participation among individuals aged 55{\textendash}74 in the United States of America: the MacArthur Foundation Research Network on an Aging Society}, journal = {Ageing and Society}, volume = {37}, year = {2017}, pages = {1313-1337}, abstract = {Chronic disease, mobility limitations and low physical functioning are determinants of an earlier age of retirement. Therefore, long-term population trends in these factors may have an impact on the proportion of individuals near traditional retirement age who continue to work. Our objective is to develop a projection model that accounts for trends in these factors in order to estimate the proportion of the population aged 55{\textendash}74 with the capacity to participate in the labour force. We used logistic regression models to quantify how chronic disease, mobility and functional status predict labour force participation among individuals aged 55{\textendash}59. Next, we obtained estimates of the population prevalence of each of these predictors for the years 2010{\textendash}2050. We then used estimated coefficients from the logistic regression models to predict the age-specific probability of capacity for work up to the age of 74. We find that population capacity for work depends on trends in disability and on level of education. Future population capacity for work depends on trends in functional limitations primarily in the population with lower levels of education. Changes in functional limitations, changes in the environment, technology and social policy targeted towards individuals with lower levels of education could result in mitigation of future decreasing capacity for work in the population near retirement age.}, keywords = {Education, Employment and Labor Force, Population Health, Retirement Planning and Satisfaction}, issn = {0144-686X}, doi = {10.1017/S0144686X16000295}, url = {https://www.cambridge.org/core/product/identifier/S0144686X16000295/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X16000295}, author = {David Rehkopf and Nancy E Adler and John W Rowe} } @article {9619, title = {The Impact of Health on Labor Supply Near Retirement}, number = {SP 2017-364}, year = {2017}, pages = {1-48}, institution = {Michigan Retirement Research Center}, address = {Ann Arbor, MI}, abstract = {Estimates of effect of health on employment differ from study to study due to differences in methods, data, institutional background and health measure. We assess the importance of these differences, using a unified framework to interpret and contrast estimate for the US and England. We find that subjective and objective health measures, and subjective measures instrumented by objective measures produce similar estimates but only if a sufficiently large number of objective measures is used. Otherwise, objective measures produce downward biased estimates. Failure to account for initial conditions produces upward biased estimates. We find that a single subjective health index yields similar estimates to multiple measures. Overall, declines in health explain up to 15\% of the decline in employment between ages 50 and 70. The effects drop with education and are larger in the US than in England. Cognition has little added explanatory power once we control for health.}, keywords = {Cognitive Ability, Employment and Labor Force, Health Changes}, url = {http://mrrc.isr.umich.edu/wp364/}, author = {Richard Blundell and Jack Britton and Monica Costa Dias and Eric French} } @article {9345, title = {The impact of Medicare Part D on cognitive functioning at older ages.}, journal = {Social Science \& Medicine}, volume = {193}, year = {2017}, pages = {118-126}, abstract = {Research has shown that the establishment of Medicare prescription drug benefit in 2006 leads to improvement in medication adherence and mortality outcomes. Despite a clear connection between physical/mental health and the risk of dementia, little is known about the extent to which this reform has affected the cognitive functioning of the elderly. Using data from the Health and Retirement Study and difference-in-differences approach, this study provides the first evidence on the cognition-enhancing effects of Medicare Part D. Our estimates show that Part D implementation is associated with 1.6\% increase in cognitive functioning or 1.1-year delay of cognitive aging among benefit-eligible persons. Further analyses indicate that most of the cognitive benefits accrue to the vulnerable populations who previously lacked prescription drug coverage, and that a reduction in cardiovascular mortality is the most likely pathway through which the expansion improved cognitive functioning.}, keywords = {Cognition \& Reasoning, Medicare Part D, Prescription Medication}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.09.037}, author = {Tae-Young Pak and GwanSeon Kim} } @article {10466, title = {The Impact of Medicare Part D on Emergency Department Visits.}, journal = {Health Economics}, volume = {26}, year = {2017}, month = {2017 04}, pages = {536-544}, abstract = {

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {Aged, Delivery of Health Care, Emergency Service, Hospital, Female, Humans, Insurance Coverage, Insurance, Health, Male, Medicare Part D, Middle Aged, prescription drugs, Surveys and Questionnaires, United States}, issn = {1099-1050}, doi = {10.1002/hec.3326}, author = {Padmaja Ayyagari and Dan M. Shane and George L Wehby} } @article {9206, title = {The impact of multimorbidity on grip strength in adults age 50 and older: Data from the Health and Retirement Survey (HRS)}, journal = {Archives of Gerontology and Geriatrics}, volume = {72}, year = {2017}, pages = {164-168}, abstract = {Background: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. Methods: A cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). Results: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with >=3 chronic diseases present (b = 3.1, 95\% CI = 2.3{\textendash}3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. Conclusion: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.}, keywords = {Comorbidity, Grip strength, Health Conditions and Status}, issn = {01674943}, doi = {10.1016/j.archger.2017.05.011}, author = {Amy M Yorke and Amy B. Curtis and Shoemaker, Michael and Vangsnes, Eric} } @mastersthesis {9482, title = {The Impact of Retirement on Health Behaviours}, volume = {M.A.}, year = {2017}, month = {12/2017}, pages = {66}, school = {University of Ottawa}, type = {Thesis}, address = {Ottawa}, abstract = {The objective of the analysis is to identify the causal effects of being retired for at least one year on health behaviours. To estimate the effect of retirement, biannual data from the 2004 to 2014 Health and Retirement Study (HRS) is used. The endogeneity of retirement is acknowledged in our model by using an instrumental variable approach with the social security eligibility ages of 62 and 65 as instruments. Additionally, the longitudinal nature of the data gives us the ability to estimate an individual Fixed Effect (FE) model to control for unobservable time-invariant individual heterogeneity. The retirement parameter estimates of the FE-2SLS model show that being retired for at least one year is associated with a 26 percentage point increase in the likelihood of meeting the physical activity guidelines and a 17 percentage point increase in the likelihood of getting a flu shot, but a 9 percentage point decrease in the likelihood of getting a cholesterol blood test. Thus retirement is associated with some improvement in health behaviours.}, keywords = {Health Behavior, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {https://ruor.uottawa.ca/bitstream/10393/37201/1/Larlee_Caroline_2017_researchpaper.pdf}, author = {Larlee, Caroline} } @article {9374, title = {The Impact of Systematic Trend and Uncertainty on Mortality and Disability in a Multistate Latent Factor Model for Transition Rates}, journal = {North American Actuarial Journal}, volume = {21}, year = {2017}, pages = {594-610}, abstract = {Multiple state functional disability models do not generally include systematic trend and uncertainty. We develop and estimate a multistate latent factor intensity model with transition and recovery rates depending on a stochastic frailty factor to capture trend and uncertainty. We estimate the model parameters using U.S. Health and Retirement Study data between 1998 and 2012 with Monte Carlo maximum likelihood estimation method. The model shows significant reductions in disability and mortality rates during this period and allows us to quantify uncertainty in transition rates arising from the stochastic frailty factor. Recovery rates are very sensitive to the stochastic frailty. There is an increase in expected future lifetimes as well as an increase in future healthy life expectancy. The proportion of lifetime spent in disability on average remains stable with no strong support in the data for either morbidity compression or expansion. The model has widespread application in costing of government-funded aged care and pricing and risk management of long-term-care insurance products.}, keywords = {Disabilities, Latent Variable Modeling, Mortality}, issn = {1092-0277}, doi = {10.1080/10920277.2017.1330157}, url = {https://www.tandfonline.com/doi/full/10.1080/10920277.2017.1330157https://www.tandfonline.com/doi/pdf/10.1080/10920277.2017.1330157}, author = {Li, Zixi and Shao, Adam Wenqiang and Sherris, Michael} } @article {9277, title = {Improving the system of financing long-term services and supports for older Americans}, journal = {The Journal of Retirement}, volume = {5}, year = {2017}, pages = {48-68}, abstract = {Medicaid currently pays for most of the long-term services and supports (LTSS) provided older Americans. With an aging population, these costs will increase rapidly. Contrary to a widely held view, current Medicaid eligibility rules allow covered households to own significant housing and retirement assets. The authors present new information about the weak efforts of states in asset recovery and discuss the extensive asset holdings, especially in housing and retirement assets, of retired households. Given that Medicaid crowds out the purchase of private long-term care insurance, liberal eligibility rules and uneven enforcement must increase the costs of governments and discourage better-off households from covering LTSS exposure through private insurance and assets. They conclude with targeted recommendations to reform Medicaid and improve the LTSS financing system, following up on proposals made by certain members of the 2013 federal Commission on Long-Term Care.}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, issn = {2326-6899}, doi = {10.3905/jor.2017.5.1.048}, url = {http://www.iijournals.com/doi/10.3905/jor.2017.5.1.048}, author = {Mark J. Warshawsky and Marchand, Ross A.} } @article {9147, title = {In Brief}, year = {2017}, keywords = {In Brief}, issn = {1536-5042}, doi = {10.1177/1536504217714250}, url = {http://journals.sagepub.com/doi/10.1177/1536504217714250} } @article {9204, title = {Incentivizing older people to delay social security claiming}, number = {57}, year = {2017}, institution = {SAFE}, address = {Frankfurt, Germany}, abstract = {Given rising life expectations around the world, it seems that old-age pension benefits will need to be cut and pension contributions boosted in many nations. Yet our research on old-age system reforms does not require raising mandatory retirement ages or contributions. Instead, we offer ways to enhance incentives for people to work longer and delay retirement. There are good reasons to incentivize older people to work longer and delay retirement. These include rising longevity, the shrinking workforce, and emerging evidence indicating that working longer can be associated with better mental and physical health for many people. Nevertheless, old age Social Security systems in many nations find that people tend to claim benefits early, usually leading to reduced benefits.In the United States, for instance, a majority of Americans claim their Social Security benefits at the earlier feasible age, namely 62, even though their monthly benefits would be 75\% higher if they waited until age 70. To test whether this is the result of people underweighting the economic value of higher lifetime benefit streams, we examine whether people would claim later and work longer if they were rewarded with a lump sum instead of a higher lifetime benefit stream for deferring. Two arguments have been offered to explain early claiming. One is that workers claim early to avoid potentially {\textquotedblleft}forfeiting{\textquotedblright} their deferred benefits should they die too soon (Brown et al., 2016). A second explanation is that many people underweight the economic value of lifetime benefit streams (Brown et al., 2017). This latter rationale motivates the present study.}, keywords = {Retirement Planning and Satisfaction, Social Security}, url = {http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/44313}, author = {Maurer, Raimond and Olivia S. Mitchell} } @article {8756, title = {Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {72}, year = {2017}, month = {2017 02}, pages = {216-222}, abstract = {

BACKGROUND: Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement.

METHODS: Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component.

RESULTS: In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95\% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95\% CI = 1.71-2.59 (excluding pain).

CONCLUSIONS: Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

}, keywords = {Aged, Chronic pain, Female, Frail Elderly, Geriatric Assessment, Humans, Male, Phenotype, Prognosis}, issn = {1758-535X}, doi = {10.1093/gerona/glw212}, url = {http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw212}, author = {Matthew C. Lohman and Karen L Whiteman and Rebecca L. Greenberg and Martha L. Bruce} } @article {9294, title = {Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment.}, journal = {American Journal of Alzheimer{\textquoteright}s Disease and Other Dementias}, year = {2017}, abstract = {

INTRODUCTION: This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI).

METHODS: Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes.

RESULTS: In a sample of 18 913 participants (weighted n = 87.5 million), 1.93\% and 1.84\% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9\%, 39.3\%, and 71.3\% among those with no CI, mild CI, and moderate/severe CI, respectively.

DISCUSSION: Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.

}, keywords = {Cognitive Ability, Comorbidity, Functional limitations}, issn = {1938-2731}, doi = {10.1177/1533317517726388}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Kurt C Stange and Kathleen A Smyth} } @article {9248, title = {Individual and health system variation in rehospitalizations the year after pneumonia.}, journal = {Medicine (Baltimore)}, volume = {96}, year = {2017}, month = {2017 Aug}, pages = {e7695}, abstract = {Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participants enrolled in Fee-for-service Medicare (FFS), (2) Veterans Administration (VA) Healthcare system, and (3) Kaiser Permanente of Northern California (KPNC). The 365-day survival and re-hospitalizations were determined for each cohort. Multinomial logistic regression was used to identify potential contributors to the different patterns.We identified 2731, 23,536, and 39,147 hospitalizations for pneumonia in FFS Medicare, VA, and KPNC, respectively, of whom 88.1\%, 92.8\%, and 89.7\% survived to hospital discharge. The median patient survived to 1 year and was rehospitalized twice in FFS (9.0\%), once in VA (14.1\%) and KPNC (9.1\%). Of the patients who survived the hospitalization, 33.3\% (FFS), 30.2\% (VA), and 26.8\% (KPNC) died during the subsequent year. Of those who survived, 29.8\% (FFS), 35.9\% (VA), and 46.1\% (KPNC) were never rehospitalized. 11.9\% (FFS), 11.9\% (VA), and 11.7\% (KPNC) had greater than 3 hospitalizations. Age, race, gender, comorbidity, ICU use, and hospital length stay collectively explained little (5-7\%) of the variation in the recovery pattern.There is significant variation in the year after the hospitalization for pneumonia across individuals, but less so across health systems. There may be important opportunities to better classify these heterogeneous individual-level pathways.}, keywords = {Hospitalization}, issn = {1536-5964}, doi = {10.1097/MD.0000000000007695}, author = {Elizabeth M Viglianti and Hallie C Prescott and Liu, Vincent and Gabriel J. Escobar and Theodore J Iwashyna} } @article {9290, title = {Individual difference predictors of ICT use in older adulthood: A study of 17 candidate characteristics}, journal = {Computers in Human Behavior}, volume = {76}, year = {2017}, pages = {526-533}, abstract = {Given the benefits of information and communication technology (ICT) use in older adulthood, a natural question is which individual difference characteristics predict ICT use and adoption. Research has provided mixed findings drawn from studies that generally focus on a narrow set of ICTs, a narrow set of individual difference constructs, and younger adults. Using data from the 2012 wave of the Health and Retirement Study, we examined 17 individual difference predictors of ICT use among older adults. Need for cognition, perceived mastery, and optimism positively predicted ICT use after controlling for all the constructs simultaneously; cynical hostility also emerged as a negative predictor of ICT use. Further, viewing more benefits of ICT use explained why those high in need for cognition used more ICTs. Directions for future research include examining the processes that link individual differences to ICT use and its subsequent benefits during the second half of life.}, keywords = {Cognitive Ability, ICT, Personality}, issn = {07475632}, doi = {10.1016/j.chb.2017.08.014}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0747563217304818http://api.elsevier.com/content/article/PII:S0747563217304818?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0747563217304818?httpAccept=text/plain}, author = {William J. Chopik and Rikard, R.V. and Cotten, Shelia Drentea Patricia} } @article {9075, title = {Individual survival curves comparing subjective and observed mortality risks.}, journal = {Health Economics}, volume = {26}, year = {2017}, month = {12/2017}, pages = {e285-e303}, abstract = {We compare individual survival curves constructed from objective (actual mortality) and elicited subjective information (probability of survival to a given target age). We develop a methodology to estimate jointly subjective and objective individual survival curves accounting for rounding on subjective reports of perceived survival. We make use of the long follow-up period in the Health and Retirement Study and the high quality of mortality data to estimate individual survival curves that feature both observed and unobserved heterogeneity. This allows us to compare objective and subjective estimates of remaining life expectancy for various groups and compare welfare effects of objective and subjective mortality risk using the life cycle model of consumption. We find that subjective and objective hazards are not the same. The median welfare loss from misperceptions of mortality risk when annuities are not available is 7\% of current wealth at age 65 whereas more than 25\% of respondents have losses larger than 60\% of wealth. When annuities are available and exogenously given, the welfare loss is substantially lower.}, keywords = {Mortality, NDI, Survival curves}, issn = {1099-1050}, doi = {10.1002/hec.3506}, author = {Luc Bissonnette and Michael D Hurd and Pierre-Carl Michaud} } @article {9144, title = {The influence of psychosocial and cognitive factors on perceived threat of Alzheimer{\textquoteright}s Disease}, journal = {American Journal of Alzheimer{\textquoteright}s Disease \& Other Dementias}, volume = {32}, year = {2017}, pages = {289-299}, abstract = {This study explored psychosocial and cognitive predictors of perceived threat of Alzheimer{\textquoteright}s disease (AD). Respondents were 1641 adults (mean age: 64.4; 54\% female; 82\% white) who completed a module in the Health and Retirement Study, a nationally representative survey of adults aged >=50. Findings show that perceived threat was significantly higher for those aged 50 to 64 (P < .001) and 65 to 74 (P < .05) than for those >=75. Respondents with a family history of AD had significantly greater perceived threat (P < .001) than those with no experience. Stronger endorsement of the beliefs that stress (P < .01) or genetics (P < .01) are important AD risk factors was significantly associated with greater perceived threat, as was having more depressive symptoms (P < .01), poorer self-rated memory (P < .01), and lower cognitive function (P < .01). Personal experience moderated the relationship between perceived threat and 2 variables: age and self-rated memory. Understanding perceived AD threat may inform practice and policies centered on early and accurate diagnosis.}, keywords = {Alzheimer{\textquoteright}s disease, Perception, Psychosocial}, issn = {1533-3175}, doi = {10.1177/1533317517714552}, url = {http://journals.sagepub.com/doi/10.1177/1533317517714552}, author = {Jenny E Ostergren and Steven G Heeringa and Carlos F. Mendes de Leon and Cathleen M. Connell and J Scott Roberts} } @article {8507, title = {The Influence of the Transportation Environment on Driving Reduction and Cessation.}, journal = {Gerontologist}, volume = {57}, year = {2017}, month = {2017 10 01}, pages = {824-832}, abstract = {

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

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

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

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

}, keywords = {Aged, Aging, Automobile Driving, environment, Family Characteristics, Female, Geographic Information Systems, Health Status, Humans, Longitudinal Studies, Male, Marital Status, Risk, Survival Analysis, Transportation, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnw088}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27342439}, author = {Jonathon M Vivoda and Steven G Heeringa and Amy J Schulz and Grengs, Joe and Cathleen M. Connell} } @article {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 {9076, title = {Instrumental variables estimation of exposure effects on a time-to-event endpoint using structural cumulative survival models.}, journal = {Biometrics}, volume = {73}, year = {2017}, month = {12/2017}, pages = {1140-1149}, abstract = {The use of instrumental variables for estimating the effect of an exposure on an outcome is popular in econometrics, and increasingly so in epidemiology. This increasing popularity may be attributed to the natural occurrence of instrumental variables in observational studies that incorporate elements of randomization, either by design or by nature (e.g., random inheritance of genes). Instrumental variables estimation of exposure effects is well established for continuous outcomes and to some extent for binary outcomes. It is, however, largely lacking for time-to-event outcomes because of complications due to censoring and survivorship bias. In this article, we make a novel proposal under a class of structural cumulative survival models which parameterize time-varying effects of a point exposure directly on the scale of the survival function; these models are essentially equivalent with a semi-parametric variant of the instrumental variables additive hazards model. We propose a class of recursive instrumental variable estimators for these exposure effects, and derive their large sample properties along with inferential tools. We examine the performance of the proposed method in simulation studies and illustrate it in a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We further use the proposed method to investigate potential benefit from breast cancer screening on subsequent breast cancer mortality based on the HIP-study.}, keywords = {Survey Methodology}, issn = {1541-0420}, doi = {10.1111/biom.12699}, author = {Martinussen, Torben and Vansteelandt, Stijn and Eric J. Tchetgen Tchetgen and David M Zucker} } @article {9313, title = {Interaction between Social/Psychosocial Factors and Genetic Variants on Body Mass Index: A Gene-Environment Interaction Analysis in a Longitudinal Setting}, journal = {International Journal of Environmental Research and Public Health}, volume = {14}, year = {2017}, month = {09/2017}, pages = {1153}, abstract = {Obesity, which develops over time, is one of the leading causes of chronic diseases such as cardiovascular disease. However, hundreds of BMI (body mass index)-associated genetic loci identified through large-scale genome-wide association studies (GWAS) only explain about 2.7\% of BMI variation. Most common human traits are believed to be influenced by both genetic and environmental factors. Past studies suggest a variety of environmental features that are associated with obesity, including socioeconomic status and psychosocial factors. This study combines both gene/regions and environmental factors to explore whether social/psychosocial factors (childhood and adult socioeconomic status, social support, anger, chronic burden, stressful life events, and depressive symptoms) modify the effect of sets of genetic variants on BMI in European American and African American participants in the Health and Retirement Study (HRS). In order to incorporate longitudinal phenotype data collected in the HRS and investigate entire sets of single nucleotide polymorphisms (SNPs) within gene/region simultaneously, we applied a novel set-based test for gene-environment interaction in longitudinal studies (LGEWIS). Childhood socioeconomic status (parental education) was found to modify the genetic effect in the gene/region around SNP rs9540493 on BMI in European Americans in the HRS. The most significant SNP (rs9540488) by childhood socioeconomic status interaction within the rs9540493 gene/region was suggestively replicated in the Multi-Ethnic Study of Atherosclerosis (MESA) (p = 0.07).}, keywords = {BMI, Genetics, Obesity}, doi = {10.3390/ijerph14101153}, url = {http://www.mdpi.com/1660-4601/14/10/1153http://www.mdpi.com/1660-4601/14/10/1153/pdf}, author = {Wei Zhao and Erin B Ware and He, Zihuai and Sharon L R Kardia and Jessica Faul} } @article {9163, title = {Inter-connected trends in cognitive aging and depression: Evidence from the Health and Retirement Study}, journal = {Intelligence}, volume = {63}, year = {2017}, pages = {56-65}, abstract = {The cohort process of cognitive aging is a contested topic in population research. The literature is largely in disagreement over how and why inter-cohort trends in cognitive aging occur in the United States. This paper examines significant trends in the rate of cognitive decline and conceptualizes the role of the depression trajectory as a late life course process that accelerates cognitive aging at the individual and population level. To this end, I draw my study sample from the Health and Retirement Study (N = 24,678) and use aging-vector models as an extension of parallel-process latent growth modeling to analyze repeated measures of cognition and depression. Findings show the acceleration of cognitive decline ({\textquotedblleft}negative{\textquotedblright} Flynn Effect) and worsening of depression risk for recent cohorts. The upward trends in depression account for significant acceleration in cognitive decline among later cohorts, thus providing a new insight into socio-genic population dynamics of cognitive aging.}, keywords = {Cognitive Ability, Depressive symptoms}, issn = {01602896}, doi = {10.1016/j.intell.2017.05.004}, url = {http://www.sciencedirect.com/science/article/pii/S0160289616303191}, author = {Oi, Katsuya} } @mastersthesis {9284, title = {The Intergenerational Transmission of Educational Attainment Revisited: The Effects of Socioeconomic Background, Genetic Inheritance, and Cohort}, volume = {Master of Arts}, year = {2017}, school = {University of North Carolina at Chapel Hill Graduate School}, type = {Thesis}, address = {Chapel Hill, NC}, abstract = {This research revisits the intertwined social and biological pathways of the intergenerational transmission of educational attainment. By estimating the effects of the whole-genome genetic variants by the continuation ratio logit regressions using 8,251 samples from the Health and Retirement Study (HRS), and considering for socioeconomic status in childhood on education at the same time, I first examine the relative individual impacts of biological and social influences. Then, I consider how parental education shapes the expression of the genetic potential by including moderating effects between the two. Finally, I explore the curvilinear trend of genetic effects over time, and use cohort separated models to investigate the decline in the moderating effects of parental education on educational attainment. The findings suggest the influences are from both genes and family socioeconomic background. Also, the genetic effects were not only negatively moderated by socioeconomic background, but changed curvilinearly over time corresponding to the expansion of higher education in the mid-twentieth century in the U.S. The pattern indicates the educational opportunities equalized at first but saturated after higher education became more accessible. This study furthers the understanding of the social mobility process and provides suggestions for policymakers on education.}, keywords = {Education, Genetics, Socioeconomic factors}, url = {https://cdr.lib.unc.edu/indexablecontent/uuid:d4cc50cc-f6a5-42ec-82d4-8a9ae22ee73b}, author = {Meng-Jung Lin} } @article {9479, title = {Intertemporal Poverty among Older Americans}, journal = {Journal of Poverty}, volume = {21}, year = {2017}, pages = {331-351}, abstract = {This study uses aggregate intertemporal poverty indices proposed by Gradin, Del Rio, and Canto (2012) to measure poverty among older American households of different races from 2001 through 2009 employing data from the Health and Retirement Study. The findings indicate that the incidence of intertemporal poverty is higher among Black and Hispanic households and that it is also more intense and of longer duration. In our investigation of anti-poverty effects of the Supplemental Nutrition Assistance Program, we find that the program has a significant impact in reducing intensity and inequality of poverty among poor populations. However, it does not significantly alter the incidence of intertemporal poverty.}, keywords = {Finances, Poverty, Racial/ethnic differences, Retirement Planning and Satisfaction}, issn = {1087-5549}, doi = {10.1080/10875549.2016.1186778}, url = {https://www.tandfonline.com/doi/full/10.1080/10875549.2016.1186778https://www.tandfonline.com/doi/pdf/10.1080/10875549.2016.1186778}, author = {Bayaz Ozturk, Gulgun and Macdonald, Sean P.} } @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 {9327, title = {Invited Commentary: Integrating Genomics and Social Epidemiology{\textemdash}Analysis of Late-Life Low Socioeconomic Status and the Conserved Transcriptional Response to Adversity}, journal = {American Journal of Epidemiology}, volume = {186}, year = {2017}, pages = {510-513}, abstract = {Socially disadvantaged children face increased morbidity and mortality as they age. Understanding mechanisms through which social disadvantage becomes biologically embedded and devising measurements that can track this embedding are critical priorities for research to address social gradients in health. The analysis by Levine et al. (Am J Epidemiol. 2017; 186(5): 503-509) of genome-wide gene expression in a subsample of US Health and Retirement Study participants suggests important new directions for the field. Specifically, findings suggest promise in integrating gene expression data into population studies and provide further evidence for the conserved transcriptional response to adversity as a marker of biological embedding of social disadvantage. The study also highlights methodological issues related to the analysis of gene expression data and social gradients in health and a need to examine the conserved transcriptional response to adversity alongside other proposed measurements of biological embedding. Looking to the future, advances in genome science are opening new opportunities for socio-genomic epidemiology.}, keywords = {Genetics, Socioeconomic factors}, issn = {0002-9262}, doi = {10.1093/aje/kwx145}, url = {http://academic.oup.com/aje/article/186/5/510/4049569/Invited-Commentary-Integrating-Genomics-and-Socialhttp://academic.oup.com/aje/article-pdf/186/5/510/19678944/kwx145.pdf}, author = {Daniel W. Belsky and Snyder-Mackler, Noah} } @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 {8482, title = {The Impact of Consumer Numeracy on the Purchase of Long-Term Care Insurance.}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 08}, pages = {1612-31}, abstract = {

OBJECTIVE: To determine the effect of consumers{\textquoteright} numeric abilities on the likelihood of owning private long-term care insurance.

DATA SOURCE: The 2010 wave of the Health and Retirement Study, a nationally representative survey of Americans age 50 and older, was used (n~=~12,796).

STUDY DESIGN: Multivariate logistic regression was used to isolate the relationship between numeracy and long-term care insurance ownership.

PRINCIPAL FINDINGS: Each additional question answered correctly on a numeracy scale was associated with a 13 percent increase in the likelihood of holding LTCI, after controlling for predictors of policy demand, education, and cognitive function.

CONCLUSIONS: Poor numeracy may create barriers to long-term care insurance purchase. Policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults{\textquoteright} ability to prepare for future long-term care expenses.

}, keywords = {Consumer Behavior, Financing, Personal, Health Surveys, Humans, Insurance, Long-Term Care, Middle Aged}, issn = {1475-6773}, doi = {10.1111/1475-6773.12439}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26799778}, author = {Brian E McGarry and Temkin-Greener, Helena and Chapman, Benjamin P and David C Grabowski and Li, Yue} } @article {8355, title = {The Impact of Food Deserts on Food Insufficiency and SNAP Participation among the Elderly}, journal = {American Journal of Agricultural Economics}, volume = {98}, year = {2016}, note = {Times Cited: 1 0 1}, pages = {19-40}, publisher = {98}, abstract = {Residents of neighborhoods with limited access to grocery stores may face barriers to obtaining adequate food for a healthy diet. Low-income elderly may be uniquely affected by these so-called food deserts due to limited transportation options, strong attachments to local neighborhoods, fixed incomes, and physical limitations for food shopping. Using 2006 and 2010 Health and Retirement Study data linked to census tract-level measures of food deserts, this study measures whether living in a food desert affects food and material hardship, participation in food assistance programs, and the food spending of elderly adults. In both cross-sectional and fixed effects regressions of elderly residents of urban counties, we find little evidence that living in a food desert affects these outcomes. We find, however, that individuals residing in a food desert without a vehicle are 12 percentage points more likely to report food insufficiency. Those SNAP recipients living in food deserts are 11 percentage points more likely to receive subsidized meals, while nonparticipants in food deserts and SNAP recipients outside of food deserts are less likely to receive subsidized meals. Our findings suggest that seniors without vehicles and SNAP recipients in food deserts may be the most vulnerable to limited food store access.}, keywords = {Consumption and Savings}, doi = {10.1093/ajae/aav044}, author = {Fitzpatrick, Katie and Nadia Greenhalgh-Stanley and Michele Ver Ploeg} } @article {8404, title = {The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue.}, journal = {Mil Med Res}, volume = {3}, year = {2016}, month = {2016}, pages = {11}, publisher = {3}, abstract = {

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

}, issn = {2095-7467}, doi = {10.1186/s40779-016-0082-5}, url = {http://mmrjournal.biomedcentral.com/articles/10.1186/s40779-016-0082-5}, author = {Alamgir, Hasanat and Caryn A Turner and Nicole J Wong and Sharon P. Cooper and Jose A. Betancourt and Henry, James and Andrew J Senchak and Tanisha L. Hammill and Mark D Packer} } @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} } @article {8371, title = {The Impact of Retirement on Smoking Behavior}, journal = {Eastern Economic Journal}, volume = {42}, year = {2016}, note = {Times Cited: 0 0}, pages = {270-287}, publisher = {42}, abstract = {We use data from the Health and Retirement Study to examine the relationship between retirement and smoking decisions. Retirement might affect smoking behavior through a change in the opportunity cost of time, job-related factors or income. To estimate the causal effect of retirement on smoking habits, we exploit eligibility for Social Security benefits at age 62 to account for the endogeneity of retirement. We find suggestive evidence that retirement increases the probability of smoking among ever smokers, but this effect is sensitive to the econometric specification used. We also find evidence of heterogeneity in the impact of retirement.}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.1057/eej.2014.51}, author = {Padmaja Ayyagari} } @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} } @article {5895, title = {The Impact of Systematic Trend and Uncertainty on Mortality and Disability in a Multi-State Latent Factor Model for Transition Rates}, year = {2016}, institution = {Kensington, Australia, University of New South Wales Business School}, abstract = {Multiple state functional disability models do not generally include systematic trend and uncertainty. We develop and estimate a multi-state latent factor intensity model with transition and recovery rates depending on a stochastic frailty factor to capture trend and uncertainty. We estimate the model parameters using U.S. Health and Retirement Study (HRS) data between 1998 and 2012 with Monte Carlo maximum likelihood estimation method. The model shows significant reductions in disability and mortality rates during this period and allows us to quantify uncertainty in transition rates arising from the stochastic frailty factor. Recovery rates are very sensitive to the stochastic frailty. There is an increase in expected future lifetimes as well as an increase in future healthy life expectancy. The proportion of lifetime spent in disability on average remains stable with no strong support in the data for either morbidity compression or expansion. The model has widespread application in costing of government funded aged care and pricing and risk management of LTC insurance products.}, keywords = {Disabilities, Healthcare}, author = {Li, Zixi and Shao, Adam Wenqiang and Sherris, Michael} } @article {5894, title = {Improved Wealth Measures in the Health and Retirement Study: Asset Reconciliation and Cross-Wave Imputation}, year = {2016}, abstract = {In this report, we present improved wealth measures for the Health and Retirement Study (HRS), which aim to reduce the effect of observation error on wealth levels and changes in wealth. The new wealth measures take account of the asset verification section in the HRS and use cross-wave information, most notably the value of the same asset in adjacent waves, in the imputation models, so imputed values better preserve serial correlation in the asset values. We document how we dealt with several methodological challenges in the implementation of these improvements. The corrections from the asset verification data reduce the standard deviations of wave-to-wave changes by substantial amounts (up to 57 percent for total wealth). The most important effect of the cross-wave imputations is a considerable reduction of the number of spikes and trenches (large changes in value followed by large changes back).}, keywords = {Demographics, Methodology}, author = {Michael D Hurd and Erik Meijer and Moldoff, Michael and Susann Rohwedder} } @article {8359, title = {In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years}, journal = {American Journal of Hospice and Palliative Medicine}, volume = {33}, year = {2016}, note = {Times Cited: 0 0}, pages = {41-46}, publisher = {33}, abstract = {In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87 ). A report of any loss increases risk of health care utilization by 20 to 30 . For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.}, keywords = {Adult children, Healthcare}, doi = {10.1177/1049909114552125}, author = {Toni Miles and Joseph C. Allegra and Amara E. Ezeamama and Simpson, Cherie and Kerstin Gerst and Elkins, Jennifer} } @article {6469, title = {Income dynamics and health: A test of competing hypotheses}, journal = {Health Policy and Technology}, volume = {5}, year = {2016}, month = {09/2016}, pages = {260-267}, abstract = {Objective: This study aims to examine the temporal processes underlying the relationship between income and health among the elderly to demonstrate the extent to which income histories have an influence on health changes. Methods: The empirical work of this study will be based on the 1992 2010 Health and Retirement Study (HRS). This study will test the low income hypothesis, the permanent income hypothesis, and the transitory income hypothesis using the method of growth curve modeling. Results: Results from growth curve analyses suggest that distinguishing these three income hypotheses is useful on theoretical, empirical, and policy grounds. It shows that the impact of low income, anticipated fluctuations in household income over the long run, as well as unanticipated income change over the short term on the changes in health over time are shaped along both socioeconomic and racial/ethnic lines. Conclusion: Given the present U.S. circumstances, perhaps something like a national healthcare system like the Obamacare and tax incentives and other benefit systems can be implemented to reduce the existing health disparities.}, keywords = {Demographics, Healthcare, Methodology, Public Policy}, doi = {10.1016/j.hlpt.2016.03.005}, url = {http://www.sciencedirect.com/science/article/pii/S2211883716300053}, author = {Hui-Peng Liew} } @article {8381, title = {Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey}, journal = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation}, volume = {25}, year = {2016}, note = {Times Cited: 0 0}, pages = {1007-15}, publisher = {25}, abstract = {OBJECTIVE: To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70years old enrolled in the US 2010 health and retirement survey. METHODS: Multivariable logistic regression models estimated odds ratios (ORs) and 95 confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5 events. HCU included hospitalization (any vs. none) and physician visits ( 20 vs. 20) over 2years. FINDINGS: Hospitalization odds declined by 25 (OR 0.75, 95 CI 0.64-0.86), odds of 20 physician visits declined by 47 (OR 0.53, 95 CI 0.45-0.63) and the odds of SRH improvement increased by 49 (OR 1.49, 95 CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 elevated for participants that reported 1-2, 3-4 and 5 versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician{\textquoteright}s visits and hospitalizations. CONCLUSION: In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.}, keywords = {Expectations, Health Conditions and Status, Healthcare}, doi = {10.1007/s11136-015-1144-y}, author = {Amara E. Ezeamama and Elkins, Jennifer and Simpson, Cherie and Smith, Shaniqua L. and Joseph C. Allegra and Toni Miles} } @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} } @article {8685, title = {The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning.}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {401-422}, abstract = {

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

}, keywords = {Advance care planning, Advance directives, African Americans, Aged, Aged, 80 and over, Continental Population Groups, European Continental Ancestry Group, Female, Health Status, Hispanic Americans, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Psychology, Social Class}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1229709}, author = {Inoue, Megumi} } @article {8342, title = {Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Jan}, pages = {71-6.e1-3}, publisher = {26}, abstract = {

PURPOSE: Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.

METHODS: IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955).

RESULTS: Using the genetic risk score as an IV, there was a 1.1\% reduction in dementia risk per year of schooling (95\% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5\%; 95\% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education.

CONCLUSIONS: IV analyses suggest education is protective against risk of dementia in older adulthood.

}, keywords = {Aged, Aged, 80 and over, Dementia, Education, Nonprofessional, Educational Status, Female, Genetic Predisposition to Disease, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Polymorphism, Single Nucleotide, Protective factors, Risk Factors, Schools, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.10.006}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and Sze Y Liu and Jennifer J Manly and M. Maria Glymour} } @article {12195, title = {Integrating objective health measurement using sensors, devices and pervasive computing in large-scale surveys}, year = {2016}, publisher = {National Institute on Aging}, address = {Bethesda, MD}, abstract = {While large-scale population studies provide a wealth of insight and knowledge about the health and wellbeing of the aging population, they typically rely on self-report which has been found to be unreliable, especially among older adults. In addition, the assessment strategy usually occurs sporadically, spaced years apart to reduce patient and investigator burden. Finally, the data itself is not fully ecologically relevant being prone to test situation biases. To overcome these shortcomings of self-report and procedural limitations many new developments using pervasive computing and continuous remote sensing strategies, incorporating high dimensional ({\textquotedblleft}big data{\textquotedblright}) analytics show great promise for transforming health data capture and follow-up. By assessing health and behavior continuously, objectively and longitudinally, it becomes possible to generate more robust models on the inter-relationships between health and behavior. This review describes the various behaviors and parameters that can be collected via continuous assessment and the devices and assessment strategies that are used to capture key behaviors. Using the framework of wellbeing, we review strategies to assess behaviors that fall into three key categories of wellbeing. These include physical and physiological function, cognitive and intellectual wellbeing, and social behaviors and function. Thus, specific behaviors that can be assessed objectively and more continuously include body composition or weight (an example of a basic physiologic measure), medication adherence (an example of an everyday cognitive-functional task as well as an important medical outcome), and time out-of-home (and example of a measure of social engagement with the world). Devices and assessment strategies that are used to capture these key behaviors include an array of wearable devices, in-home sensor platforms, internet based surveys, computer tracking software, and {\textquotedblleft}smart{\textquotedblright} devices. We review the applicability of these data collection methods to Health and Retirement Study and give suggestions for future avenues of research.}, keywords = {Wellbeing}, author = {Austin, Johanna and Reynolds, Christina and Kaye, Jeffrey} } @article {6468, title = {Interdependence between the Social and Material Convoy: Links between Volunteering, Widowhood, and Housing Transitions}, journal = {Social Work Research}, volume = {40}, year = {2016}, month = {03/2016}, pages = {71-82}, chapter = {71}, abstract = {Relocation in older adulthood may occur due to triggering events, such as widowhood. Guided by Kahn and Antonucci s convoy model, this study explores the influence of volunteering on decision to relocate following the death of a spouse. Using three waves of data from the Health and Retirement Study (2006, 2008, and 2010), 5,146 community-dwelling married older individuals who were 65 years or older in 2008 were included. Findings from two multinomial logistic regression models showed that widows and widowers who were not volunteering in 2008 were more likely to move out of area in 2010 than their married counterparts, whereas the relationship between widowhood and relocation was not detected among those involved in volunteering. This article emphasizes the interdependency of social relationships and residences, a fundamental of one s material convoy, for older adults. Volunteering experiences may not only affect instrumental and emotional support after the loss of a key anchor in one s social convoy, but may also facilitate a widowed older adult to age in place rather than relocate.}, keywords = {Other, Retirement Planning and Satisfaction}, doi = {10.1093/swr/svw002}, url = {http://swr.oxfordjournals.org/content/early/2016/03/28/swr.svw002.abstract}, author = {Shen, Huei-Wern and Tam E Perry} } @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 {9234, title = {Issue Brief: Occupation, Cognitive Decline and Retirement}, year = {2016}, pages = {UM16-10}, institution = {Michigan Retirement and Disability Research Center, Survey Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Little is known about occupational differences in age-related cognitive decline. This information is an important starting point for understanding the potential role that cognitive decline may play in workforce departure and whether, as with physical health declines, cognitive decline influences rates of Social Security disability insurance claims or claims before the full retirement age. This issue brief uses longitudinal data on cognitive functioning in the Health and Retirement Study to describe differences in rates of age-related cognitive decline across broad occupational categories and to relate these to different work transitions at common retirement ages. Findings support prior research showing that cognitive decline may lead to earlier than planned retirement, and appear to be consistent with research showing that workers may shift to less cognitively demanding jobs as a result of cognitive decline.}, keywords = {Cognitive Ability, Employment and Labor Force, Retirement Planning and Satisfaction}, url = {https://mrdrc.isr.umich.edu/pubs/issue-brief-occupation-cognitive-decline-and-retirement-2/}, author = {McFall, Brooke Helppie and Amanda Sonnega} } @article {8231, title = {The Impact of a Randomly Assigned Time and Place Management Initiative on Work and Retirement Expectations}, journal = {Work Aging and Retirement}, volume = {1}, year = {2015}, note = {Times Cited: 0 0}, pages = {350-368}, publisher = {1}, abstract = {This article examines the causal relationship between a workplace flexibility arrangement and retirement expectations. The data come from a unique large-scale randomly assigned time and place management (TPM) initiative that recently took place at a regional healthcare system in the United States with more than 9,000 employees. A difference-in-differences approach was used to assess treatment impacts among older full-time career employees and comparisons were made with a nationally representative group of older Americans from the Health and Retirement Study (HRS). We found evidence that the TPM initiative had a statistically significant impact on employees{\textquoteright} retirement expectations; employees in the treatment group were more likely than those in the control group to expect to remain with the organization until retirement, though treatment impacts dissipated somewhat toward the end of the study. The results indicate that workplace flexibility could be one solution to promote continued work later in life, as flexible work arrangements have the potential to impact retirement expectations and patterns of labor force withdrawal.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, doi = {10.1093/workar/wav012}, author = {Kevin E. Cahill and Jacquelyn Boone James and Pitt-Catsouphes, Marcie} } @article {8331, title = {The Impact of Cognitive Impairment and Comorbid Depression on Disability, Health Care Utilization, and Costs}, journal = {Psychiatric Services}, volume = {66}, year = {2015}, pages = {1245-1248}, publisher = {66}, abstract = {Objectives: This study examined the impact of co-occurring cognitive impairment and depression on functional limitations, hospital and nursing home admissions, and out-of-pocket expenditures (OOPEs) among older adults. Methods: Individual mixed-effects regressions were performed to examine the relationship between cognitive impairment and depression and selected outcomes among 18,315 community-dwelling adults ages 50 and over from the Health and Retirement Study from 1998 to 2010. Results: Cognitive impairment and depression were independently associated with the outcomes of interest, and the estimated effects were largest among individuals with both conditions. Cognitive impairment with comorbid depression predicted limitations in activities of daily living (odds ratio OR =3.02) and instrumental activities of daily living (OR=4.18), hospitalizations (OR=1.53), nursing home admissions (OR=3.34), and an increase of 1,150 in annual OOPEs. Conclusions: Compared with cognitive impairment or depression alone, cognitive impairment plus depression was associated with substantial functional limitations, health services utilization, and costs.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1176/appi.ps.201400511}, url = {http://dx.doi.org/10.1176/appi.ps.201400511}, author = {Xiang, Xiaoling and An, Ruopeng} } @article {NBERw21484, title = {The Impact of Social Security Income on Cognitive Function at Older Ages}, journal = {American Journal of Health Economics}, year = {2015}, abstract = {Prior literature has documented a positive association between income and cognitive function at older ages, however, the extent to which this association represents causal effects is unknown. In this study, we use an exogenous change in Social Security income due to amendments to the Social Security Act in the 1970s to identify the causal impact of Social Security income on cognitive function of elderly individuals. We find that higher benefits led to significant improvements in cognitive function and that these improvements in cognition were clinically meaningful. Our results suggest that interventions even at advanced ages can slow the rate of decline in cognitive function.}, keywords = {Cognition, cognitive function, Social Security, Social Security Benefits}, doi = {10.3386/w21484}, url = {http://www.nber.org/papers/w21484}, author = {Padmaja Ayyagari and Frisvold, David} } @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 {8199, title = {The Impact of the Recession on the Wealth of Older Immigrant and Native Households in the United States}, journal = {IZA Journal of Labor Policy}, volume = {4}, year = {2015}, note = {Date revised - 2015-04-01 Availability - URL:http://www.izajolp.com/content Publisher{\textquoteright}s URL}, publisher = {4}, abstract = {Using the 2006 and 2010 Health and Retirement Study, we explore how the recent recession impacted the wealth holding and retirement plans of older households in the United States. Of particular interest to us is whether the impact on household asset ownership, asset wealth and household retirement behavior varied with the nativity of the household and its standing in the wealth distribution prior to the onset of the recession. We find that the so-called Great Recession made a significant dent on the portfolios of older American households by eroding the value of specific assets to the point of delaying their planned retirement. Furthermore, its impacts were unevenly distributed across demographic and economic groups, with mixed and immigrant households in the middle and top wealth quartiles prior to the recession enduring significantly larger wealth losses than natives due, primarily, to their greater losses in primary housing ownership and primary housing values.}, keywords = {Employment and Labor Force, Housing, Net Worth and Assets, Pensions, Public Policy, Retirement Planning and Satisfaction, Women and Minorities}, doi = {10.1186/s40173-015-0033-x}, author = {Amuedo-Dorantes, Catalina and Pozo, Susan} } @mastersthesis {6416, title = {Implications of Homeownership for Endogenous Risk Aversion, Asset Pricing and Portfolio Composition}, volume = {3709258}, year = {2015}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2015 Last updated - 2015-08-22 First page - n/a}, month = {2015}, pages = {113}, school = {University of California, San Diego}, type = {Ph.D.}, address = {San Diego, CA}, abstract = {The dissertation studies the role of housing in asset pricing and household asset allocation. Housing is unique in the sense that it is both an asset and a consumption good. In addition, any adjustment in housing consumption will incur a non-convex adjustment cost. This makes housing adjustment infrequent. Due to these unique characteristics, the role of housing in a household portfolio is quite different from financial assets such as stocks and bonds. The first chapter, "The Housing CCAPM with Adjustment Costs and Heterogeneous Agents" examines how the inclusion of housing consumption in the utility function can increase the volatility and countercyclicality of the stochastic discount factor and thus help explain a higher level of equity premium despite only moderate curvature of the utility function. The keys to better performance of the model are (i) existence of the adjustment cost (ii) non-separability between housing goods and nondurable goods in the utility function and (iii) low substitutability between housing consumption and nondurable consumption. It is also shown that the housing CCAPM performs better than a standard CCAPM in explaining the variation of cross-sectional risk premia. Chapter 2, "Implications of the Housing Market for Endogenous Risk Aversion" studies household portfolio choice in a partial equilibrium model with housing consumption, adjustment costs, and varying housing prices. It is shown that household relative risk aversion is dependent on their house value to wealth ratio. Therefore, by changing the household{\textquoteright}s house value to wealth ratio, variation in house prices can affect household stock holdings through a change in household risk aversion. In addition, the model has two specific implications for households. The first is that volatile house price dynamics leads to more frequent moving. The second is that household moving leads to higher relative risk aversion. In general equilibrium, these effects would imply that volatile housing prices can lead to a higher moving frequency and thus result in a higher level of aggregate risk aversion, which would increase the price of risk in the risky asset markets. We provide empirical evidence that there is a high correlation between housing price volatility and the price of risk. Chapter 3, "Implications of the Housing Model for Moving Frequency, Relative Risk Aversion and the Portfolio Share of Risky Assets" tests the implications of the household portfolio choice model developed in Chapter 2 using household level data from the Panel Study of Income Dynamics and finds that the empirical evidence is consistent with the model. Firstly, we use cross-sectional variation in state level house prices and household moving to study the relationship between the volatility of house prices and moving frequency. Secondly, we use household moving and portfolio data to study the effect of moving on risk aversion. In addition, Chapter 3 also studies the effect of becoming unemployed on household moving by solving a model with housing consumption, adjustment costs, and a stochastic labor income process. The result suggests that the overall effect of unemployment is to reduce the frequency of moving. In addition, a sudden shift to an unemployed status can increase household risk aversion. Thus in general equilibrium, we would expect that a higher unemployment rate will increase economy wide risk aversion, which will in turn decrease the demand for stocks and increase the risk premium required. This provides a new channel (through the change in risk aversion) for the unemployment rate to affect asset prices.}, keywords = {Housing, Methodology, Net Worth and Assets, Public Policy, Risk Taking}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1699058643?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+Full+Text\&rft_val_fmt=info:ofi/}, author = {Liang, Xuan} } @article {8316, title = {Improving the validity of activity of daily living dependency risk assessment.}, journal = {J Appl Gerontol}, volume = {34}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Apr}, pages = {329-42}, publisher = {34}, abstract = {

OBJECTIVES: Efforts to prevent activity of daily living (ADL) dependency may be improved through models that assess older adults{\textquoteright} dependency risk. We evaluated whether cognition and gait speed measures improve the predictive validity of interview-based models.

METHOD: Participants were 8,095 self-respondents in the 2006 Health and Retirement Survey who were aged 65 years or over and independent in five ADLs. Incident ADL dependency was determined from the 2008 interview. Models were developed using random 2/3rd cohorts and validated in the remaining 1/3rd.

RESULTS: Compared to a c-statistic of 0.79 in the best interview model, the model including cognitive measures had c-statistics of 0.82 and 0.80 while the best fitting gait speed model had c-statistics of 0.83 and 0.79 in the development and validation cohorts, respectively.

CONCLUSION: Two relatively brief models, one that requires an in-person assessment and one that does not, had excellent validity for predicting incident ADL dependency but did not significantly improve the predictive validity of the best fitting interview-based models.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Female, Gait, Geriatric Assessment, Humans, Independent Living, Interviews as Topic, Male, Quality Improvement, Reproducibility of Results, Risk Assessment}, issn = {1552-4523}, doi = {10.1177/0733464812471894}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {8306, title = {In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life}, journal = {Journal of Health and Social Behavior}, volume = {56}, year = {2015}, note = {Times Cited: 0 0}, pages = {59-73}, publisher = {56}, abstract = {The health consequences of marital dissolution are well known, but little work has examined the impact of health on the risk of marital dissolution. In this study we use a sample of 2,701 marriages from the Health and Retirement Study (1992-2010) to examine the role of serious physical illness onset (i.e., cancer, heart problems, lung disease, and/or stroke) in subsequent marital dissolution due to either divorce or widowhood. We use a series of discrete-time event history models with competing risks to estimate the impact of husband{\textquoteright}s and wife{\textquoteright}s physical illness onset on risk of divorce and widowhood. We find that only wife{\textquoteright}s illness onset is associated with elevated risk of divorce, while either husband{\textquoteright}s or wife{\textquoteright}s illness onset is associated with elevated risk of widowhood. These findings suggest the importance of health as a determinant of marital dissolution in later life via both biological and gendered social pathways.}, keywords = {Adult children, Health Conditions and Status, Net Worth and Assets}, doi = {10.1177/0022146514568351}, author = {Karraker, Amelia and Kenzie Latham} } @article {8156, title = {Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {860-5}, publisher = {70}, abstract = {

BACKGROUND: Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages. Previous studies have examined the association between prevalent diabetes and various impairments and disabilities. Methods considering incident, rather than prevalent, diabetes as the exposure of interest can reduce bias in estimates of these associations.

METHODS: Risk-set matching, a type of propensity score matching meant to handle time-varying exposures, was used to estimate the relationship between incident diabetes and mobility limitations among adults in the Health and Retirement Study. This approach ensures that covariates precede diabetes onset rather than follow it.

RESULTS: Individuals who were diagnosed with diabetes during the study period accumulated more subsequent mobility limitations than were accumulated by matched controls. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 24.9\% more mobility limitations at study exit than those who did not.

CONCLUSIONS: The magnitude of the relationship between diabetes and limitations estimated in this article is smaller than that presented in previous studies, but the method presented here is likely to provide a less-biased estimate of the association between diabetes and accumulation of mobility limitations.

}, keywords = {Bias, Diabetes Mellitus, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Propensity Score, Risk Assessment, Risk Factors, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu212}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/11/19/gerona.glu212.abstract}, author = {Ezra I. Fishman} } @article {8222, title = {Income, Poverty, and Material Hardship Among Older Americans.}, journal = {RSF}, volume = {1}, year = {2015}, month = {2015 Nov}, pages = {55-77}, publisher = {1}, abstract = {

Using data from the 2008 and 2010 waves of the Health and Retirement Study to analyze the determinants of material hardship among individuals ages sixty-five and older, I look at five self-reported hardships: food insecurity, skipped meals, medication cutbacks, difficulty paying bills, and dissatisfaction with one{\textquoteright}s financial situation. One-fifth of the elderly report one or more of these hardships. Although hardship is more likely for those with low incomes, most older Americans experiencing hardship are not poor. I analyze whether alternative measures of resources do a better job of predicting hardship than does income relative to the federal poverty threshold. I find that spending relative to the poverty threshold does a worse job predicting hardship than does income relative to poverty. Subtracting out-of-pocket medical spending from income yields a measure that is an even better predictor of hardship. In multivariate models, I find that self-reported health, activity limitations, and disability are significant predictors of hardship. Having reliable children (as assessed by the respondent) or an able-bodied spouse reduces the likelihood of hardship. Poor health increases hardship through three channels: by lowering income, by increasing out-of-pocket medical spending, and through its direct effect on hardship. The first two of these-lower income and higher medical spending-are much less quantitatively important than the third; in a nutshell, poor health makes it harder to get by with less.

}, issn = {2377-8253}, doi = {10.7758/RSF.2015.1.1.04}, author = {Helen G Levy} } @article {8229, title = {Increase in Disability Prevalence Before Hip Fracture.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Oct}, pages = {2029-35}, publisher = {63}, abstract = {

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

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

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

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

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

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

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Dementia, Disability Evaluation, Disabled Persons, Educational Status, Female, Health Surveys, Hip Fractures, Humans, Income, Male, Mobility Limitation, Prevalence, United States}, issn = {1532-5415}, doi = {10.1111/jgs.13658}, author = {Irena Cenzer and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Kenneth E Covinsky} } @article {6470, title = {Individual and Work Factors Related to Perceived Work Ability and Labor Force Outcomes}, journal = {Journal of Applied Psychology}, volume = {100}, year = {2015}, note = {Export Date: 20 January 2015 Article in Press}, pages = {376-398}, chapter = {376}, abstract = {Perceived work ability refers to a worker{\textquoteright}s assessment of his or her ability to continue working in his or her job, given characteristics of the job along with his or her resources. Perceived work ability is a critical variable to study in the United States, given an aging workforce, trends to delay retirement, and U.S. policy considerations to delay the age at which full Social Security retirement benefits may be obtained. Based on the job demands-resources model, cognitive appraisal theory of stress, and push/pull factors related to retirement, we proposed and tested a conceptual model of antecedents and outcomes of perceived work ability using 3 independent samples of U.S. working adults. Data regarding workers{\textquoteright} job characteristics were from self-report and Occupational Information Network measures. Results from relative importance analysis indicated that health and sense of control were consistently and most strongly related to work ability perceptions relative to other job demands and job and personal resources when perceived work ability was measured concurrently or 2 weeks later in samples with varying occupations. Job demands (along with health and sense of control) were most strongly related to work ability perceptions when perceived work ability was measured in a manufacturing worker sample 1.6 years later. Perceived work ability also predicted lagged labor force outcomes (absence, retirement, and disability leave) while controlling for other known predictors of each. Consistent indirect effects were observed from health status and sense of control to all 3 of these outcomes via perceived work ability.}, keywords = {Employment and Labor Force, Health Conditions and Status}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84910003696andpartnerID=40andmd5=f924dfde692ab1f7b24f01f2e3a0a0f8}, author = {McGonagle, Alyssa K. and Gwenith G Fisher and Janet L. Barnes-Farrell and James Grosch} } @mastersthesis {6283, title = {Individual personality differences in adjustment to retirement}, volume = {M.S.}, year = {2015}, month = {2015}, pages = {89}, school = {Colorado State University}, abstract = {Retirement is an important life event to study at present, because more people are entering their retirement years and are spending more time in retirement than ever before in our nation{\textquoteright}s history. Historically, research has shown mixed results on effects of retirement that are not accurately explained by any one theory. These mixed results suggest the possibility of individual differences in retirement adjustment that may not be accounted for with aggregated data. Wang, Henkens, and Shultz (2011) proposed a comprehensive framework of retirement adjustment: the resource-based dynamic perspective, which reasons that adjustment is influenced by antecedent variables, via level of resources possessed by the individual at a given time. The current study seeks to assess the relation between personality as an antecedent variable and retirement adjustment in a longitudinal analysis of participants from the nationally representative Health and Retirement Study. Resources are also modeled as covariates in the analysis. Results should be interpreted with caution due to limitations in model fit. Results from the Growth Mixture Model (GMM) revealed two classes of retirement trajectories and certain personality traits were significant as predictors for these trajectories. Implications for both research and practice are discussed.}, keywords = {Health Conditions and Status, Healthcare, Other, Retirement Planning and Satisfaction}, author = {Eby, Rachel E.} } @mastersthesis {11129, title = {The Influence of the Built Environment on the Driving Behaviors and Mental Health of Older Adults.}, volume = {Health Behavior and Health Education}, year = {2015}, school = {University of Michigan}, abstract = {Due to increases in life expectancy, the aging of the baby boom generation, and a decline in birth rates, the US population is aging rapidly. In the future, older people will not only comprise a larger proportion of the general population, but also the driving population. This issue is characterized by a conflict between roadway safety for those who can no longer safely drive, and loss of independence when driving reduction and cessation become necessary. Previous research on driving decision making among older adults has largely focused on individual- and interpersonal-level factors. This study examined the influence of the physical transportation environment on driving reduction and cessation, after controlling for the effects of other predictors. Differences by gender and race were also assessed, as was the influence of the transportation environment on depressive symptoms. Longitudinal survival analysis techniques and generalized estimating equations were used to analyze seven waves of data spanning a 12-year period from 1998 through 2010. Results showed that after controlling for the effects of demographics, health, and social support, there was a significant influence of the transportation environment on both driving reduction and driving cessation. As roadway density and congestion increased, the odds of driving reduction and cessation also increased. Men were more affected than women by the transportation environment, and Whites and Hispanics were more affected than African Americans and those of Other race. Driving reduction, driving cessation, and the transportation environment also significantly predicted the rate of depressive symptoms over time. Depressive symptoms were positively associated with driving limitations, while a more congested environment predicted fewer depressive symptoms. Other predictors of driving reduction and cessation included relationship status, household size, and having a friend who lives nearby. Results suggest that policy changes and modifications to the physical environment should be made to improve older drivers{\textquoteright} ability to remain engaged in life. Creating mixed-use livable communities with goods and services in close proximity are warranted to mitigate some of the mobility challenges of older adulthood. Older individuals should also consider and plan for how their transportation environment will affect their desire to age in place.}, keywords = {Driving, driving behavior, Environment Design, health, Mental Health}, url = {https://deepblue.lib.umich.edu/handle/2027.42/113589}, author = {Jonathon M Vivoda} } @article {8318, title = {Instrumental variable estimation in a survival context}, journal = {Epidemiology}, volume = {26}, year = {2015}, note = {Times Cited: 1 0 1}, pages = {402-410}, publisher = {26}, abstract = {Bias due to unobserved confounding can seldom be ruled out with certainty when estimating the causal effect of a nonrandomized treatment. The instrumental variable (IV) design offers, under certain assumptions, the opportunity to tame confounding bias, without directly observing all confounders. The IV approach is very well developed in the context of linear regression and also for certain generalized linear models with a nonlinear link function. However, IV methods are not as well developed for regression analysis with a censored survival outcome. In this article, we develop the IV approach for regression analysis in a survival context, primarily under an additive hazards model, for which we describe 2 simple methods for estimating causal effects. The first method is a straightforward 2-stage regression approach analogous to 2-stage least squares commonly used for IV analysis in linear regression. In this approach, the fitted value from a first-stage regression of the exposure on the IV is entered in place of the exposure in the second-stage hazard model to recover a valid estimate of the treatment effect of interest. The second method is a so-called control function approach, which entails adding to the additive hazards outcome model, the residual from a first-stage regression of the exposure on the IV. Formal conditions are given justifying each strategy, and the methods are illustrated in a novel application to a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We also establish that analogous strategies can also be used under a proportional hazards model specification, provided the outcome is rare over the entire follow-up.}, keywords = {Health Conditions and Status, Methodology}, doi = {10.1097/ede.0000000000000262}, author = {Eric J. Tchetgen Tchetgen and Stefan Walter and Vansteelandt, Stijn and Martinussen, Torben and M. Maria Glymour} } @inbook {5260, title = {Inter-Cohort Variation in the Consequences of U.S. Military Service for Men{\textquoteright}s Mid- to Late-Life Body Mass Index Trajectories}, booktitle = {A Life Course Perspective on Health Trajectories and Transitions}, year = {2015}, pages = {133-154}, publisher = {Springer}, organization = {Springer}, address = {New York}, abstract = {Body mass index (BMI) is an important health indicator that changes with age and may be shaped in important ways by prior military service. While a high proportion of older men in the United States served in the military, to date, there has been no longitudinal, population-representative study of veteran status differences in men s mid- to late-life BMI trajectories. In this chapter, we use data from the 1992 2010 Health and Retirement Study (HRS) and growth curve models to examine veteran status differences in mid- to late-life BMI trajectories for cohorts of men born in the United States during the first half of the twentieth century. Without any controls in the models, veterans exhibit lower BMI, on average, than non-veterans. Once we add controls for birth cohort, early-life characteristics that occur prior to military service, potentially mediating mid- to late-life characteristics, and methodological controls for proxy report, attrition, and death during the study period, the effect of veteran status is small, marginally significant, and positive net of other factors, veterans are marginally heavier than their non-veteran counterparts. Taken together, our analyses demonstrate the large effect of the secular trend in increased weight across the population younger cohorts are substantially heavier than older cohorts regardless of their veteran status and a substantively small but consistent, positive intra-cohort effect of veteran status.}, keywords = {Demographics, Health Conditions and Status, Methodology}, author = {Janet M Wilmoth and Andrew S London and Christine L Himes}, editor = {Burton-Jeangros, Claudine and Cullati, St{\'e}phane and Sacker, Amanda and Blane, David} } @article {8295, title = {Internet Use and Well-Being in Older Adults}, journal = {Cyberpsychology Behavior and Social Networking}, volume = {18}, year = {2015}, note = {Times Cited: 0 0}, pages = {268-272}, publisher = {18}, abstract = {The Internet has become an important social context in the lives of older adults. Extant research has focused on the use of the Internet and how it influences well-being. However, conflicting findings exist. The purpose of the study was to develop an integrative research model in order to determine the nature of the relationships among Internet use, loneliness, social support, life satisfaction, and psychological well-being. Specifically, loneliness and social support were tested as potential mediators that may modify the relationship between Internet use and indicators of well-being. Data from the U.S. Health and Retirement Study (HRS) were used, and the association among Internet use, social support, loneliness, life satisfaction, and psychological well-being was explored. The sample consisted of 5,203 older adults (aged 65 years and older). The results indicated that higher levels of Internet use were significant predictors of higher levels of social support, reduced loneliness, and better life satisfaction and psychological well-being among older adults.}, keywords = {Adult children, Health Conditions and Status, Other}, doi = {10.1089/cyber.2014.0549}, author = {Jinmoo Heo and Sanghee Chun and Lee, Sunwoo and Lee, Kyung Hee and Kim, Junhyoung} } @article {6476, title = {The Identification of Regions of Significance in the Effect of Multimorbidity on Depressive Symptoms Using Longitudinal Data: An Application of the Johnson-Neyman Technique}, journal = {Gerontology}, volume = {60}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, pages = {274-281}, chapter = {274}, abstract = {Background: The investigation of multimorbidity and aging is complex and highly intertwined with aging-related changes in physical and cognitive capabilities, and mental health and is known to affect psychological distress and quality of life. Under these circumstances it is important to understand how the effects of chronic conditions evolve over time relative to aging-related and end-of-life changes. The identification of periods in time where multimorbidity impacts particular outcomes such as depressive symptoms, versus periods of time where this is not the case, reduces the complexity of the phenomenon. Objective: We present the Johnson-Neyman (J-N) technique in the context of a curvilinear longitudinal model with higher-order terms to probe moderators and to identify regions of statistical significance. In essence, the J-N technique allows one to identify conditions under which moderators impact an outcome from conditions where these effects are not significant. Methods: To illustrate the use of the J-N technique in a longitudinal sample, we used data from the Health and Retirement Study. Analyses were based on time-to-death models including participants who died within the study duration of 12 years. Results: Multimorbidity differentially affects rates of change in depression. For some periods in time the effects are statistically significant while in other periods the same effects are not statistically different from zero. Conclusion: The J-N technique is useful to continuously probe moderating effects and to identify particular interactions with the model for time when certain effects are or are not statistically significant. In the context of multimorbidity this method is particularly useful for interpreting the complex interactions with differential change over time. 2014 S. Karger AG, Basel.}, keywords = {Health Conditions and Status, Methodology}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84895711235andpartnerID=40andmd5=d4f89914e4429927b0a42ae963405bcf}, author = {Rast, P. and Rush, J. and Andrea M Piccinin and Scott M Hofer} } @article {8056, title = {Identifying diabetics in Medicare claims and survey data: implications for health services research.}, journal = {BMC Health Serv Res}, volume = {14}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Apr 03}, pages = {150}, publisher = {14}, abstract = {

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

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

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

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

}, keywords = {Aged, Aged, 80 and over, Algorithms, Diabetes Mellitus, Female, Glycated Hemoglobin, Health Services Research, Humans, Insurance Claim Review, Male, Medicare, Prevalence, United States}, issn = {1472-6963}, doi = {10.1186/1472-6963-14-150}, author = {Joseph W Sakshaug and David R Weir and Lauren Hersch Nicholas} } @article {8051, title = {Immigrants and retirement resources}, journal = {Social Security Bulletin}, volume = {74}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus}, pages = {27-45}, publisher = {74}, abstract = {The extensive literature documenting differences in wages between immigrant and native-born workers suggests that immigrants may enter retirement at a significant financial disadvantage relative to workers born in the United States. However, little work has examined differences in retirement resources and retirement security between immigrants and natives. In this article, we use data from the Health and Retirement Study linked with restricted data from the Social Security Administration to compare retirement resources of immigrants and natives. Our results suggest that while immigrants have lower levels of Social Security benefits than natives, when holding demographic characteristics constant, immigrants have higher levels of net worth. The estimated immigrant differentials vary a great deal by number of years in the United States, with the most recent immigrants being the least prepared for retirement.}, keywords = {Demographics, Net Worth and Assets, Retirement Planning and Satisfaction, Social Security}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84896524474andpartnerID=40andmd5=976830d676d69e4ce7cb6b6bbe280982}, author = {P. Sevak and Lucie Schmidt} } @article {8133, title = {The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US}, journal = {Bmc Cancer}, volume = {14}, year = {2014}, note = {Times Cited: 0 0}, pages = {926-926}, publisher = {14}, abstract = {Background: Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status. Methods: In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese). Results: Mean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. 0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. 0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p .001). In ELSA, mean BMI change in normal-weight cancer survivors was 0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were 0.09 (SD = 0.81) and 0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was 0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were 0.003 (SD = 0.66) and 0.27 (SD = 1.27). Conclusion: Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality.}, keywords = {Health Conditions and Status}, author = {Sarah E Jackson and Williams, Kate and Andrew Steptoe and Wardle, Jane} } @mastersthesis {6430, title = {The impact of childhood SES on decline in cognition among older adults}, volume = {3622199}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-07-25 First page - n/a}, month = {2014}, pages = {187}, school = {University of Massachusetts Boston}, type = {Ph.D.}, address = {Boston}, abstract = {Previous studies have demonstrated that late-life cognitive change is associated with socioeconomic status (SES) developed from childhood to adulthood. Although the association between childhood SES and late-life cognitive functioning has been demonstrated empirically, few studies examined the relationships between childhood SES and cognitive performance longitudinally. Therefore, the purpose of this study was to investigate the impact of childhood and adult SES on different cognitive domain (global cognition, memory, and mental status) changes. Using a nationally representative sample from the Health and Retirement Study (HRS), cognition change from 1998 to 2010 was examined using growth curve models. The results showed that childhood SES indicators were related to all cognitive functions, adult SES indicators were mediating the effects of childhood SES on cognitive functions, and cumulative SES indicator was related to cognitive functions. In terms of the rate of decline in cognitive functions, indicators of childhood SES were significantly related. In addition, both childhood and adult SES indicators were significantly related to between and within-person variation in cognitive functions. Gender and race differences in the relationship between childhood SES and cognitive functions were also affirmed. These findings suggest that childhood SES has long-term effects on cognitive status as well as for cognitive change in later life although some of the childhood effects are mediated by adult SES factors.}, keywords = {Adult children, Demographics, Event History/Life Cycle, Health Conditions and Status}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1547725256?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat}, author = {Jiyoung Lyu} } @article {5984, title = {The Impact of Health Insurance on Stockholding: A Regression Discontinuity Approach}, year = {2014}, institution = {Bonn, Germany, Institute for the Study of Labor}, abstract = {Using data from the US Health and Retirement Study, we study the causal effect of increased health insurance coverage through Medicare and the associated reduction in health-related background risk on financial risk-taking. Given the onset of Medicare at age 65, we identify our effect of interest using a regression discontinuity approach. We find that getting Medicare coverage induces stockholding for those with at least some college education, but not for their less-educated counterparts. Hence, our results indicate that a reduction in background risk induces financial risk-taking in individuals for whom informational and pecuniary stock market participation costs are relatively low. Tables, Figures, Appendixes, References.}, keywords = {Medicare/Medicaid/Health Insurance, Methodology, Net Worth and Assets, Risk Taking}, url = {http://ftp.iza.org/dp8635.pdf}, author = {Christelis, Dimitris and Dimitris Georgarakos and Anna Sanz-de-Galdeano} } @article {8120, title = {The Impact of Mid- and Late-Life Loss on Insomnia Findings From the Health and Retirement Study, 2010 Cohort}, journal = {Family and Community Health}, volume = {37}, year = {2014}, note = {Times Cited: 0 0}, pages = {317-326}, publisher = {37}, abstract = {Bereavement and insomnia are both well-documented risk factors for illness. We use cohort data to estimate risk of insomnia after death of a family member among adults aged 50 to 70 years. Each day, 6700 persons die in the United States. During the next 20 years, this number will increase. In this cohort, any loss increases the likelihood of insomnia. The highest rates of insomnia occur among women aged 50 to 59 years; men aged 65 to 70 years, and persons reporting death of a spouse/partner or child. Physical activity reduces this risk by one-third. Bereavement is a public health issue requiring a targeted response.}, keywords = {Adult children, Health Conditions and Status}, doi = {10.1097/fch.0000000000000039}, author = {Simpson, Cherie and Joseph C. Allegra and Amara E. Ezeamama and Elkins, Jennifer and Toni Miles} } @mastersthesis {6238, title = {Improving retirement security in the United States}, volume = {3642719}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-10-22 First page - n/a}, month = {2014}, pages = {351}, school = {Northeastern University}, type = {Ph.D.}, address = {Boston}, abstract = {The public media, surveys of workers and the general public have indicated increasing concern with retirement security in the face of lengthening life expectancies, the costs of retirement living, and anxieties over the reported insufficiency of retirement savings balances to fund a decent retirement. The major questions of this dissertation are, first, whether the major parts of the United States retirement income security system, namely Social Security and the private pension system, are currently providing sufficient retirement security for all retirees? And second, how could this national system be reformed, if necessary, to provide greater retirement income security? Because the problem of elderly security is an international one, the United States retirement income security system is compared to those of some of the other economically advanced countries of the OECD (Organization for Economic Cooperation and Development), and more particularly, France, Sweden and Japan. An assessment of the contrasting design elements and retirement income security outcomes is made. Recommendations for reform of the United States system are offered which are based on an appraisal of the peculiar strengths and weaknesses of the United States system as well as on any promising design elements of the other examined national systems that might be adaptable to the United States.}, keywords = {Cross-National, Health Conditions and Status, Pensions, Public Policy, Retirement Planning and Satisfaction, Social Security}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1609374280?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:}, author = {Burns, Michael J.} } @article {8115, title = {Increased 1-year healthcare use in survivors of severe sepsis.}, journal = {Am J Respir Crit Care Med}, volume = {190}, year = {2014}, note = {Times Cited: 1}, month = {2014 Jul 01}, pages = {62-9}, publisher = {190}, abstract = {

RATIONALE: Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors{\textquoteright} post-discharge healthcare use.

OBJECTIVES: To measure inpatient healthcare use of severe sepsis survivors compared with patients{\textquoteright} own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.

METHODS: This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998-2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we measured patients{\textquoteright} use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3-45] vs. 7 [0-29]; P < 0.001) and a higher proportion of days alive (median, 9.6\% [interquartile range, 1.4-33.8\%] vs. 1.9\% [0.0-7.9\%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2\% [95\% confidence interval, 41.3-47.2\%] vs. 31.4\% [95\% confidence interval, 28.6-34.2\%] at 1 year), a steeper decline in days spent at home (difference-in-differences, -38.6 d [95\% confidence interval, -50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4\% [95\% confidence interval, 2.8-8.1\%]; P < 0.001).

CONCLUSIONS: Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.

}, keywords = {Aged, Female, Health Facilities, Humans, Insurance Claim Review, Long-term Care, Male, Medical Record Linkage, Medicare, Mortality, Outcome Assessment, Health Care, Patient Readmission, Prospective Studies, Sepsis, Skilled Nursing Facilities, Survivors, United States}, issn = {1535-4970}, doi = {10.1164/rccm.201403-0471OC}, author = {Hallie C Prescott and Kenneth M. Langa and Liu, Vincent and Gabriel J. Escobar and Theodore J Iwashyna} } @article {8119, title = {Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality.}, journal = {PLoS One}, volume = {9}, year = {2014}, note = {Times Cited: 0 0}, month = {2014}, pages = {e108540}, publisher = {9}, abstract = {

BACKGROUND: Guidelines recommend incorporating life expectancy (LE) into clinical decision-making for preventive interventions such as cancer screening. Previous research focused on mortality risk (e.g. 28\% at 4 years) which is more difficult to interpret than LE (e.g. 7.3 years) for both patients and clinicians. Our objective was to utilize the Gompertz Law of Human Mortality which states that mortality risk doubles in a fixed time interval to transform the Lee mortality index into a LE calculator.

METHODS: We examined community-dwelling older adults age 50 and over enrolled in the nationally representative 1998 wave of the Health and Retirement Study or HRS (response rate 81\%), dividing study respondents into development (n = 11701) and validation (n = 8009) cohorts. In the development cohort, we fit proportional hazards Gompertz survival functions for each of the risk groups defined by the Lee mortality index. We validated our LE estimates by comparing our predicted LE with observed survival in the HRS validation cohort and an external validation cohort from the 2004 wave of the English Longitudinal Study on Ageing or ELSA (n = 7042).

RESULTS: The ELSA cohort had a lower 8-year mortality risk (14\%) compared to our HRS development (23\%) and validation cohorts (25\%). Our model had good discrimination in the validation cohorts (Harrell{\textquoteright}s c 0.78 in HRS and 0.80 in the ELSA). Our predicted LE{\textquoteright}s were similar to observed survival in the HRS validation cohort without evidence of miscalibration (Hosmer-Lemeshow, p = 0.2 at 8 years). However, our predicted LE{\textquoteright}s were longer than observed survival in the ELSA cohort with evidence of miscalibration (Hosmer-Lemeshow, p<0.001 at 8 years) reflecting the lower mortality rate in ELSA.

CONCLUSION: We transformed a previously validated mortality index into a LE calculator that incorporated patient-level risk factors. Our LE calculator may help clinicians determine which preventive interventions are most appropriate for older US adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Female, Humans, Life Expectancy, Longevity, Longitudinal Studies, Male, Middle Aged, Mortality, Proportional Hazards Models, Risk Factors}, issn = {1932-6203}, doi = {10.1371/journal.pone.0108540}, author = {Sei J. Lee and W John Boscardin and Katharine A Kirby and Kenneth E Covinsky} } @mastersthesis {6151, title = {International sex and age differences in physical function and disability}, volume = {3644708}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-11-27 First page - n/a}, month = {2014}, pages = {144}, school = {University of Southern California}, type = {Ph.D.}, address = {Los Angeles}, abstract = {Worldwide population aging will undoubtedly be accompanied by an increase in the number of disabled older adults. Female gender and increased age are two of the most widely identified risk factors for poor physical functioning and disability. Yet the contexts in which people are aging vary markedly across countries. Countries differ greatly in their level of economic development, both past and present. Economic development is in turn related to improvements in infrastructure, health care, public health, education, etc. that are hypothesized to be related to improved physical function and less disability. Therefore, this dissertation examined whether sex and age differences/changes in both objectively-measured physical performance and reported difficulties with functional tasks and activities of daily living (ADLs) were similar or varied across seven countries whose per capita GNP ranged from $200 to $40,100 (United Sates, Taiwan, Korea, Mexico, China, Indonesia, and the Tsimane of Bolivia). It also sought to determine if sex differences and age differences varied systematically in terms of macro-level indicators including GDP, life expectancy, and measures of gender equality. Overall, sex differences were remarkably consistent across countries with very different contexts. Sex differences in physical performance and functional limitations were more pronounced than sex differences in difficulty with basic self-care tasks, but the magnitude of differences did not vary systematically in relation to country-level measures of development or gender equality. This may be because gender equality can be either protective or detrimental, depending on the domain. In terms of age differences, it was necessary to consider both the level of performance/prevalence of difficulty at younger ages as well as age differences, since poor performance/high levels of difficulty among the young-old indicate that "aging" has already occurred. Some populations did appear to be "aging" more rapidly, particularly those at the lowest end of the development spectrum, however, there was no clear evidence for a linear correlation between macro-level indicators of development and age differences. Interestingly, findings showed that functioning in some domains could be fairly well maintained despite declines in other domains, and these varied across countries. For example, Indonesians appeared to be "aging" more rapidly in terms of upper body strength, but showed relatively high levels of lower body function and less age-related decline. This may be due to differences across populations in patterns of work, physical activity, the built environment, etc.}, keywords = {CHARLS, Cross-National, Demographics, Disabilities, Health Conditions and Status, IFLS, KLoSA, Methodology, MHAS}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1625050780?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:}, author = {Felicia V Wheaton} } @mastersthesis {6219, title = {Internet use and mental health/well-being in old age: Exploring the roles of social integration and social support}, volume = {3618429}, year = {2014}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-06-21 First page - n/a}, month = {2014}, pages = {193}, school = {The University of Alabama at Birmingham}, type = {Ph.D.}, address = {Birmingham, AL}, abstract = {The escalating pressures put on the US healthcare system, due in part to the growing needs of the expanding older adult population, has motivated research dedicated to more fully understanding the mental health and mental well-being needs of this population and ways to address these needs and alleviate the pressure on the healthcare system. An increasing area of interest is in examining the role information and communication technologies (ICTs), such as Internet-connected computers and smartphones, in the health of older adults. Research has shown that ICTs can successfully be used to help treat, manage, and cope with mental health/well-being issues, but previous literature also finds that ICTs can contribute to mental health/well-being outcomes more directly. While studies have shown that ICTs may benefit older adults with regards to mental health/well-being, less is known through what mechanisms this relationship is enacted. This study uses data from the Health and Retirement Study to compare Internet-using older adults (aged 65+) with non-users on depression, life satisfaction, loneliness, personal growth, and purpose in life. Specific attention is given to examining the potential mediating roles of social integration (i.e., quantity of social ties) and social support (i.e., quality of social ties), as a Durkheimian perspective of Internet use argues that Internet use can be both beneficial and detrimental to an individual{\textquoteright}s social life, and changes in social life through Internet use can in turn affect mental health/well-being. Results of cross-sectional and longitudinal analyses finds Internet users, compared to non-users, typically enjoy more favorable mental health/well-being outcomes. Measures of social integration and social support are found to mediate the relationship between Internet use and mental health/well-being, but only partially. Additional analyses find that demographic characteristics, such as income and functional limitations, moderate the relationship between Internet use and mental health/well-being in older adults. The findings suggest that ICT interventions that incorporate elements that help older adults maintain social contacts and develop new ones may lessen mental health/well-being issues and the burdens associated with them.}, keywords = {Adult children, Health Conditions and Status, Other, Retirement Planning and Satisfaction}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1529435615?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat}, author = {Berkowsky, Ronald W.} } @article {8028, title = {An investigation of activity profiles of older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Sep}, pages = {809-21}, publisher = {69}, abstract = {

OBJECTIVES: In this study, we advance knowledge about activity engagement by considering many activities simultaneously to identify profiles of activity among older adults. Further, we use cross-sectional data to explore factors associated with activity profiles and prospective data to explore activity profiles and well-being outcomes.

METHOD: We used the core survey data from the years 2008 and 2010, as well as the 2009 Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS). The HRS CAMS includes information on types and amounts of activities. We used factor analysis and latent class analysis to identify activity profiles and regression analyses to assess antecedents and outcomes associated with activity profiles.

RESULTS: We identified 5 activity profiles: Low Activity, Moderate Activity, High Activity, Working, and Physically Active. These profiles varied in amount and type of activities. Demographic and health factors were related to profiles. Activity profiles were subsequently associated with self-rated health and depression symptoms.

DISCUSSION: The use of a 5-level categorical activity profile variable may allow more complex analyses of activity that capture the "whole person." There is clearly a vulnerable group of low-activity individuals as well as a High Activity group that may represent the "active ageing" vision.

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Cross-Sectional Studies, Employment, Female, Florida, Health Surveys, Hispanic or Latino, Human Activities, Humans, Male, Middle Aged, Models, Psychological, Motor Activity, Prospective Studies, Regression Analysis, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu002}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract}, author = {Morrow-Howell, Nancy and Putnam, Michelle and Lee, Yung Soo and Jennifer C. Greenfield and Inoue, Megumi and Chen, Huajuan} } @article {8015, title = {Involuntary Retirement, U.S. Social Security Program Participation and the Great Recession}, journal = {Public Finance and Management}, volume = {14}, year = {2014}, note = {Date revised - 2015-03-01 Availability - URL:http://www.spaef.com/pfm.php Publisher{\textquoteright}s URL}, pages = {329-356}, publisher = {14}, abstract = {Involuntary retirement covers economic and health related dislocations. Over 1992-2011, three-in-ten retirees in the Health and Retirement Study (HRS) report an involuntary retirement. Roughly half of these involuntary retirements are health-related. Following the Great Recession, involuntary retirement in the U.S. grew much faster than voluntary retirement. I find that while the population receiving Social Security retirement benefits grew 6 slower than average, the population receiving no public retirement or disability benefits grew 79 faster than average and the population reporting health-related involuntary retirement grew 270 faster than average. While incomes are found to have fallen for all retiree groups, those reporting health-related involuntary retirements are found to have retirement income declines of 38 and the lowest pre-retirement incomes of any measured group. These findings suggest patterns of vulnerability that have important implications for proposals seeking to reform the U.S. Social Security Program.}, keywords = {Disabilities, Employment and Labor Force, Health Conditions and Status, Public Policy, Retirement Planning and Satisfaction, Social Security, Women and Minorities}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1667944354?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aeconlitshellandrft_val_fmt=info:ofi/fmt:kev:mtx:journa}, author = {Seligman, Jason S.} } @article {8109, title = {Item response theory for measurement validity}, journal = {Shanghai Archives of Psychiatry}, volume = {26}, year = {2014}, note = {Export Date: 6 August 2014}, pages = {171-177}, publisher = {26}, abstract = {Summary: Item response theory (IRT) is an important method of assessing the validity of measurement scales that is underutilized in the field of psychiatry. IRT describes the relationship between a latent trait (e.g., the construct that the scale proposes to assess), the properties of the items in the scale, and respondents{\textquoteright} answers to the individual items. This paper introduces the basic premise, assumptions, and methods of IRT. To help explain these concepts we generate a hypothetical scale using three items from a modified, binary (yes/no) response version of the Center for Epidemiological Studies-Depression scale that was administered to 19, 399 respondents. We first conducted a factor analysis to confirm the unidimensionality of the three items and then proceeded with Mplus software to construct the 2-Parameter Logic (2-PL) IRT model of the data, a method which allows for estimates of both item discrimination and item difficulty. The utility of this information both for clinical purposes and for scale construction purposes is discussed. Copyright 2014 by Editorial Department of the Shanghai Archives of Psychiatry.}, keywords = {Health Conditions and Status, Methodology}, doi = {10.3969/j.issn.1002-0829.2014.03.010}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84904168760andpartnerID=40andmd5=0d61baede66c3f2ba9dbc676ec6738e3}, author = {Frances Margaret Yang and Solon T. Kao} } @article {5962, title = {If My Blood Pressure Is High, Do I Take It To Heart? Behavioral Impacts of Biomarker Collection in the Health and Retirement Study}, year = {2013}, institution = {Cambridge, MA, National Bureau of Economic Research}, abstract = {Starting in 2006, respondents in the U.S. Health and Retirement Study were asked to submit biomarkers and were notified of certain results. Respondents with very high blood pressure were given a card during the interview; all respondents were notified by mail of their BP, hemoglobin A1c, and total and HDL cholesterol readings alongside recommended thresholds. About 5.8 percent received the high blood pressure card, and 5.4 percent had high A1c levels, an indicator of diabetes. Rates of undiagnosed high BP and diabetes according to these biomarkers were 1.5 and 0.7 percent. Average treatment effects of biomarker collection on the panel overall were effectively zero, but notification of rare and dangerous readings triggered new diagnoses, increased pharmaceutical usage, and altered health behaviors among small subsamples of respondents and their spouses. Very high BP or A1c readings raised new diagnosis and medication usage by 20 to 40 percentage points. Uncontrolled high BP triggered reductions in own smoking and own and spouse s drinking. High A1c was associated with a 2.2 percent drop in weight and an increase in exercise among respondents without a previous diagnosis of diabetes, but with no changes among those already diagnosed, whose self-reported health and disability worsened.}, keywords = {Health Conditions and Status, Healthcare}, author = {Ryan D. Edwards} } @mastersthesis {6012, title = {Illness-related diabetes social support and glycemic control among middle aged and older adults}, volume = {1544617}, year = {2013}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-01-21 First page - n/a}, month = {2013}, pages = {84}, school = {University of South Carolina}, type = {M.S.P.H.}, address = {Columbia, SC}, abstract = {Objective: The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC. Methods: We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95\% confidence intervals (CIs) for the association between IRDSS and GC, test an interaction between race/ethnicity and IRDSS, and investigate the association between individual IRDSS variables and GC. Final models were adjusted for socio-demographic characteristics, lifestyle factors and clinical characteristics. Results: 79.5\% and 76.7\% of males and females respectively are classified as having adequate glycemic control. Among females, there was a significant association between IRDSS and GC (OR: 2.39; 95\% CI: 1.44, 4.00), but no significant association was observed among males. There was a significant interaction between race/ethnicity and IRDSS (p-value < 0.10). Among Hispanic females, there was a higher odds (OR: 5.75; 95\% CI: 1.01, 32.63) of adequate glycemic control in those who had high levels of IRDSS. The strongest association was found between high levels of emotional oriented social support and GC among females (OR=2.05; 95\% CI: 1.18, 3.54). Conclusion: Our findings suggest that the relationship between IRDSS and GC varied by gender, where we only observed an association among females. Although we found a significant interaction between Hispanic race/ethnicity and IRDSS among females, our results should be interpreted with caution due to small sample sizes for the groups. We found that type of social support for self-care activities may play a role in achieving GC, where emotional support was most important. Further studies should aim at identifying factors which may determine gender differences in the association between IRDSS and GC. Race/ethnicity as an effect modifier of this association also needs further exploration in studies with larger sample sizes.}, keywords = {Adult children, Demographics, Health Conditions and Status, Healthcare, Methodology, Public Policy, Women and Minorities}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1438176454?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat}, author = {Mondesir, Favel L.} } @article {7892, title = {Impact of cigarette smoking on utilization of nursing home services.}, journal = {Nicotine Tob Res}, volume = {15}, year = {2013}, month = {2013 Nov}, pages = {1902-9}, abstract = {

INTRODUCTION: Few studies have examined the effects of smoking on nursing home utilization, generally using poor data on smoking status. No previous study has distinguished utilization for recent from long-term quitters.

METHODS: Using the Health and Retirement Study, we assessed nursing home utilization by never-smokers, long-term quitters (quit >3 years), recent quitters (quit <=3 years), and current smokers. We used logistic regression to evaluate the likelihood of a nursing home admission. For those with an admission, we used negative binomial regression on the number of nursing home nights. Finally, we employed zero-inflated negative binomial regression to estimate nights for the full sample.

RESULTS: Controlling for other variables, compared with never-smokers, long-term quitters have an odds ratio (OR) for nursing home admission of 1.18 (95\% CI: 1.07-1.2), current smokers 1.39 (1.23-1.57), and recent quitters 1.55 (1.29-1.87). The probability of admission rises rapidly with age and is lower for African Americans and Hispanics, more affluent respondents, respondents with a spouse present in the home, and respondents with a living child. Given admission, smoking status is not associated with length of stay (LOS). LOS is longer for older respondents and women and shorter for more affluent respondents and those with spouses present.

CONCLUSIONS: Compared with otherwise identical never-smokers, former and current smokers have a significantly increased risk of nursing home admission. That recent quitters are at greatest risk of admission is consistent with evidence that many stop smoking because they are sick, often due to smoking.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Black or African American, Cross-Sectional Studies, Female, Hispanic or Latino, Humans, Length of Stay, Logistic Models, Longitudinal Studies, Male, Middle Aged, Nursing homes, Risk, Self Report, Smoking, Socioeconomic factors, United States, White People}, issn = {1469-994X}, doi = {10.1093/ntr/ntt079}, url = {http://ntr.oxfordjournals.org/content/early/2013/06/18/ntr.ntt079.abstract}, author = {Kenneth E. Warner and Ryan J McCammon and Brant E Fries and Kenneth M. Langa} } @article {7858, title = {The impact of house price movements on non-durable goods consumption of older households}, journal = {Annals of Economics and Finance}, volume = {14}, year = {2013}, note = {Export Date: 24 September 2013 Source: Scopus}, pages = {491-510}, publisher = {14}, abstract = {Using Health and Retirement Study (HRS) data, we create a new, up-to-date panel dataset to investigate the impact of house price movements on the non-durable goods consumption of older households. We find that older homeowners respond asymmetrically when experiencing house price gains and house price losses. More specifically, they increase total non-durable goods expenditure when house prices appreciate, but fail to reduce consumption when house prices fall.}, keywords = {Net Worth and Assets}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84874026500andpartnerID=40andmd5=9b24de128cf6ceeaf4346ecc7151389a}, author = {Shenyi Jiang and Wei Sun and Anthony Webb} } @article {7963, title = {The impact of immigrant status and racial/ethnic group on differences in responses to a risk aversion measure}, journal = {Journal of Financial Counseling and Planning}, volume = {24}, year = {2013}, note = {Export Date: 21 April 2014 Source: Scopus}, pages = {63-76}, publisher = {24}, abstract = {Factors related to differences in risk aversion were analyzed with a measure of risk aversion inferred from answers to a hypothetical income gamble question in the U.S. Health and Retirement Study. Cumulative logistic regressions, controlling for income, age, gender, health status, current job status, and home ownership, showed that Blacks were more risk averse than Whites, but Hispanics born in the United States were not different from Whites. U.S. born respondents in an other group, largely Asian, were also not different from Whites. Hispanics and those in the other group who were immigrants were more risk averse than Whites. Racial/ethnic differences found in other risk aversion studies may be partly due to differences in immigrant status. 2013 Association for Financial Counseling and Planning Education. All rights of reproduction in any form reserved.}, keywords = {Demographics, Net Worth and Assets, Risk Taking}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84892566141andpartnerID=40andmd5=4e12b8c031640244bc493910cb0f6d15}, author = {Fang, M. C. and Sherman D. Hanna and Chatterjee, Swarn} } @article {7964, title = {Impact of social integration on metabolic functions: evidence from a nationally representative longitudinal study of US older adults}, journal = {Bmc Public Health}, volume = {13}, year = {2013}, note = {Times Cited: 0}, publisher = {13}, abstract = {Background: Metabolic functions may operate as important biophysiological mechanisms through which social relationships affect health. It is unclear how social embeddedness or the lack thereof is related to risk of metabolic dysregulation. To fill this gap we tested the effects of social integration on metabolic functions over time in a nationally representative sample of older adults in the United States and examined population heterogeneity in the effects. Methods: Using longitudinal data from 4,323 adults aged over 50 years in the Health and Retirement Study and latent growth curve models, we estimated the trajectories of social integration spanning five waves, 1998-2006, in relation to biomarkers of energy metabolism in 2006. We assessed social integration using a summary index of the number of social ties across five domains. We examined six biomarkers, including total cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, waist circumference, and systolic and diastolic blood pressure, and the summary index of the overall burden of metabolic dysregulation. Results: High social integration predicted significantly lower risks of both individual and overall metabolic dysregulation. Specifically, adjusting for age, sex, race, and body mass index, having four to five social ties reduced the risks of abdominal obesity by 61 (odds ratio OR 95 confidence interval Cl = 0.39 0.23, 0.67 , p = .007), hypertension by 41 (OR 95 Cl = 0.59 0.42, 0.84 , p = .021), and the overall metabolic dysregulation by 46 (OR 95 Cl = 0.54 0.40, 0.72 , p .001). The OR for the overall burden remained significant when adjusting for social, behavioral, and illness factors. In addition, stably high social integration had more potent metabolic impacts over time than changes therein. Such effects were consistent across subpopulations and more salient for the younger old (those under age 65), males, whites, and the socioeconomically disadvantaged. Conclusions: This study addressed important challenges in previous research linking social integration to metabolic health by clarifying the nature and direction of the relationship as it applies to different objectively measured markers and population subgroups. It suggests additional psychosocial and biological pathways to consider in future research on the contributions of social deficits to disease etiology and old-age mortality.}, keywords = {Demographics, Health Conditions and Status, Other}, doi = {10.1186/1471-2458-13-1210}, author = {Yang Claire Yang and Li, Ting and Ji, Yinchun} } @article {LIN20131205, title = {The impact of the partnership long-term care insurance program on private coverage}, journal = {Journal of Health Economics}, volume = {32}, year = {2013}, pages = {1205 - 1213}, abstract = {We examine the impact of U.S. states{\textquoteright} adoption of the partnership long-term care (LTC) insurance program on households{\textquoteright} purchases of private coverage. Targeting middle-class households, this program increases the benefits of privately insuring via a higher asset threshold for Medicaid eligibility for LTC coverage. We find that the program generates few new purchases of LTC insurance, and that those it generates are almost entirely by wealthy individuals.}, keywords = {Insurance, Long-term Care, Medicaid, Partnership, Program}, issn = {0167-6296}, doi = {https://doi.org/10.1016/j.jhealeco.2013.09.010}, url = {http://www.sciencedirect.com/science/article/pii/S016762961300129X}, author = {Lin, Haizhen and Jeffrey T Prince} } @article {7762, title = {The influence of unpaid work on the transition out of full-time paid work.}, journal = {Gerontologist}, volume = {53}, year = {2013}, month = {2013 Feb}, pages = {92-101}, abstract = {

PURPOSE: Continued employment after retirement and engagement in unpaid work are both important ways of diminishing the negative economic effects of the retirement of baby boomer cohorts on society. Little research, however, examines the relationship between paid and unpaid work at the transition from full-time work. Using a resource perspective framework this study examines how engagement in unpaid work prior to and at the transition from full-time work influences whether individuals partially or fully retire.

DESIGN AND METHODS: This study used a sample of 2,236 Americans between the ages 50 and 68, who were interviewed between 1998 and 2008. Logistic regression was used to estimate transitioning into partial retirement (relative to full retirement) after leaving full-time work.

RESULTS: We found that the odds of transitioning into part-time work were increased by continuous volunteering (78\%) and reduced by starting parental (84\%), grandchild (41\%), and spousal (90\%) caregiving and unaffected by all other patterns of engagement in unpaid work.

IMPLICATIONS: Our findings suggest that volunteering is complementary with a transition to part-time work, and starting a new caregiving role at this transitioncreates a barrier to continued employment. In order to provide workers the opportunity to engage in the work force longer at the brink of retirement, it may be necessary to increase the support mechanisms for those who experience new caregiving responsibilities.

}, keywords = {Age Factors, Aged, Employment, Female, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Retirement, Salaries and Fringe Benefits, Volunteers, Work}, issn = {1758-5341}, doi = {10.1093/geront/gns080}, author = {Dawn C Carr and Ben Lennox Kail} } @article {7910, title = {The influence of working later in life on memory functioning}, journal = {Advances in Life Course Research}, volume = {18}, year = {2013}, note = {Times Cited: 0}, pages = {288-295}, publisher = {18}, abstract = {This article examines the influence of work status on subsequent memory trajectories in later years. Using a subsample of 8165 older adults who participated in the Health and Retirement Study and were 65 years or older in 2002, we examined work status and memory functioning after controlling for age and demographic characteristics. In growth curve analyses, work status predicted the rate of immediate memory decline from 2002 to 2006 with full-time employed individuals showing less immediate memory decline after controlling for age. However, work status categories were not associated with subsequent age-adjusted delayed memory trajectories. The findings from these growth curve analyses support the hypothesis that working late in life helps to impede immediate memory declines that often occur in later years.}, keywords = {Employment and Labor Force, Health Conditions and Status}, doi = {10.1016/j.alcr.2013.09.001}, author = {Kandauda Wickrama and Catherine W. O{\textquoteright}Neal} } @article {5963, title = {Inheritance Reporting in the Health and Retirement Study Data: Evidence of Forward Telescoping}, year = {2013}, institution = {Ann Arbor, MI, Institute for Social Research}, abstract = {Intergenerational transfers are often under-reported in household surveys (Laitner and Sonnega, 2010). This paper demonstrates that over-reporting can be an issue as well. Using data from the 1992-2008 Health and Retirement Study, a biannual longitudinal survey, we find that the first autocorrelations of inheritance reports are substantially higher than autocorrelations at longer lags. This evidence is consistent with over-reporting due to forward telescoping. We estimate that, of all inheritances reported in a survey wave, 5 to 10 had been already reported in the prior wave. This results in a similar magnitude overestimation of total two-year amounts of inheritance transfers. Additionally, this reporting error affects regression estimates, when inheritance measures are used as independent variables. In an example of regression analysis, we find that parameter estimates of inheritance variables are biased toward zero by about 2 to 12 . To mitigate forward telescoping in inheritance reports, it is advisable to employ bounded/dependent interviewing in longitudinal surveys.}, keywords = {Adult children, Event History/Life Cycle, Methodology, Net Worth and Assets}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2267507}, author = {Gouskova, Elena} } @article {7882, title = {Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, year = {2013}, abstract = {Background. Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.Methods. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.Results. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio AOR = 1.28, 95 confidence interval CI = 1.15 1.43, p .001), use of home health care services (AOR = 1.29, 95 CI = 1.09 1.52, p = .004), and any health service use (AOR = 1.28, 95 CI = 1.15 1.41, p .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95 CI = 1.50 1.96, p .001), use of home health care services (AOR = 1.64, 95 CI = 1.32 2.04, p .001), nursing home use (AOR = 1.45, 95 CI = 1.10 1.90, p = .009), and any health service use (AOR = 1.72, 95 CI = 1.51 1.95, p .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.Conclusions. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.}, keywords = {Health Conditions and Status, Healthcare, Public Policy}, doi = {10.1093/gerona/glt050}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2013/05/09/gerona.glt050.abstract}, author = {Christopher N Kaufmann and Sarah L. Canham and Ramin Mojtabai and Amber M Gum and Dautovich, Natalie D. and Kohn, Robert and Adam P Spira} } @article {7812, title = {Intergenerational transfers in long term care}, journal = {Review of Economics of the Household}, volume = {11}, year = {2013}, note = {Copyright - Springer Science Business Media New York 2013 Document feature - Equations; Tables; References Last updated - 2013-06-07 SubjectsTermNotLitGenreText - United States--US Altonji, J G; Hayashi, F; Kotlikoff, L J. Parental altruism and inter vivos transfers: Theory and evidence. JOURNAL OF POLITICAL ECONOMY, 105. 6 (1997): 1121-1166. UNIV CHICAGO PRESS Becker, Gary Stanley. A treatise on the family. A treatise on the family (1981): xii-288. Harvard University Press Bernheim, H. D., Schleifer, A., and Sommers, L. (1985). The strategic bequest motive. Journal of Political Economy, 57 (5), 1138 1159. Cox, D; Rank, M R. INTER-VIVOS TRANSFERS AND INTERGENERATIONAL EXCHANGE. REVIEW OF ECONOMICS AND STATISTICS, 74. 2 (1992): 305-314. MIT PRESS Cox, D. (1987). Motives for private income transfers. Journal of Political Economy, 95 (3), 508 546. Engers, M., and Stern, S. (2002). Long term care and family bargaining. International Economic Review, 43 (1), 73 114. Gale, W G; Scholz, J K. INTERGENERATIONAL TRANSFERS AND THE ACCUMULATION OF WEALTH. JOURNAL OF ECONOMIC PERSPECTIVES, 8. 4 (1994): 145-160. AMER ECON ASSN Gruber, J., and Grabowski, D. (2007). Moral hazard in nursing home use. Journal of Health Economics , 26 (3), 560 577. Hiedemann, Bridget; Stern, Steven; Hiedemann, Bridget. Strategic Play among Family Members When Making Long-Term Care Decisions. Journal of Economic Behavior and Organization, 40. 1 (1999): 29-57 Joulfaian, D. Gift taxes and lifetime transfers: time series evidence. JOURNAL OF PUBLIC ECONOMICS, 88. 9-10 (2004): 1917-1929. ELSEVIER SCIENCE SA Kohli, Martin; Kunemund, Harald; Kohli, Martin. Intergenerational Transfers in the Family: What Motivates Giving? GLOBAL AGING AND CHALLENGES TO FAMILIES (2003): 123-142. Aldine de Gruyter Lee, J., Kim, H., and Tanenbaum, S. (2006) Medicaid and family wealth transfer. The Gerontologist, 46 (1), 6 13. L pez Anuarbe, M. (2012). Parental inter vivos gifts to their adult children: A longitudinal approach. Working Paper. L pez Anuarbe, M. (2010). Intergenerational transfers in the long term care market . University of Connecticut Doctoral Dissertation. Economics Department, University of Connecticut. McGarry, K. Inter vivos transfers and intended bequests. JOURNAL OF PUBLIC ECONOMICS, 73. 3 (1999): 321-351. ELSEVIER SCIENCE SA McGarry, Kathleen; Schoeni, Robert F. Transfer behavior in the Health and Retirement Study: measurement and the redistribution of resources within the family. Journal of Human Resources, v30. n1 (1995): pS184(43). University of Wisconsin Press McGarry, K., and Schoeni, R. F. (1997). Transfer behavior within the family: Results from the asset and health dynamics survey. Journals of Gerontology, 52B, 82-92. National Alliance for Caregiving and AARP. (2008). Caregiving in the U.S. Bethesda, MD and Washington, DC; AARP Public Policy Institute (2008), Valuing the invaluable: The economic value of family caregiving, 2008 Update; family caregiver alliance (2004, June). Family caregiving and long-term care: A crucial issue for America s families (policy brief). San Francisco, CA. This article was accessed on November 29th, 2009. Norton, E. C., and Van Houtven, C. H. (2006). Inter-vivos transfers and exchange. Southern Economic Journal, 73 (1), 157 172. Pezzin, Liliana E; Schone, Barbara Steinberg. Intergenerational household formation, female labor supply and informal caregiving: A bargaining approach. Journal of Human Resources, 34. 3 (1999): 475-503. University of Wisconsin Press Pezzin, L. E., Pollack, R. A., and Schone, B. S. (2009). Long-term care of the disabled elderly: Do children increase caregiving by spouses? Review of Economics of the Household, 7 , 323 339. Pezzin, Liliana E.; Pollak, Robert A.; Schone, Barbara S. Efficiency in family bargaining: Living arrangements and caregiving decisions of adult children and disabled elderly parents. CESIFO ECONOMIC STUDIES, 53. 1 (2007): 69-96. OXFORD UNIV PRESS Sloan, F., Picone, G., and Hoerger, T. J. (1997). The supply of children s time to disabled elderly parents. Economic Inquiry, 35 (2), 295 308. Soldo, B. J., Hurd, M. D., Rodgers, W. L., and Wallace, R. B. (1997). Asset and health dynamics among the oldest old: An overview of the AHEAD study. The Journals of Gerontology Series B , 52B(Special Issue), 1 20. Soldo, B J; Hill. Family structure and transfer measures in the health and retirement study - Background and overview. JOURNAL OF HUMAN RESOURCES, 30. (1995): S108-S137. UNIV WISCONSIN PRESS}, pages = {235-258}, publisher = {11}, abstract = {How are parental inter-vivos transfers to their children and children{\textquoteright}s informal care of parents influenced by personal characteristics, family conditions and state specific long term care policies? AHEAD data from 1993 and 1995 and a two-party choice model are used to guide the estimation of OLS and binary logit models of the amount and likelihood of inter-vivos transfers to children and informal care of parents. Results suggest that both parents{\textquoteright} characteristics and their offspring{\textquoteright}s characteristics affect parental gifts to children and children{\textquoteright}s time assistance to their parents, highlighting the interdependent nature of these decisions. Furthermore, though state policies did not consistently affect parental gift giving, the availability of state respite care support -short-term breaks for informal family caregivers- (1 significance level) and adult day care centers (5 significance level) were positively related to the amount and likelihood of children{\textquoteright}s time assistance to their parents. These findings highlight the importance of some state programs such as respite care support in encouraging intra-family support for the elderly. Support for programs that reduce the caregiving burden may encourage more children to care for their elderly parents. PUBLICATION ABSTRACT}, keywords = {Adult children, Consumption and Savings, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy}, doi = {10.1007/s11150-012-9154-9 . http://dx.doi.org/10.1007/s11150-012-9156-7}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1357220955?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl}, author = {Lopez-Anuarbe, Monika} } @mastersthesis {6243, title = {Investigating the relationship between recent dental visits, memory, and dementia risk factors}, volume = {3598460}, year = {2013}, note = {Copyright - Copyright ProQuest, UMI Dissertations Publishing 2013 Last updated - 2014-01-20 First page - n/a}, month = {2013}, pages = {112}, school = {Fielding Graduate University}, type = {Ph.D.}, address = {Santa Barbara, CA}, abstract = {Research has concluded in recent years that oral health status is associated with dementia. However, little has been understood about how dental visits, which are a modifiable lifestyle variable, affect memory. The current study applied generalized estimating equations models to the RAND Health and Retirement Study nationally representative longitudinal database in order to determine whether recent dental visits predicted (a) higher memory scores, (b) subjective memory status, and (c) perceived change in self-rated memory. Results indicated that persons with recent dental visits obtained better episodic memory scores, had better self-rated memory, and reported perceived change in self-rated memory. The findings suggested that visiting the dentist and maintaining oral health are crucial for healthy cognitive aging. It is concluded that older adults should regularly visit the dentist in order to maintain memory capabilities.}, keywords = {Gerontology, Health Conditions and Status, Healthcare, Methodology, Risk Taking}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1459230336?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004\&ctx_enc=info:ofi/enc:UTF-8\&rfr_id=info:sid/ProQuest+Dissertations+\%26+Theses+A\%26I\&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertat}, author = {Carlson, Holly I.} } @inbook {5255, title = {Involuntary Job Transitions and Subjective Well-Being}, booktitle = {Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health}, year = {2013}, pages = {76-96}, publisher = {Stanford University Press}, organization = {Stanford University Press}, address = {Stanford, CA}, abstract = {This chapter examines whether lasting reductions in earnings and wealth due to job loss have consequences on well-being beyond financial concerns. In particular, the analysis uses data from the Health and Retirement Study (HRS) to examine the impact of job loss on two different measures of self-reported psychological well-being, one meant to capture life satisfaction and another that gauges a person{\textquoteright}s sense of purpose in life. The research indicates that job loss, independent of a variety of background factors, reduces satisfaction by roughly 25 to 50 percent and that self-assessments by individuals of their purpose in life also typically declines by roughly 15 percent. This work suggests that job loss takes a toll on the nonfinancial as well as the financial well-being of individuals.}, keywords = {Employment and Labor Force, Expectations, Other}, author = {Ariel Kalil and Thomas DeLeire}, editor = {Kenneth A. Couch and Mary C. Daly and Julie M Zissimopoulos} } @article {7685, title = {The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States.}, journal = {Health Soc Care Community}, volume = {20}, year = {2012}, note = {Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6.}, month = {2012 Jan}, pages = {42-51}, publisher = {20}, abstract = {

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

}, keywords = {Activities of Daily Living, Aged, Black or African American, Female, Health Status, Healthcare Disparities, Humans, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Poverty, Sex Factors, Socioeconomic factors, Time Factors, United States, White People}, issn = {1365-2524}, doi = {10.1111/j.1365-2524.2011.01012.x}, author = {Kim, Jinhyun and Virginia E. Richardson} } @article {7688, title = {The Importance of Anti-Discrimination and Workers{\textquoteright} Compensation Laws on the Provision of Workplace Accommodations Following the Onset of a Disability}, journal = {Industrial and Labor Relations Review}, volume = {65}, year = {2012}, pages = {161}, publisher = {65}, abstract = {The Americans with Disabilities Act of 1990 (ADA) was the first federal disability-based anti-discrimination law that applied to a broad range of workers. Whereas some studies have focused on its impact on workplace accommodation, this is the first to do so while accounting for previous state anti-discrimination and Workers{\textquoteright} Compensation laws. Using data from the Health and Retirement Study, the authors find that prior to the implementation of the ADA, employers were more likely to accommodate workers if their disability onset was work-related and hence likely to be covered by Workers{\textquoteright} Compensation laws. State anti-discrimination laws significantly increased accommodations to workers whose disabilities were not work-related, effectively bringing their accommodation rates in line with workers whose disabilities were. Though implementation of the ADA increased accommodation for all workers, the authors point out that failure to account for pre-existing state anti-discrimination and Workers{\textquoteright} Compensation laws will underestimate its effect. PUBLICATION ABSTRACT}, keywords = {Employment and Labor Force, Health Conditions and Status, Other}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2588500331andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {R.V. Burkhauser and Maximilian D. Schmeiser and Robert R. Weathers II} } @article {5933, title = {Improving the Social Security Statement}, year = {2012}, note = {Copyright - Copyright Social Science Research Network Jan 2012 Language of summary - English ProQuest ID - 919479167 Last updated - 2012-02-02 Place of publication - Rochester Corporate institution author - Biggs, Andrew G DOI - 2576680121; 67156722; 79688; 10.2139/ssrn.1991397; 1991397}, institution = {Rochester, Social Security Administration}, abstract = {The Social Security Statement is sent annually to each individual over age 25. The Statement contains information regarding the Social Security program, the individual{\textquoteright}s past covered earnings and contributions, and an estimate of the individual{\textquoteright}s future retirement benefits. Given the complexity of the Social Security benefit formula, the Statement represents the best and perhaps only estimate of the benefits to which an individual may be entitled. Knowledge of benefits is important, as individuals must plan their own retirement saving around their Social Security benefits. However, little research has been conducted regarding how effectively the Statement has improved Americans{\textquoteright} knowledge of benefit levels. We here use data from the Health and Retirement Study to gauge near-retirees{\textquoteright} ability to predict their Social Security retirement benefits both before and after the Statement began universal distribution to all near retirees in 1995. Results are ambiguous. The initial automatic distribution of the Statement did not appear to produce an immediate increase in knowledge of retirement benefit levels. However, continued receipt over a number of years prior to claiming may have reduced individual errors in predicting benefits. Financial literacy with regard to Social Security benefit levels may be improved through greater research into the contexts in which recipients understand and retain the benefit estimates contained in the Statement.}, keywords = {Public Policy, Retirement Planning and Satisfaction, Social Security}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/919479167?accountid=14667http://ssrn.com/abstract=1991397}, author = {Andrew G. Biggs} } @article {7754, title = {Income Replacement Ratios in the Health and Retirement Study}, journal = {Social Security Bulletin}, volume = {72}, year = {2012}, pages = {1}, publisher = {72}, abstract = {This article describes the income replacement ratio as a measure of retirement income adequacy and identifies several issues analysts must consider when calculating a replacement ratio. The article presents the income replacement ratios experienced by participants in the original sample cohort of the Health and Retirement Study (HRS), who were born between 1931 and 1941. Replacement ratios are shown by the respondent{\textquoteright}s birth cohort, age when first classified as retired in the HRS, and preretirement income quartile. Median replacement ratios fall as the retirement period grows longer. PUBLICATION ABSTRACT}, keywords = {Income, Retirement Planning and Satisfaction, Social Security}, author = {Patrick, J. Purcell} } @article {7718, title = {The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.}, journal = {Patient Educ Couns}, volume = {87}, year = {2012}, note = {Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15.}, month = {2012 Apr}, pages = {74-80}, publisher = {87}, abstract = {

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

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

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

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

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

}, keywords = {Aged, Blood Glucose Self-Monitoring, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Disease Management, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Multivariate Analysis, Risk Factors, Self Care, Self Efficacy, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires, Treatment Outcome}, issn = {1873-5134}, doi = {10.1016/j.pec.2011.07.013}, url = {http://www.ncbi.nlm.nih.gov/pubmed/21840149}, author = {Donna M Zulman and Ann Marie Rosland and Choi, Hwajung and Kenneth M. Langa and Michele M Heisler} } @article {8784, title = {International Comparisons in Health Economics: Evidence from Aging Studies}, journal = {Annual Review of Economics}, volume = {4}, year = {2012}, pages = {57-81}, abstract = {The authors provide an overview of the growing literature that uses micro-level data from multiple countries to investigate health outcomes, and their link to socioeconomic factors, at older ages. Since the data are at a comparatively young stage, much of the analysis is at an early stage and limited to a handful of countries, with analysis for the US and England being the most common. What is immediately apparent as they get better measures is that health differences between countries amongst those at older ages are real and large. Countries are ranked differently according to whether one considers life-expectancy, prevalence or incidence of one condition or another. And the magnitude of international disparities may vary according to whether measures utilize doctor diagnosed conditions or biomarker-based indicators of disease and poor health. But one key finding emerges {\textendash} the US ranks poorly on all indicators with the exception of self-reported subjective health status.}, keywords = {Aging, Comparisons, Cross-National, Meta-analyses}, doi = {10.1146/annurev-economics-080511-110944}, author = {James P Smith and James Banks} } @article {5945, title = {The Interplay of Wealth, Retirement Decisions, Policy and Economic Shocks}, year = {2012}, institution = {Ann Arbor, The University of Michigan}, abstract = {We develop a model of health investments and consumption over the life cycle where health affects longevity, provides flow utility, and retirement is endogenous. We develop a rich, numerical life-cycle model to study the complex interrelationship between health and wealth and the age of retirement. The decision to retire depends on a number of factors including earnings and health shocks, demographic characteristics, preferences, pensions, and social security. We incorporate these features in a computational model of optimal wealth and retirement decisions, solving the model household-by-household using data from the HRS. We use the model to study how workers would respond to an increase in the early eligibility age of retirement (EEA), and to what extent will the bad economy alter retirement plans. We find that increasing the EEA results in sizeable responses to the age of retirement but does not affect health outcomes very much. A 20 percent reduction in wealth induces households to delay retirement by one year, on average, with poor households being relatively unaffected.}, keywords = {Consumption and Savings, Demographics, Event History/Life Cycle, Health Conditions and Status, Healthcare, Net Worth and Assets, Retirement Planning and Satisfaction, Social Security}, url = {http://www.mrrc.isr.umich.edu/publications/publications_download.cfm?pid=860}, author = {John Karl Scholz and Ananth Seshadri} } @article {7707, title = {Investment Choice and Savings in Defined Contribution Pensions}, journal = {Pensions: An International Journal}, volume = {17}, year = {2012}, note = {Journal Article}, pages = {25-35}, publisher = {17}, abstract = {This article presents econometric evidence from Health and Retirement Study on the role that investment choice plays in the participants{\textquoteright} saving levels in the defined contribution (DC) pensions. I distinguish the effect of unconstrained investment choice from the one constrained in company stocks. My preferred estimates indicate that participants with investment choice contribute over three percentage points more of their salary into the DC plan than people without choice, and people constrained in company stocks contribute about three percentage points less in their retirement saving account.}, keywords = {Consumption and Savings, Event History/Life Cycle, Net Worth and Assets, Retirement Planning and Satisfaction}, url = {URL:http://www.palgrave-journals.com/pm/archive/index.html Publisher{\textquoteright}s URL}, author = {Li, Zhe} } @article {5943, title = {Investment Decisions in Retirement: The Role of Subjective Expectations}, year = {2012}, institution = {Ann Arbor, The University of Michigan}, abstract = {The rapid transition from defined benefit (DB) pension plans to defined contribution (DC) plans has a potential benefit of offering pension holders greater control over how their pension accumulations are invested. If pension holders are willing to take some risk, investments in the stock market could increase their economic preparation for retirement, and, indeed, economic theory as well as the typical advice of financial advisors calls for stock market investments. Yet, the rate of stock holding is much below what theory suggests it should be, undoing any benefit associated with the greater control coming from DC plans. The leading explanations for this under-investing include excessive risk aversion, costs of entry, and misperceptions about possible returns in the stock market. We show that excessive risk aversion is not able to account for the low fraction of stock holding. However, a model with heterogeneous subjective expectations about stock market returns is able to account for low stock market participation, and tracks the share of risky assets conditional on participation reasonably well. Based on the model with subjective expectations, we estimate a welfare loss of up to 12 compared to investment under rational expectations, if actual returns follow the same distribution as in the past 50 years. The policy implication is that there is considerable scope for welfare improvement as a result of consumer education regarding stock market returns. However, the welfare loss is much smaller if individuals are not very risk averse or if actual returns follow the same distribution as in the past 10 years}, keywords = {Net Worth and Assets, Pensions}, url = {http://www.mrrc.isr.umich.edu/publications/publications_download.cfm?pid=865}, author = {Marco Angrisani and Michael D Hurd and Erik Meijer} } @mastersthesis {5994, title = {The Impact of Family and Non-Family Roles on Caregiver Health Over Time}, volume = {Ph.D.}, year = {2011}, pages = {157}, school = {University of Minnesota}, address = {Minneapolis, MN}, abstract = {Using stress process and life course theory, this dissertation investigated pathways of adult child caregivers{\textquoteright} family (caregiving, marital, parenting) and non-family (employment) roles and their relation to caregiver psychological and physical health over time. Eight waves of data (1992-2006) from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong substantive and statistical evidence for a 4-class model of caregivers{\textquoteright} role pathways. The four pathways were (a) Married, Working Caregivers (22.5\%), (b) Married, Retired Caregivers with Co-Residing Child (12.5\%), (c) Married, Retired Caregivers (30.5\%), and (d) Not Married, Retired Caregivers (34.6\%). Married, Working Caregivers , who were more likely to be male, White, and younger than most other pathways, had more optimal psychological and subjective physical health, but were more likely to have high blood pressure compared to caregivers in other pathways. Results suggest that (a) adult child caregivers have distinct family and non-family role pathways, (b) caregivers{\textquoteright} gender, race/ethnicity, and age predict pathway membership, and (c) caregivers{\textquoteright} role pathways are connected to psychological and physical health over time. Future research should explore how adult child caregivers{\textquoteright} role pathways structurally differ for male versus female and younger versus older caregivers to further explain the heterogeneity of adult child caregivers{\textquoteright} role pathways. Family practitioners may be helpful in identifying practices and policies that help adult child caregivers manage their diverse range of long-term family and non-family roles.}, keywords = {Adult children, Event History/Life Cycle, Healthcare, Methodology, Other}, url = {https://hdl.handle.net/11299/109832}, author = {Matzek, A.} } @mastersthesis {6105, title = {Impact of Health Conditions on Cognitive Change in Later Life: A Cross-Study Comparative Analysis}, volume = {M.Sc.}, year = {2011}, note = {ISBN 9780494884256 Dissertation/thesis number MR88425 ProQuest document ID 1074789598}, month = {2011}, school = {University of Victoria (Canada)}, type = {M.Sc.}, abstract = {Relatively few studies have considered how changes in health are associated with changes in cognition in aging populations. Even fewer have investigated the similarities and differences of the health-cognition link evidenced across independent longitudinal studies of aging that differ in country and birth cohort. The main objective of the current research is to evaluate aging-related cognitive change in the context of physical health conditions and to compare patterns and synthesize results across several longitudinal studies of aging. This cross-study evaluation is based on data from three longitudinal studies of aging: 1) the OCTO-Twin Study, a longitudinal investigation of same-sex twin pairs drawn from the population-based Swedish Twin Registry (N = 702; 67\% female; mean age is 83.5), 2) the Health and Retirement Study (HRS), a study of middle-aged and older adults in the U.S. (N = 21,364; 57\% female; mean age is 65.8), and 3) the English Longitudinal Study of Aging (ELSA), a study of middle-aged and older adults in the U.K. (N = 11,397; 54\% female; mean age is 65.3). Data were analyzed using latent growth curve (LGC) analysis to evaluate 1) the impact of diagnosed health conditions and 2) the additive impact of comorbidity on level and rate of change in distinct cognitive outcomes. Our findings indicate that particular health conditions significantly impact initial status and rate of change in cognition, but do so differently across longitudinal studies of aging. The argument is made that the inclusion of health in our predictive models is essential as we try to parse out the effects of pathological aging vs. normative age-related change in cognition. The results of this study show the importance of replication in longitudinal research and for contrasting patterns of effects across independent studies in order to build a cumulative basis for further understanding of the dynamics among aging, health, and cognition in populations that differ in cohort, culture, and country.}, keywords = {Cross-National, Health Conditions and Status, Methodology, Public Policy}, author = {Sparks, Catharine} } @article {7648, title = {The Impact of Physical Activity on Disability Incidence among Older Adults in Mexico and the United States.}, journal = {J Aging Res}, volume = {2011}, year = {2011}, month = {2011 Apr 10}, pages = {420714}, publisher = {2011}, abstract = {

Evidence suggests that transitions among older adults towards healthy habits, such as physical activity, appear underway in developed countries such as the USA but not in developing countries such as Mexico. However, little is known about the potential benefit of physical activity in preventing disability among elders in countries at different stages of epidemiological transition. We explore the impact of physical activity on the disablement process among elders in Mexico compared to the USA. Data are from two waves of the Mexican Health and Aging Study and the Health and Retirement Study. We examine the impact of exercise on the transition from no disability to ADL limitations two years later. Findings indicate that exercise is more common in the U.S. than in Mexico. There is a positive effect of exercise on negative outcomes in both countries. However, the protective effect of exercise is stronger in the U.S. than in Mexico.

}, issn = {2090-2212}, doi = {10.4061/2011/420714}, author = {Kerstin Gerst and Alejandra Michaels-Obregon and Rebeca Wong} } @article {7590, title = {The impact of private long-term care insurance on the use of long-term care.}, journal = {Inquiry}, volume = {48}, year = {2011}, month = {2011 Spring}, pages = {34-50}, publisher = {48}, abstract = {

This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.

}, keywords = {Aged, Aged, 80 and over, Decision making, Female, Health Services Accessibility, Home Care Services, Home Nursing, Humans, Insurance, Long-Term Care, Likelihood Functions, Long-term Care, Male, Models, Econometric, Nursing homes, Private Sector, Regression Analysis, United States}, issn = {0046-9580}, doi = {10.5034/inquiryjrnl_48.01.05}, author = {Yong Li and Gail A Jensen} } @article {7640, title = {Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage.}, journal = {JAMA}, volume = {306}, year = {2011}, note = {McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov{\textquoteright}t United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9.}, month = {2011 Jul 27}, pages = {402-9}, publisher = {306}, abstract = {

CONTEXT: Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear.

OBJECTIVE: To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005.

MAIN OUTCOME MEASURE: Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services).

RESULTS: Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95\% confidence interval {CI}, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95\% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95\% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95\% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95\% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage.

CONCLUSION: Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

}, keywords = {Aged, Aged, 80 and over, Cost Control, Costs and Cost Analysis, Data collection, Female, Health Expenditures, Health Services, Humans, Insurance Claim Review, Longitudinal Studies, Male, Medicare Part D, Patient Care, Physicians, Skilled Nursing Facilities, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1026}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Haiden A. Huskamp} } @mastersthesis {6344, title = {The implications of Alzheimer{\textquoteright}s Risk for Household Financial Decision Making: Essays on the acquisition of human capital}, year = {2011}, school = {University of Michigan}, type = {Dissertation Chapter}, keywords = {Health Conditions and Status, Retirement Planning and Satisfaction}, url = {https://irs.princeton.edu/sites/g/files/toruqf276/files/uploads/documents/ReivsedRobertWillis.pdf}, author = {John Hsu} } @article {5900, title = {The Importance of State Anti-Discrimination Laws on Employer Accommodation and the Movement of their Employees onto Social Security Disability Insurance}, number = {WP 2011-251}, year = {2011}, institution = {The University of Michigan, Michigan Retirement Research Center}, address = {Ann Arbor, MI}, abstract = {The rate of application for Social Security Disability Insurance (SSDI) benefits, as well as the number of beneficiaries has been increasing for the past several decades, threatening the solvency of the SSDI program. One possible remedy is to promote continued employment amongst those experiencing the onset of a work limiting disability through the provision of workplace accommodations. Using the Health and Retirement Study data linked to Social Security administrative records and a state fixed effects model, we find that the provision of workplace accommodation reduces the probability of application for SSDI following disability onset. We estimate that receipt of an accommodation reduces a worker s probability of applying for SSDI by 30 percent over five years and 21 percent over 10 years. We then attempt to control for the potential endogeneity of accommodation receipt by exploiting exogenous variation in the implementation of state and federal anti-discrimination laws to estimate the impact of workplace accommodation on SSDI application in an instrumental variables (IV) model. While our coefficients continue to indicate that accommodation reduces SSDI application, we obtain implausibly large estimates of this effect. Overall our results imply that increasing accommodation is a plausible strategy for reducing SSDI applications and the number of beneficiaries.}, keywords = {Disabilities, Employment and Labor Force, Public Policy, Social Security}, url = {https://mrdrc.isr.umich.edu/pubs/the-importance-of-state-anti-discrimination-laws-on-employer-accommodation-and-the-movement-of-their-employees-onto-social-security-disability-insurance-2/}, author = {R.V. Burkhauser and Lauren Hersch Nicholas and Maximilian D. Schmeiser} } @article {7586, title = {Incidence of dementia and cognitive impairment, not dementia in the United States.}, journal = {Ann Neurol}, volume = {70}, year = {2011}, month = {2011 Sep}, pages = {418-26}, abstract = {

OBJECTIVE: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND.

METHODS: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in-home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population-weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia.

RESULTS: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person-years and 22.9 (SE, 2.9) per 1,000 person-years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person-years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person-years progressed from CIND to dementia. Over a 5.9-year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND.

INTERPRETATION: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cognition Disorders, Cohort Studies, Dementia, Diagnostic and Statistical Manual of Mental Disorders, disease progression, Female, Humans, Logistic Models, Longitudinal Studies, Male, Models, Statistical, United States}, issn = {1531-8249}, doi = {10.1002/ana.22362}, author = {Brenda L Plassman and Kenneth M. Langa and Ryan J McCammon and Gwenith G Fisher and Guy G Potter and James R Burke and David C Steffens and Norman L Foster and Bruno J Giordani and Frederick W Unverzagt and Kathleen A Welsh-Bohmer and Steven G Heeringa and David R Weir and Robert B Wallace} } @article {7633, title = {Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval.}, journal = {Int J Environ Res Public Health}, volume = {8}, year = {2011}, note = {Bobo, Janet Kay Greek, April A AA016534/AA/NIAAA NIH HHS/United States R24 HD042828-10/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Switzerland International journal of environmental research and public health Int J Environ Res Public Health. 2011 Aug;8(8):3263-76. Epub 2011 Aug 5.}, month = {2011 Aug}, pages = {3263-76}, publisher = {8}, abstract = {

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed >= 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3\% of sample), "Decreasing Drinkers" (5.9\%), "Stable Drinkers" (24.2\%), and "Non/Infrequent Drinkers" (64.6\%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

}, keywords = {Aged, Alcohol Drinking, Alcoholic Intoxication, Alcoholism, Cohort Studies, depression, Ethanol, Female, Follow-Up Studies, Humans, Longitudinal Studies, Middle Aged, Retirement, Risk Factors, Smoking, Surveys and Questionnaires, United States}, issn = {1660-4601}, doi = {10.3390/ijerph8083263}, author = {Janet Kay Bobo and April A Greek} } @mastersthesis {6284, title = {Individual and Additive Effects of Lifestyle Behaviors on Cognition: A Longitudinal Study}, volume = {Ph.D.}, year = {2011}, pages = {250}, school = {University of Illinois at Chicago, Health Sciences Center}, type = {3484979}, address = {Chicago, IL}, abstract = {Decreasing the incidence and prevalence of dementia is a national priority. An intervention with the potential to delay the average age of onset of Alzheimer{\textquoteright}s disease by just one year would greatly reduce the personal and societal costs associated with the disease. The series of proposed studies for this analysis will determine the extent to which a set of modifiable lifestyle behaviors that include physical, social, and cognitive activity, smoking, and alcohol consumption, are associated with multiple measures of cognition. The overall strategy is to examine the individual, interactive, and combined effects of these behaviors on a variety of cognitive outcome measures at 1-year and 7-years post-baseline, using multiple datasets derived from the health and retirement study. The datasets were derived from a sample of N=2037 respondents who completed surveys in 2000, 2001, 2002, and 2008. Demographic and other health status measures will be controlled for. Findings revealed that demographic characteristics had the most consistent association with cognition across outcome measures and across years. Total mental status score was the most sensitive outcome measure of bivariate relations in both the 1-year and 7-year analyses. Lifestyle behaviors at baseline had more significant associations with cognitive scores in the 7-year than the 1-year analyses. Of all the behaviors analyzed, cognitive activity had a significant association with more cognitive outcomes and in more models than any other behavior, followed by alcohol consumption. When controlling for other behaviors, cognitive activity continued to stand out above the others as being a significant predictor of cognitive outcomes. These findings begin to clarify the associations between behavioral risk factors and subsequent cognitive performance among older adults. The findings suggest that a lifestyle including cognitive activity and moderate alcohol consumption, more than any other behavior or a combination of behaviors, may result in promoting cognitive health for both the short-term and long-term. This work highlights the differing conclusions that can be drawn based on the outcome measure use, the time between measurement of predictors and outcomes, and the extent of covariates accounted for.}, keywords = {Health Conditions and Status, Healthcare, Public Policy}, author = {Eisenstein, A.} } @article {7678, title = {The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, note = {Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V.}, month = {2011 Oct}, pages = {1882-91}, publisher = {101}, abstract = {

OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.

METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.

RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.

}, keywords = {Age Factors, Aged, Dental Care, Employment, Female, Health Care Surveys, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300227}, author = {Richard J. Manski and John F Moeller and Patricia A St Clair and Jody Schimmel and Haiyan Chen and John V Pepper} } @article {5915, title = {The Influence of Public Policy on Health, Wealth and Mortality}, number = {UM11-12}, year = {2011}, institution = {The University of Michigan}, address = {Ann Arbor, MI}, abstract = {In this project we extend an augmented lifecycle model, incorporating a Grossman-style model of health capital, to enhance understanding of factors influencing consumption, wealth and health. We develop three primary results when using the model to explore the effects of stylized versions of Medicare and Social Security on wealth and longevity. First, our model calibration implies consumption and health are complements. As health depreciates with age, households will get less utility from consumption than would be in the case of a lifecycle model that does not endogenize health. Second, it appears that forward-looking households, when confronted by a substantially reduced safety net, will respond by reducing consumption and by reducing their health investment and therefore longevity. Third, there is a potentially important difference between short- and long- run responses to policy.}, keywords = {Consumption and Savings, Event History/Life Cycle, Health Conditions and Status, Net Worth and Assets, Public Policy}, url = {https://mrdrc.isr.umich.edu/projects/the-influence-of-public-policy-on-health-wealth-and-mortality/}, author = {John Karl Scholz and Ananth Seshadri} } @article {5920, title = {Inter-Vivos Giving Over the Lifecycle}, number = {WR-524-1}, year = {2011}, institution = {RAND Corporation }, address = {Santa Monica, CA}, abstract = {Inter-vivos cash transfers and bequests between family members total hundreds of billions of dollars each year. They may equalize resources within a generation of a family as well as across family generations. Transfers delayed to the end of life may represent a significant motive for saving. The authors use longitudinal data from the Health and Retirement Study on inter-vivos transfers that span up to twelve years to: describe financial transfers made by parents to children and their correlation with donor characteristics, examine age patterns in giving behavior, the persistence of transfers, and how transfers change in response to changes in marital status, economic status and health. Their empirical analysis is motivated by a dynamic life-cycle model with intervivos transfers as an argument in the utility function which generates hypotheses about the age pattern of transfers and how mortality risk, risk aversion and economic resources affect giving behavior.}, keywords = {Adult children, Consumption and Savings, Employment and Labor Force, Event History/Life Cycle, Women and Minorities}, doi = {https://doi.org/10.7249/WR524-1}, author = {Michael D Hurd and James P Smith and Julie M Zissimopoulos} } @article {7607, title = {Intrinsic Rewards of Work, Future Time Perspective, the Economy in the Future and Retirement Planning}, journal = {The Journal of Consumer Affairs}, volume = {45}, year = {2011}, pages = {419-444}, publisher = {45}, abstract = {This study incorporated intrinsic rewards of work, future time perspective and perspective on the economy in the future to create a model for the psychological mechanism of planning for retirement. The data set included those who were not retired (N = 2,266) in the 1992 Health and Retirement Study. Confirmatory factor analyses and structural equation modeling were used. The analyses were conducted separately on the different types of retirement plans. The results suggest that human resource professionals should (1) encourage employees who perceive high intrinsic rewards of work to plan for their retirement, and (2) remind employees that retirement might be closer than they anticipate. PUBLICATION ABSTRACT}, keywords = {Health Conditions and Status, Methodology, Other, Retirement Planning and Satisfaction}, doi = {https://doi.org/10.1111/j.1745-6606.2011.01211.x}, author = {Ting-Ying Yang and DeVaney, Sharon A.} } @article {7584, title = {Introduction to the Health and Retirement Study: An Evaluation and Scientific Ideas for the Future}, journal = {Forum for Health Economics and Policy}, volume = {14}, year = {2011}, pages = {Article 1}, publisher = {14}, keywords = {Methodology}, doi = {10.2202/1558-9544.1259}, author = {James P Smith} } @article {7497, title = {Impact of cognitive impairment on screening mammography use in older US women.}, journal = {Am J Public Health}, volume = {100}, year = {2010}, month = {2010 Oct}, pages = {1917-23}, publisher = {100}, abstract = {

OBJECTIVES: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.

METHODS: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.

RESULTS: Women with severe cognitive impairment had lower rates of mammography (18\%) compared with women with normal cognition (45\%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group{\textquoteright}s median survival of 3.3 years (95\% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50\%.

CONCLUSIONS: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Humans, Incidence, Longitudinal Studies, Mammography, Medicare, Patient Acceptance of Health Care, Social Class, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.158485}, author = {Kala M. Mehta and Kathy Z Fung and Christine E Kistler and Chang, Anna and Louise C Walter} } @mastersthesis {6383, title = {The impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression among older adults}, volume = {Ph.D.}, year = {2010}, note = {ISBN 9781124254692}, month = {2010}, pages = {136}, school = {The Ohio State University}, type = {Dissertation}, abstract = {Socioeconomic inequalities have been viewed as significant contributors to health disparities. However, little is known about the impact of cumulative socioeconomic inequalities on physical functioning, self-rated health, and depression across time, especially in later life. In addition, despite a strong connection between socioeconomic inequalities and the presence of private health insurance, few studies have examined how lack of private health insurance affects individuals{\textquoteright} health trajectories. Thus, this study focuses on the impact of socioeconomic inequalities and lack of private health insurance on physical functioning, self-rated health, and depression using longitudinal panel data from the Health and Retirement Study (HRS). The latent growth curve model was conducted in three steps: unconditional model, conditional model, and multiple group analysis. First, the unconditional growth curve model presented that individuals{\textquoteright} physical functioning, self-rated health, and depression tend to worsen as people age. However, significant variability in the initial level of health outcomes and their rate of change among individuals were found. Second, the conditional growth curve model was conducted to test potential covariate effects on this variability. Results from the conditional model showed that higher level of income and assets significantly predicted better physical functioning and self-rated health but less depressive symptoms. In particular, increases in income or assets significantly predicted slower worsening in physical functioning, self-rated health, and depression. However, iii higher level of education was a significant predictor for better self-rated health and less depression at baseline but not for physical functioning. In addition, having private health insurance significantly predicted better physical functioning, self-rated health, and less depressive symptoms at baseline. In particular, decline in physical functioning was slower among those who have private health insurance over time. Third, the multiple group analysis was conducted to examine potential moderating effects of gender and race on health trajectories. Results from the multiple group analysis showed that economic status had greater impact on females{\textquoteright} declines in physical functioning, self-rated health, and depression than on males{\textquoteright}. Despite lower initial level of physical functioning and self-rated health among Blacks than among Whites, they were less likely to suffer rapid declines in physical functioning and self-rated health after controlling for socioeconomic status. These results indicated that Blacks might have resilience factors such as religious activities and social support networks buffer health declines. Specific implications for social policy, practice, and research are discussed.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Other, Women and Minorities}, author = {Kim, Jinhyun} } @mastersthesis {6123, title = {The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards}, volume = {Ph.D.}, year = {2010}, note = {(Ginger)ISBN 9781124268521}, month = {2010}, pages = {118}, school = {University of Maryland, College Park}, type = {Dissertation}, abstract = {The classic model of moral hazard suggests that health insurance may reduce preventive care because the insurer will pay for part of the treatment in case of disease. However, if health insurance covers preventive care as well, the reduced cost of preventive care will encourage the insured to consume more preventive care. These two countervailing effects are referred to as ex ante and ex post moral hazards (Zweifel \& Manning 2000). Most studies do not distinguish the two effects, leading to a potentially wrong characterization of moral hazard. Using Medicare coverage as an example, this thesis identifies ex ante and ex post moral hazard effects of health insurance on cancer prevention. As we know, Medicare eligibility rules increase health insurance coverage at age 65. However, some preventive screenings were not covered in Medicare until recently. The different timing of Medicare eligibility and Medicare expansion of preventive care allows me to use a difference-in-differences framework to separate ex ante and ex post moral hazards. I focus on female uptake of breast cancer screening and male uptake of prostate cancer screening, using the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). In both datasets, I find evidence in support of ex ante and ex post moral hazards. No evidence shows that people try to delay screening until it has been covered by Medicare. Moreover, the level of prevention and responsiveness to insurance changes vary with demographics, with larger effects among whites and the better-educated. Then I take a second look at the moral hazard problem in the health insurance market using the Health and Retirement Study (HRS). Compared with MEPS or NHIS, the panel nature of HRS allows me to control for individual fixed effects and therefore provides a more stringent test. The major findings on female uptake of breast cancer screening are consistent. I find strong ex ante and ex post moral hazard effects in female uptake of breast cancer screening, and individual reactions to Medicare enrollment and Medicare{\textquoteright}s preventive care coverage vary by factors such as race and income. However, moral hazards on male uptake of prostate cancer screening is not found, mainly due to poor quality of data.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Other}, author = {Tang, Li} } @article {7485, title = {The Impact of Job Stress on Smoking and Quitting: Evidence from the HRS.}, journal = {B E J Econom Anal Policy}, volume = {10}, year = {2010}, note = {Using Smart Source Parsing}, month = {2010 Jan 01}, publisher = {10}, abstract = {

Job-related stress might affect smoking behavior because smoking may relieve stress and stress can make individuals more present-focused. Alternatively, individuals may both self-select into stressful jobs and choose to smoke based on unobserved factors. We use data from the Health and Retirement Study to examine how job stress affects the probability that smokers quit and the number of cigarettes smoked for current smokers. To address the potential endogeneity of job stress based on time invariant factors, we include individual fixed effects, which control for factors such as ability to handle stress. Occupational fixed effects are also included to control for occupational characteristics other than stress; time dummies control for the secular decline in smoking rates. Using a sample of people who smoked in the previous wave, we find that job stress is positively related to continuing to smoke among recent smokers. The results indicate that the key impact of stress is on the extensive margin of smoking, as opposed to the number of cigarettes smoked.

}, issn = {1935-1682}, doi = {10.2202/1935-1682.2259}, url = {http://www.bepress.com/bejeap/vol10/iss1/art27}, author = {Padmaja Ayyagari and Jody L Sindelar} } @article {NBERw16406, title = {The Impact of State Tax Subsidies for Private Long-Term Care Insurance on Coverage and Medicaid Expenditures}, year = {2010}, institution = {NBER}, abstract = {In spite of the large expected costs of needing long-term care, only 10-12 percent of the elderly population has private insurance coverage. Medicaid, which provides means-tested public assistance and pays for almost half of long-term care costs, spends more than $100 billion annually on long-term care. In this paper, I exploit variation in the adoption and generosity of state tax subsidies for private long-term care insurance to determine whether tax subsidies increase private coverage and reduce Medicaid{\textquoteright}s costs for long-term care. The results indicate that the average tax subsidy raises coverage rates by 2.7 percentage points, or 28 percent. However, the response is concentrated among high income and asset-rich individuals, populations with low probabilities of relying on Medicaid. Simulations suggest each dollar of state tax expenditure produces approximately $0.84 in Medicaid savings, over half of which funnels to the federal government.}, keywords = {Long-term care insurance, Medicaid, Taxes}, doi = {10.3386/w16406}, url = {http://www.nber.org/papers/w16406}, author = {Gopi Shah Goda} } @article {5810, title = {Individuals{\textquoteright} Uncertainty about Future Social Security Benefits and Portfolio Choice}, year = {2010}, note = {RAND Corporation Publications Department Working Paper}, institution = {Santa Monica, RAND Corporation Publications Department Working Papers}, abstract = {Little is known about the degree to which individuals are uncertain about their future Social Security benefits, how this varies within the U.S. population, and whether this uncertainty influences financial decisions related to retirement planning. To illuminate these issues, the authors present empirical evidence from the Health and Retirement Study Internet Survey and document systematic variation in respondents{\textquoteright} uncertainty about their future Social Security benefits by individual characteristics. They find that respondents with higher levels of uncertainty about future benefits hold a smaller share of their wealth in stocks.}, keywords = {Consumption and Savings, End of life decisions, Expectations, Income, Methodology, Net Worth and Assets}, url = {http://www.rand.org/pubs/working_papers/2010/RAND_WR782.pdf}, author = {Delavande, Adeline and Susann Rohwedder} } @article {5789, title = {Inference of Signs of Interaction Effects in Simultaneous Games with Incomplete Information, Second Version}, number = {10-021}, year = {2010}, note = {Using Smart Source Parsing pp Penn Institute for Economic Research, Department of Economics, University of Pennsylvania, PIER Working Paper Archive}, institution = {University of Pennsylvania}, address = {Philadelphia, PA}, abstract = {This paper studies the inference of interaction effects, i.e., the impacts of players{\textquoteright} actions on each other{\textquoteright}s payoffs, in discrete simultaneous games with incomplete information. We propose an easily implementable test for the signs of state-dependent interaction effects that does not require parametric specifications of players{\textquoteright} payoffs, the distributions of their private signals or the equilibrium selection mechanism. The test relies on the commonly invoked assumption that players{\textquoteright} private signals are independent conditional on observed states. The procedure is valid in the presence of multiple equilibria, and, as a by-product of our approach, we propose a formal test for multiple equilibria in the data-generating process. We provide Monte Carlo evidence of the test{\textquoteright}s good performance infinite samples. We also implement the test to infer the direction of interaction effects in couples{\textquoteright} joint retirement decisions using data from the Health and Retirement Study.}, keywords = {Methodology, Other, Retirement Planning and Satisfaction}, url = {https://economics.sas.upenn.edu/pier/working-paper/2010/inference-signs-interaction-effects-simultaneous-games-incomplete}, author = {{\'A}ureo de Paula and Tang, Xun} } @mastersthesis {6052, title = {The Influence of Individual Characteristics and Cohort Membership on Preventive Service Use in the Near Elderly}, year = {2010}, month = {2010}, school = {The Johns Hopkins University}, address = {United States, Maryland}, abstract = {Despite the known benefits of preventive care in reducing morbidity and mortality, many Americans do not receive preventive services. Among the near elderly (50-64 years), the use of preventive services remains below recommended levels. Using the Health and Retirement Study, this dissertation examined the influence of individual characteristics and cohort membership on preventive service use in the near elderly through three separate analyses. The first examined differences in preventive service use between two near elderly birth cohorts. The second examined characteristics associated with different influenza vaccination patterns--no vaccination versus receiving at least one vaccination; and intermittent compared to regular vaccination. The third compared characteristics associated with receiving intermittent or regular mammograms in near elderly women. Results show that improvements in education, income, and access to medical care in the later birth cohort led to increases in their use of preventive services. Other factors such as increases in obesity could adversely affect the preventive service use in future near elderly cohorts. In addition, the characteristics associated with the use of preventive care differ by type of service. There were some differences in the factors associated with the two vaccination patterns. Predisposing characteristics--age, gender, race, marital status, and education were significant predictors of receiving at least one vaccination. However, only race and education were associated with regular vaccination. Insurance, chronic conditions, and physician visits were associated with both vaccination patterns. In comparison, enabling but not predisposing characteristics--insurance, income, and physician visits, were significant predictors of regular mammography. Obese women and those in poor health were also less likely to receive regular mammograms. The health of the near elderly and their use of medical care are increasingly important to policymakers because of their impact on Medicare. Several proposals have been developed to allow the uninsured near elderly to buy-in to Medicare. However, this dissertation shows that in addition to health insurance, other characteristics such as cohort membership also influence preventive service use among near elderly individuals. It may also be useful for policymakers to consider that the characteristics associated with preventive service use differ by type of service.}, keywords = {Health Conditions and Status, Healthcare, Other}, author = {Petigara, Tanaz Kavas} } @article {5783, title = {The Influence of Retiree Health Benefits on Retirement Patterns}, number = {No. 10-163}, year = {2010}, institution = {W. E. Upjohn Institute for Employment Research }, address = {Kalamazoo, MI}, abstract = {We estimate the effect of employer offers of retiree health benefits (RHBs) on the timing of retirement using a sample of Health and Retirement Study (HRS) men observed over a period of up to 12 years. We hypothesize that the effect of RHBs differs for workers of different ages--a hypothesis we can test now that the main HRS cohort has aged sufficiently. We apply three wellknown panel data estimators and find that, for men in their 50s, RHBs have little or no effect on retirement decisions; however, a substantial effect emerges for men in their early 60s. We use simulations to illustrate how RHBs alter retirement patterns.}, keywords = {Consumption and Savings, Insurance, Public Policy, Retirement Planning and Satisfaction}, url = {https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.665.2810\&rep=rep1\&type=pdf}, author = {James Marton and Stephen A. Woodbury} } @article {7507, title = {The Influences on Bridge Employment Decisions}, journal = {International Journal of Manpower}, volume = {31}, year = {2010}, pages = {322-336}, publisher = {31}, abstract = {Population aging, and changes in labor force participation among older adults, will have tremendous impacts on the aging workforce. Thus it is imperative that the factors that influence whether older workers will continue in their career employment, engage in bridge employment, or fully retire, should be understood better. This paper aims to focus on these issues. In the present study longitudinal data for 2,869 older workers from the Health and Retirement Study (HRS) data set in the USA were used to examine the influence of demographic (e.g., income), nonwork related factors (e.g., marital satisfaction), and work related factors (e.g., job involvement) on late-life employment decisions over a ten year period from 1992 to 2002. The results indicate a wide variety of factors impact employment decisions later in life. Specifically, it was found that work related factors of job involvement and schedule flexibility, as well as the nonwork related factors of certainty of retirement plans, attitudes toward retirement, and job seeking self-efficacy all distinguished the various employment statuses (e.g., completely retired, partly retirement, and not retired at all) of older workers over a ten year period.}, keywords = {Consumption and Savings, Demographics, Employment and Labor Force, Other, Retirement Planning and Satisfaction, Time Use, Women and Minorities}, doi = {https://doi.org/10.1108/01437721011050602}, author = {Pengcharoen, Chanjira and Kenneth S. Shultz} } @article {5822, title = {Informal Care and Formal Home Care Use in Europe and the United States}, year = {2010}, abstract = {The provision of informal care by adult children is an important form of long-term care for older individuals and can reduce the use of medical services if they are substitutes. We examine how informal care by all children and formal care interact, which is critically important given demographic trends and the many policies proposed to promote informal care. The purpose of this study is to compare the United States and European countries, by merging data from the U.S. Health and Retirement Study (HRS) with its European counterpart, the Survey of Health, Ageing and Retirement in Europe (SHARE). We argue that the institutional setting is different across the Atlantic, as European home care schemes are predominantly publicly run, whereas the market plays a bigger role in the United States. We use a fexible simultaneous equations approach that allows for a different relationship between informal and formal home care in the two regions, using couples. We find that in Europe it is predominantly the supply of formalhome care that influences decisions by children to provide informal care, while in the United States parents{\textquoteright} decisions to use formal home care are based on the amount of informal care received and the amount of informal care provided by children is dependent on the amount of formal care.}, keywords = {Adult children, Cross-National, Healthcare, SHARE}, url = {ftp://cemfi-server.cemfi.es/pdf/papers/wshop/Holly_seminar.pdf}, author = {Holly, Alberto and Lufkin, Thomas and Edward C Norton and Courtney Harold Van Houtven} } @article {5800, title = {Intergenerational Transfers in the Health and Retirement Study Data}, number = {WP 2010-238}, year = {2010}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {Many economic analyses of public policy issues are based upon the life-cycle model of household behavior. The usual formulation omits private intergenerational transfers. This paper considers the possibility of a more sophisticated formulation that includes the latter. We examine 1992-2008 HRS data on inheritances and inter vivos gifts. We uncover an underreporting problem in the data: a household s financial respondent often seems to understate transfers from his/her in-laws. Nevertheless, other aspects of the data seem very useful. About 30-40 percent of households eventually inherit. Inheritances seem to reflect a mixture of intentional and accidental bequests, with the latter twice as prevalent.}, keywords = {Adult children, Event History/Life Cycle}, url = {https://mrdrc.isr.umich.edu/pubs/intergenerational-transfers-in-the-health-and-retirement-study-data-2/}, author = {John Laitner and Amanda Sonnega and Michigan Retirement Research Center} } @mastersthesis {6392, title = {Investigating age group differences in depression symptoms among older adults with operational impairments}, volume = {Doctor of Philosophy}, year = {2010}, school = {The University of Nebraska - Lincoln}, address = {Lincoln}, abstract = {Health and Retirement Study data from 2006 was used to examine whether health has a moderating effect on the relationship between age and depression. The sample consisted of 9,988 respondents in the 2006 data sample. Ages ranged from 41 to 102 with an average age of 69 and a standard deviation (SD) of 11.0 years. Gender, race/ethnicity, marital status, number of years of education, work status, and perceived health status were each analyzed by Ordinary Least Squares to determine the true population relationship between each of these factors and the depression of the participants. The majority (54\%) of the sample was female; 50\% were married, and 25\% were widowed. Only 26\% were working full-time. The large majority were Caucasian, with 16.5\% being African-American. The mean level of education in years was 12.4 with an SD of 3.3 years. Health, measured by ADL and IADL was allowed to freely vary, rather than restricting its variance by selecting only those with ADL or IADL limitations. The average level of depressive symptomatology, ranging from 0 to 8, was quite low with a mean of 1.6 depressive symptoms and an SD of 2.0. This indicates the average person experienced less than 2 symptoms. DSM-IV, for example, requires 5 or more for a diagnosis of depression. Self-rated health had the largest unique effect on health ( B = - .25), indicating that as health declined, the number of depressive symptomatologies increased. ADL limitations exerted the next largest unique effect ( B = .18), indicating an increase in depressive symptoms with increasing ADL limitations. IADL limitations operated in a similar manner. As hypothesized, age was significantly related to the level of depressive symptoms with the number of symptoms growing with increasing age. With the present data it seems that age does have a significant, independent effect on depression for those suffering from at least one limitation of ADL or IADL. Only one interaction, age by IADL, had a significant unique effect on depressive symptomatology (t(1) =3.4; p<.01). The contribution of the set was trivial, explaining only .004\% additional variance in depressive symptomatology.}, keywords = {Health Conditions and Status, Healthcare}, url = {https://digitalcommons.unl.edu/dissertations/AAI3411996}, author = {Kohnke, Kevin J.} } @article {7419, title = {The Impact of Childhood Health on Adult Labor Market Outcomes.}, journal = {Rev Econ Stat}, volume = {91}, year = {2009}, month = {2009 Sep 01}, pages = {478-489}, publisher = {91}, abstract = {

This paper examines impacts of childhood health on SES outcomes observed during adulthood-levels and trajectories of education, family income, household wealth, individual earnings and labor supply. The analysis is conducted using data that collects these SES measures in a panel who were originally children and who are now well into their adult years. Since all siblings are in the panel, one can control for unmeasured family and neighborhood background effects. With the exception of education, poor childhood health has a quantitatively large effect on all these outcomes. Moreover, these estimated effects are larger when unobserved family effects are controlled. (JEL codes; I, J).

}, issn = {0034-6535}, doi = {10.1162/rest.91.3.478}, url = {http://www.mitpressjournals.org/doi/abs/10.1162/rest.91.3.478}, author = {James P Smith} } @article {7364, title = {The Impact of Obesity and Arthritis on Active Life Expectancy in Older American Men and Women}, journal = {Obesity}, volume = {17}, year = {2009}, note = {PMID: 19023280}, pages = {363-369}, publisher = {17}, abstract = {This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged greater than or equal to70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60 of remaining life for 70-year-old men and women lived with disability, respectively (P 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health-care professionals to make concerted efforts to address both conditions in clinical settings.}, keywords = {Disabilities, Expectations, Health Conditions and Status}, author = {Sandra L Reynolds and McIlvane, Jessica M.} } @article {7293, title = {The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, note = {PMID 19196689}, month = {2009 Jan}, pages = {118-24}, publisher = {64}, abstract = {

BACKGROUND: The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals.

METHODS: We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working.

RESULTS: Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout.

CONCLUSIONS: Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

}, keywords = {Aged, Attitude to Health, Cohort Studies, Cross-Sectional Studies, Educational Status, Female, Health Status Indicators, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Mortality, Occupations, Odds Ratio, Retirement, Social Class, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbn006}, author = {Ralitza Gueorguieva and Jody L Sindelar and Tracy Falba and Jason M. Fletcher and Patricia S Keenan and Wu, Ran and William T Gallo} } @article {5752, title = {The Implications of Declining Retiree Health Insurance}, number = {WP$\#$2009-15}, year = {2009}, institution = {Center for Retirement Research at Boston College}, address = {Boston}, abstract = {A large number of retirees have employer-sponsored retiree health insurance (RHI). While RHI is a common source of supplemental coverage for Medicare beneficiaries, it is also the only affordable source of health insurance for many retirees under age 65 who have no access to Medicare. However, employers are scaling back their RHI benefits in response to rising health costs and changes in accounting rules, by either eliminating benefits which shifts costs to retirees, or tightening vesting requirements. Using data from the Health and Retirement Study, this paper examines the potential consequences of eliminating RHI for both pre-Medicare and Medicare-eligible retirees. For younger retirees the likely primary response is to work longer, and we find that number of workers age 55 to 64 would increase by 7 percent, as some of those who have their access to RHI eliminated would work rather than retire. Of those who still choose to retire, most lack any employer-sponsored health insurance option and would need to find an alternative source of coverage or go uninsured. For Medicare beneficiaries over 65, we estimate that about three quarters would replace RHI with another form of supplemental coverage. This shift would slightly reduce total spending and utilization for individuals who choose basic Medicare or a Medicare HMO as opposed to a Medigap plan, but health outcomes would probably be unaffected no matter which supplemental option is chosen. In short, a full elimination of RHI would primarily impact early retirees who must face the cost of much more expensive insurance or of financing illness without insurance. Policymakers may want to consider encouraging insurers to step in to provide more affordable plans for these early pre-Medicare retirees}, keywords = {Employment and Labor Force, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {https://crr.bc.edu/working-papers/the-implications-of-declining-retiree-health-insurance/}, author = {Courtney Monk and Alicia H. Munnell} } @article {7422, title = {Incidence and remission of urinary incontinence in a community-based population of women >= 50 years.}, journal = {Int Urogynecol J Pelvic Floor Dysfunct}, volume = {20}, year = {2009}, note = {Times Cited: 1 Komesu, Yuko M. Rogers, Rebecca G. Schrader, Ronald M. Lewis, Cindi M.}, month = {2009 May}, pages = {581-9}, publisher = {20}, abstract = {

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

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

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

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

}, keywords = {Age Factors, Black People, disease progression, Female, Hispanic or Latino, Humans, Incidence, Logistic Models, Longitudinal Studies, Middle Aged, Odds Ratio, Prevalence, Remission, Spontaneous, Severity of Illness Index, United States, Urinary incontinence, White People}, doi = {10.1007/s00192-009-0838-5}, author = {Yuko M Komesu and Rebecca G Rogers and Ronald M Schrader and Cynthia M. Lewis} } @article {7300, title = {Income Security for Workers}, journal = {Journal of Disability Policy Studies}, volume = {19}, year = {2009}, pages = {204-220}, publisher = {19}, abstract = {The current mix of public and private programs to support workers after they experience disability onset provides benefits to millions of workers and former workers. Yet, despite the large and growing costs of these programs, the inflation-adjusted household incomes of workers with disabilities have been falling for more than two decades, both absolutely and, especially, relative to the incomes of those without disabilities. The aging of the baby boom generation is likely to make matters worse, and the government{\textquoteright}s fiscal circumstance will make it increasingly difficult to sustain existing public programs. Current public policy initiatives might eventually improve the disability support system, but they are not likely to ward off the adverse consequences of the pending crisis. Policy changes that leverage existing private sector practices and capabilities might achieve greater success but have received little attention and are far from proven.}, keywords = {Employment and Labor Force, Insurance, Other, Social Security}, doi = {10.1177/1044207308314949}, author = {David Stapleton and R.V. Burkhauser and Peiyun She and Robert R. Weathers II and Livermore, Gina A.} } @article {7421, title = {Individual well-being in middle and older adulthood: do spousal beliefs matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Sep}, pages = {586-96}, publisher = {64B}, abstract = {

Associations between health, control beliefs, and well-being in later life are frequently conceptualized in terms of the characteristics of individuals. However, spousal interdependencies in psychosocial characteristics are also likely to be relevant for well-being. The present study investigated associations of self-rated health, control, and relationship closeness with life satisfaction and positive and negative affect in a sample of 2,235 spousal dyads. A significant proportion of variance in health, control, closeness, and well-being occurred between dyads. Individuals{\textquoteright} self-rated health, control, and relationship closeness were associated with higher well-being. Spouses{\textquoteright} self-rated health and control beliefs were consistently and positively associated with individuals{\textquoteright} well-being; however, effect sizes were small. Some evidence for individual{\textquoteright}s control beliefs buffering the association between health and well-being emerged, whereas spouses{\textquoteright} perceived control was not a significant moderator of the health-well-being association. Results highlight the importance of couple interdependencies for contextualizing health and well-being in older adulthood.

}, keywords = {Adult, Affect, Aged, Aged, 80 and over, Aging, Attitude to Health, Culture, Female, Humans, Individuality, Internal-External Control, Male, Marriage, Middle Aged, Quality of Life, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbp058}, author = {Tim D Windsor and Lindsay H Ryan and Jacqui Smith} } @article {7367, title = {The influence of long-term care insurance on the likelihood of nursing home admission.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Oct}, pages = {1862-7}, publisher = {57}, abstract = {

OBJECTIVES: To determine the effect of long-term care (LTC) insurance on nursing home use.

DESIGN: Longitudinal analysis, 1998 to 2006 waves of the Health Retirement Study.

SETTING: Community-dwelling nationally representative sample.

PARTICIPANTS: Nineteen thousand one hundred seventy adults aged 50 and older, 1998 wave.

METHODS: Two groups of respondents were created at baseline: those with and without an LTC insurance policy. Respondents admitted to the nursing home from 1998 to 2006 were identified. Propensity scores were used to control for known predictors of LTC insurance possession. A Cox proportional hazards model was used to compare the probability of nursing home admission over 8 years of follow-up for respondents possessing LTC insurance and those without a policy.

RESULTS: Of the 19,170 respondents aged 50 and older in 1998, 1,767 (9.2\%) possessed LTC insurance. A total of 1,778 (8.5\%) were admitted to a nursing home during the 8-year period: 149 (8.7\%) of those with LTC insurance and 1,629 (8.4\%) of those without LTC insurance. The hazard ratio, adjusted for propensity score, for those with LTC insurance entering a nursing home compared with those without was 1.07 (95\% confidence interval=0.83-1.38). Likelihood of nursing home admission was relatively low because the low-risk population included in the study, limiting the power to detect small differences in risk of nursing home utilization between groups.

CONCLUSION: There was no difference in nursing home utilization between low-risk older adults who did and did not possess an LTC insurance policy.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Insurance, Long-Term Care, Longitudinal Studies, Male, Middle Aged, Nursing homes}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02433.x}, author = {Tanya R Gure and Mohammed U Kabeto and Kenneth M. Langa} } @article {7397, title = {Insuring the Near-Elderly: How Much Would Medicare Save?}, journal = {Annals of Internal Medicine}, volume = {151}, year = {2009}, pages = {816-817}, publisher = {151}, abstract = {Providing insurance to uninsured near-elderly adults would result in 98 billion of savings for Medicare in the first decade after that group becomes eligible for Medicare. This calculation rests on the assumption that personal characteristics recorded in the HRS (Health and Retirement Study) data account for all of the differences between the continuously insured and continuously uninsured groups that might affect their utilization after they become eligible for Medicare. Here, Bhattacharya looks at how much Medicare would be saved for insuring the near-elderly.}, keywords = {Insurance, Medicare/Medicaid/Health Insurance}, doi = {10.7326/0003-4819-151-11-200912010-00158}, author = {Bhattacharya, Jay} } @article {5754, title = {Integrating Retirement Models}, number = {15607}, year = {2009}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {This paper advances the specification and estimation of models of retirement and saving in two earner families. The complications introduced by the interaction of retirement decisions by husbands and wives have led researchers to adopt a number of simplifications to increase the feasibility of estimating family retirement models. Our model relaxes these restrictions. It includes the extended choice set created when each spouse makes an independent retirement decision. It also includes the full range of complexity found in dynamic-stochastic models of retirement decision making, so far analyzed only in the context of single earner households. Retirement outcomes include full retirement, partial retirement and full-time work. Reverse flows from states of lesser to greater work are also included. The preference structure incorporates heterogeneity in time preference, varying taste parameters for full-time and part-time work, and the possibility of changes in preferences after retirement. The opportunity set reflects the full range of nonlinearities created by pensions and Social Security. Financial returns are stochastic. Exogenous shocks such as layoffs are also included. Estimation is based on data from the Health and Retirement Study. The solution method is based on backward induction. We show that this method is superior to a method based on a Nash equilibrium, providing plausible behavioral predictions when Nash equilibrium criteria fall silent. In contrast to some recent studies, the findings suggest the flow of wives into the labor force in the last few decades has probably reduced the amount of husbands work. The model also provides plausible responses to various policies. For example, we find that any effort to promote opportunities for partial retirement as a means to increase overall work is likely to be unsuccessful as any induced decline in full retirements is offset by a decrease in full-time work.}, keywords = {Adult children, Methodology, Retirement Planning and Satisfaction}, doi = {10.3386/w15607}, author = {Alan L Gustman and Thomas L. Steinmeier} } @article {5772, title = {International Differences in Longevity and Health and Their Economic Consequences}, number = {15235}, year = {2009}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {In 1975, 50 year-old Americans could expect to live slightly longer than their European counterparts. By 2005, American life expectancy at that age has diverged substantially compared to Europe. We find that this growing longevity gap is primarily the symptom of real declines in the health of near-elderly Americans, relative to their European peers. In particular, we use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Europe. We find that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Europeans could save up to 1.1 trillion in discounted total health expenditures from 2004 to 2050.}, keywords = {Cross-National, Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy}, doi = {10.3386/w15235}, author = {Pierre-Carl Michaud and Dana P Goldman and Darius Lakdawalla and Adam Gailey and Yuhui Zheng} } @article {7392, title = {The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Dec}, pages = {2293-9}, publisher = {57}, abstract = {

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke.

DESIGN: Longitudinal cohort.

SETTING: U.S. national sample, community based.

PARTICIPANTS: U.S. adults aged 50 and older and their spouses.

MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married).

RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95\% confidence interval (CI)=1.11-1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95\% CI=1.12-1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women.

CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

}, keywords = {Aged, Cardiovascular Diseases, Female, Health Surveys, Humans, Incidence, Longitudinal Studies, Male, Marital Status, Middle Aged, Risk Factors, Sexuality, Stroke}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02555.x}, author = {J Maselko and Lisa M. Bates and Mauricio Avendano and M. Maria Glymour} } @article {7368, title = {Intervivos Giving in the Older Population: Who Receives Financial Gifts from the Childless?}, journal = {Ageing Soc}, volume = {29}, year = {2009}, month = {2009 Nov 01}, pages = {1207-1225}, publisher = {29}, issn = {0144-686X}, doi = {10.1017/S0144686X08008362}, author = {Michael D Hurd} } @article {7207, title = {Identification of dementia: agreement among national survey data, medicare claims, and death certificates.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Feb}, pages = {313-26}, publisher = {43}, abstract = {

OBJECTIVE: To estimate the proportion of seniors with dementia from three independent data sources and their agreement.

DATA SOURCES: The longitudinal Asset and Health Dynamics among the Oldest Old (AHEAD) study (n=7,974), Medicare claims, and death certificate data.

STUDY DESIGN: Estimates of the proportion of individuals with dementia from: (1) self- or proxy-reported cognitive status measures from surveys, (2) Medicare claims, and (3) death certificates. Agreement using Cohen{\textquoteright}s kappa; multivariate logistic regression.

PRINCIPAL FINDINGS: The proportion varied substantially among the data sources. Agreement was poor (kappa: 0.14-0.46 depending upon comparison assessed); the individuals identified had relatively modest overlap.

CONCLUSIONS: Estimates of dementia occurrence based on cognitive status measures from three independent data sources were not interchangeable. Further validation of these sources is needed. Caution should be used if policy is based on only one data source.

}, keywords = {Aged, Consensus, Data Interpretation, Statistical, Death Certificates, Dementia, Female, Health Surveys, Humans, Incidence, Insurance Claim Review, Male, Mass Screening, Medicare, Research Design, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00748.x}, author = {Truls Ostbye and Donald H. Taylor Jr. and Elizabeth C. Clipp and Lynn Van Scoyoc and Brenda L Plassman} } @article {7217, title = {Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {367-84}, publisher = {20}, abstract = {

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

}, keywords = {Activities of Daily Living, Age Factors, Arthritis, Comorbidity, depression, Depressive Disorder, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Heart Diseases, Humans, Hypertension, Lung Diseases, Male, Mental Disorders, Middle Aged, Neoplasms, Obesity, Risk Factors, Sex Factors, Stroke, United States, Weight Gain}, issn = {0898-2643}, doi = {10.1177/0898264308315851}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7257, title = {Imputing Risk Tolerance From Survey Responses.}, journal = {J Am Stat Assoc}, volume = {103}, year = {2008}, month = {2008 Sep 01}, pages = {1028-1038}, publisher = {103}, abstract = {

Economic theory assigns a central role to risk preferences. This article develops a measure of relative risk tolerance using responses to hypothetical income gambles in the Health and Retirement Study. In contrast to most survey measures that produce an ordinal metric, this article shows how to construct a cardinal proxy for the risk tolerance of each survey respondent. The article also shows how to account for measurement error in estimating this proxy and how to obtain consistent regression estimates despite the measurement error. The risk tolerance proxy is shown to explain differences in asset allocation across households.

}, issn = {0162-1459}, doi = {10.1198/016214508000000139}, author = {Miles S Kimball and Claudia R Sahm and Matthew D. Shapiro} } @article {5735, title = {Income Data for Policy Analysis: A Comparative Assessment of Eight Surveys: Final Report}, year = {2008}, institution = {U.S. Department of Health and Human Services}, address = {Washington, D.C.}, abstract = {Income is a critical variable in policy analysis, and because of this, most federal household surveys collect at least some data on income. Yet income is exceedingly difficult to measure well in a household survey. Income questions produce some of the highest item nonresponse rates recorded in surveys, and comparisons of survey estimates with benchmarks developed from administrative records provide evidence of significant under-reporting for many sources. Mathematica Policy Research, Inc. (MPR) and its subcontractor, Denmead Services \& Consulting, have conducted a comprehensive and systematic assessment of the income data and its utility for policy-related analyses in eight major surveys: the Survey of Income and Program Participation (SIPP); the Annual Social and Economic Supplement to the Current Population Survey (CPS); the American Community Survey (ACS); the Household Component of the Medical Expenditure Panel Survey (MEPS); the National Health Interview Survey (NHIS); the Medicare Current Beneficiary Survey Cost and Use files (MCBS); the Health and Retirement Study (HRS); and the Panel Study of Income Dynamics (PSID). The assessment included both descriptive and empirical components. The descriptive component compiled extensive information on survey design and methodology in addition to the measurement of income and poverty and presented these data in a side-by-side format. The empirical component generated comparative tabulations of the distribution of income and poverty status for a range of personal characteristics for a common universe, income concept, and family definition, to the extent that this was feasible. Additional analysis focused on the implications of specific design choices. [416 PDF pages]}, keywords = {Methodology, Public Policy}, url = {https://aspe.hhs.gov/pdf-report/income-data-policy-analysis-comparative-assessment-eight-surveys}, author = {Czajka, John L. and Denmead, Gabrielle} } @article {7197, title = {Informal care and Medicare expenditures: testing for heterogeneous treatment effects.}, journal = {J Health Econ}, volume = {27}, year = {2008}, month = {2008 Jan}, pages = {134-56}, publisher = {27}, abstract = {

We estimate the effect of informal care on Medicare expenditures not only for care provided by children but also by the source of informal care (sons versus daughters, children versus others) and recipient characteristics (marital status). Our conceptual framework predicts heterogeneous effectiveness by source and recipient of informal care. We estimate two-part expenditure models as a function of informal care, controlling for endogeneity. We find that informal care by children reduces Medicare long-term care and inpatient expenditures of single elderly. We find that children are less effective caregivers among recipients who are married. For single elderly, child caregivers are more effective than other types. Gender of a child caregiver does not matter.

}, keywords = {Adult, Aged, Caregivers, Health Expenditures, Humans, Medicare, Models, Econometric, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2007.03.002}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {5729, title = {Involuntary Retirements: Prevalence, Causes, and Impacts}, year = {2008}, abstract = {This paper examines the prevalence, causes, and impacts of involuntary retirement using data from the Health and Retirement Study (HRS), wherein 30 percent of retirees experience involuntary retirement. We find that factors motivating voluntary retirement (aging, pensions, Social Security, savings, and preferences) are much weaker determinants of involuntary retirement, whereas poor health and job loss are very significant determinants for this group. Our results indicate that involuntary retirees are at much greater risk of falling into poverty and account for the great majority of reports of retirement dissatisfaction. We suggest policymakers consider social insurance reform with the fundamental differences between voluntary and involuntary retirement in mind.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, author = {Lachance, Marie-Eve and Seligman, Jason S.} } @mastersthesis {6161, title = {Immigrant Status, Health, and Mortality in Later Life}, year = {2007}, month = {2007}, school = {The University of Texas at Austin}, abstract = {Given the growing importance of the immigrant population in the United States, identifying the determinants of immigrant health following migration is critical to understanding the impact of international migration on the health of the nation. Using the Health and Retirement Study (HRS), this study examined nativity differences in mortality and physical functioning in later life, with special attention to (1) the determinants of nativity differences in mortality and physical functioning and (2) the association between mortality and disability in terms of the compression of morbidity paradigm. This study found that immigrant men had lower mortality compared to their U.S.-born counterparts of similar racial/ethnic backgrounds. However, immigrant women were indistinguishable from U.S.-born women of similar racial/ethnic backgrounds. With respect to physical functioning, immigrants showed lower levels of functional limitations but were indistinguishable from U.S.-born residents of similar racial/ethnic backgrounds in terms of disability. The data also showed that the effect of immigrant status somewhat differs across mortality and physical functioning. While all foreign-born racial/ethnic minorities showed lower or comparable mortality risks compared to native-born whites, foreign-born Hispanics showed poorer functional health than native-born whites. This study also found that socioeconomic status, social integration, and health behaviors play important roles in explaining the observed nativity differences in mortality and physical functioning. In particular, compared to prior research, the results indicate that socioeconomic factors better explain the observed nativity differences in mortality and physical functioning compared to social integration and health behaviors. This study also illustrated that integrating mortality and disability is a valuable way to investigate immigrant health. Compared to U.S.-born residents, the analysis of active life expectancy revealed that mortality is loosely coupled with disability for immigrants and that, except for foreign-born whites, immigrants{\textquoteright} lengthy lives are expected to be a prolonged period of disability. Overall, the results indicate that immigrant{\textquoteright}s socioeconomic adaptation into U.S. society has a great impact on immigrant health in later life. This study also suggests that social policies aimed at promoting immigrant health need to be accompanied by a more general effort to integrate immigrants into U.S. society.}, keywords = {Demographics, Health Conditions and Status}, url = {https://repositories.lib.utexas.edu/bitstream/handle/2152/13280/wooh05958.pdf\%3Bjsessionid\%3DE37C5FAE0EEFA3E406945DDA79982CAD?sequence\%3D2}, author = {Woo, Hae-bong} } @inbook {5214, title = {The Impact of Pensions on Nonpension Investment Choices}, booktitle = {Redefining Retirement: How Will Boomers Fare?}, year = {2007}, note = {ProCite field 6 : In ProCite field 8 : eds}, pages = {179-210}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {New York, NY}, abstract = {This chapter documents the investment choices of workers outside their company pensions. The Health and Retirement Study is used to evaluate how investment patterns outside pension holdings have been influenced by the shift from defined benefit to defined contribution pensions. Since workers with defined benefit plans can expect steady income in retirement, they might be thought to invest less conservatively outside their pensions. Nevertheless, the data show otherwise. Defined contribution participants also hold stock investments outside their pension portfolios. These findings suggest that increased stock holding as defined benefit plans decline in importance.}, keywords = {Consumption and Savings, Net Worth and Assets, Pensions}, isbn = {9780199230778}, doi = {DOI:10.1093/acprof:oso/9780199230778.003.0009}, author = {Friedberg, Leora and Anthony Webb} } @mastersthesis {6271, title = {The Impact of Retirement on Trajectories of Physical Health of Married Couples}, volume = {Doctor of Philosophy}, year = {2007}, month = {2007}, school = {Case Western Reserve University}, address = {Cleveland, OH}, abstract = {Retirement{\textquoteright}s impact on health in married couples is important due to increasing life expectancy and the retirement of Baby Boomers. There is mixed evidence about retirement{\textquoteright}s effects, if any, on physical health. In addition, there is a lack of research that examines the effect of one spouse{\textquoteright}s retirement on the other spouse{\textquoteright}s health. Secondary analysis was conducted using longitudinal data from the Health and Retirement Study (HRS), which was designed to obtain information about health and economic status from pre- to post-retirement. The sample consisted of 1,666 non-Hispanic married couples (176 Black couples and 1490 White couples) where both spouses participated in HRS from 1992 to 2000 and at least one spouse was age 51-61 at baseline. Political economy, social stratification, and interdependence theories provided the conceptual framework. Multilevel modeling was used to analyze spouses{\textquoteright} short-term and long-term changes in health after retirement. Health was measured using four separate indicators (number of disease diagnoses, lower body difficulties, self-rated health, mortality). Retirement was operationalized two ways: self-defined retirement and labor force status (working, retirement, unemployed, disabled). Other predictors were demographics, health-related control variables and household characteristics. Husbands experienced an increase in their number of disease diagnoses and their risk of having at least one lower body difficulty (e.g., difficulty walking up a flight of stairs) during the first wave of their retirement, but fewer disease diagnoses long-term (i.e., up to 8 years post-retirement), compared to non-retired husbands. Wives experienced worse self-rated health during the first wave of their own retirement. Wives{\textquoteright} retirement had a short-term positive impact on the self-rated health of husbands, but husbands{\textquoteright} retirement did not affect wives{\textquoteright} health. The health of certain individuals was more negatively affected by retirement than others due to their social stratification characteristics (race, education, income, wealth, age). Health disadvantage was predicted by both higher and lower social status (depending on gender, health outcome, retirement measure, and length of time since retirement). Findings of this study are important for social workers helping married couples through retirement transitions, for furthering empirical knowledge and research methodology, and for their implications for social justice and policy reform. Indexing (document details)}, keywords = {Adult children, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {https://www.semanticscholar.org/paper/The-Impact-of-Retirement-on-Trajectories-of-Health-Curl/8c86756ea2330c33ffc8f2c7f9ed6405761e8050}, author = {Angela L Curl} } @article {5701, title = {Imperfect Knowledge of Pension Plan Type}, number = {13379}, year = {2007}, institution = {National Bureau of Economic Research }, address = {Cambridge, MA}, abstract = {This paper investigates the reasons for discrepancies between the pension plan type reported by respondents to the Health and Retirement Study (HRS) and pension plan type obtained from documents produced by their employers, called Summary Plan Descriptions (SPDs). The analysis suggests the discrepancies are sizable and are mainly due to misreports by respondents. Discrepancies between respondent and firm reports of plan type are first documented for different years and from different data sources. Changes over time in respondent and firm reports are analyzed for those who say their plans did not change. Plan type from payroll data produced by Watson Wyatt, a pension consulting company, is examined and compared to respondent reports for employees covered by Watson Wyatt plans. The Watson Wyatt payroll data report plan type without error, and yet we find the patterns of discrepancies between respondent and firm provided data are the same as for the HRS employer and respondent data. We also explore other evidence gathered by the HRS in the course of interviews and various experiments. Our findings that errors are mainly the result of misreporting by respondents, together with findings from experiments, suggest a number of changes in survey design that can help to reduce reporting error. They also suggest that models of retirement and saving behavior should allow for imperfect knowledge by decision makers.}, keywords = {Methodology, Pensions}, doi = {DOI 10.3386/w13379}, author = {Alan L Gustman and Thomas L. Steinmeier and N. Tabatabai} } @article {7140, title = {Informal caregiving and Body Mass Index among older adults.}, journal = {J Gerontol Nurs}, volume = {33}, year = {2007}, month = {2007 Apr}, pages = {42-51}, publisher = {33}, abstract = {

The authors sought to obtain nationally representative estimates of the time of informal caregiving provided to older adults classified into the four standard Body Mass Index (BMI) classifications. They estimated multivariate regression models using data from the 2000 Health and Retirement Study to determine the weekly hours of informal caregiving for older adults classified into the four standard BMI classifications. In the fully adjusted models, being underweight was associated with receiving significantly more informal care, however, obesity was not associated with more informal care. The implications of these findings are discussed in terms of nursing practice and research to prevent weight loss and frailty.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Body Mass Index, Body Weight, Caregivers, Female, Geriatric Assessment, Humans, Male, Social Class}, issn = {0098-9134}, doi = {10.3928/00989134-20070401-06}, author = {Kristi Rahrig Jenkins and Mohammed U Kabeto and Fultz, Nancy H. and Kenneth M. Langa} } @article {11437, title = {Intergenerational transfers and the prospects for increasing wealth inequality}, journal = {Social Science Research}, volume = {36}, year = {2007}, pages = {1105-1134}, abstract = {Analyzing two cohorts from the Health and Retirement Survey from 1992 to 2002, we investigate the growth of wealth inequality and the determinants of intergenerational transfers. Although wealth inequality has grown substantially, patterns of intergenerational transfers that we are able to assess have changed only modestly. Based on these results, we conclude that concerns that the level of inequality will continue to increase across its full distribution appear unwarranted. This conclusion, however, is limited in two important respects. First, it is based on a single cohort comparison which, however well-chosen, does not guarantee that other cohort comparisons would yield the same results. Second, the nature of survey research on wealth prevents any incisive analysis of the explosive growth of the wealth holdings of those at the very top of the distribution (i.e., those at the 99th percentile and beyond). Thus, we cannot rule out the possibility that a comparison of those beyond the 99th percentile to everyone else would give evidence that, at this pivot point of the distribution, a new level of self-perpetuation has in fact arrived.}, keywords = {Changes in inequality, Intergenerational transfers, Racial stratification, Wealth}, isbn = {0049-089X}, doi = {10.1016/j.ssresearch.2006.09.006}, author = {Morgan, Stephen L. and John C. Scott} } @article {7161, title = {An interpersonal continuity of care measure for Medicare Part B claims analyses.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S160-8}, publisher = {62B}, abstract = {

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3\%, and interpersonal continuity of care with any physician was 26.1\%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Disability Evaluation, Female, Health Services Accessibility, Health Surveys, Humans, Insurance Claim Review, Male, Medicare Part B, Mobility Limitation, Physician-Patient Relations, Primary Health Care, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s160}, author = {Frederic D Wolinsky and Thomas R Miller and John F Geweke and Elizabeth A Chrischilles and An, Hyonggin and Robert B Wallace and Claire E Pavlik and Kara B Wright and Robert L. Ohsfeldt and Gary E Rosenthal} } @article {7100, title = {The Impact of Age and Health on Vehicle Choices among Elders}, journal = {Journal of Family and Economic Issues}, volume = {27}, year = {2006}, pages = {437-457}, publisher = {27}, abstract = {We examine older Americans choice of vehicle types and the impact of age and health status on this choice. Using the 1998 and 2000 Health and Retirement Study (HRS) and the 2001 HRS Consumption and Activities Mail Survey (CAMS), we estimate a multinomial logit model of older Americans choice of vehicle types. We find that both age and health status influence the type of vehicle purchased or leased. Compared to Americans aged 50 59, those aged 70 or older prefer passenger cars to trucks and sport utility vehicles (SUVs). We also find that elders with health problems are more likely to prefer SUVs to passenger cars than those without health problems.}, keywords = {Consumption and Savings, Health Conditions and Status}, author = {Hyungsoo Kim and Jinkook Lee and Kim, Doh-Khul} } @article {7104, title = {The Impact of Comorbidity on Wealth Changes in Later Life}, journal = {Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, volume = {61B}, year = {2006}, pages = {S307}, publisher = {61B}, abstract = {Despite the high prevalence of comorbidity in later life, scientists do not fully understand its financial impact. The objective of this study was to enhance researchers{\textquoteright} understanding of the impact of compounded health problems on the wealth of older people. Using data from the Asset and Health Dynamics Among the Oldest Old study (1995 to 2002 waves), we conducted ordinary least squares regression analysis on wealth changes. We found that comorbidity leads to significant wealth depletion in later life, especially for single elders. Single elders with comorbidity depleted 20 to 22 of their wealth over a 2- to 3-year time period, especially those with the combination of heart disease and diabetes. The impact of comorbidity was disproportionately greater than the estimated impact of a single health problem. However, the impact of comorbidity did not appear to be significant among married people. We found that compounded health problems also create compounded financial problems in later life. For an accurate estimation of the financial consequences of health problems, it is important to consider comorbid health problems, as the effect of comorbidity is not equal to the sum of the effects of single health problems.}, keywords = {Demographics, Healthcare, Net Worth and Assets}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Hyungsoo Kim and Jinkook Lee} } @article {7108, title = {The Impact of Elder Care on Women{\textquoteright}s Labor Supply}, journal = {Inquiry}, volume = {43}, year = {2006}, pages = {195-210}, publisher = {43}, abstract = {Adult daughters traditionally have served as primary caregivers for frail unmarried adults, but the levels of care they have provided in the past may interfere with their growing work responsibilities. This paper examines the impact of time transfers to elderly parents on labor supply at midlife. Using a sample of women ages 55 to 67 in the Health and Retirement Study, we estimate panel data models of annual hours of paid work controlling for the endogeneity of time assistance to parents. The results indicate that time help to parents strongly reduces female labor supply at midlife.}, keywords = {Adult children, Demographics, Healthcare}, author = {Richard W. Johnson and LoSasso, Anthony T.} } @article {5666, title = {The Impact of Health Insurance Availability on Retirement Decision Reversals}, year = {2006}, institution = {The University of Michigan, Michigan Retirement Research Center}, abstract = {This paper uses the longitudinal aspect of the Health and Retirement Survey to explore the characteristics associated with reversals in retirement (referred to here as unretirement ). Through the use of survival time analysis, this paper show that health insurance plays a significant role in unretirement decisions. This role is underestimated when a static probit analysis is used alone. The results hold up for a number of different retirement identifiers that are based both on self-reports of retirement and actual work levels. The results are also robust to various definitions of retirement prompted by the difficult question of how to classify partial retirements. The importance of health insurance provision in a retiree s decision also remains significant when other shocks and the prospect of planned unretirement are introduced.}, keywords = {Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, url = {http://www.mrrc.isr.umich.edu/publications/papers/}, author = {Joshua Congdon-Hohman} } @article {9743, title = {The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey}, journal = {Occupational and Environmental Medicine}, volume = {63}, year = {2006}, month = {Jun-06-2006}, pages = {683 - 687}, abstract = {Background: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. Objective: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. Methods: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. Results: Over the 10 year study frame, 582 individuals (13.5\% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95\% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95\% CI = 1.18 to 4.98) relative to working persons. Conclusion: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.}, keywords = {Economics, Job loss, Myocardial Infarction, Stroke, Unemployment}, issn = {1351-0711}, doi = {10.1136/oem.2006.026823}, url = {http://oem.bmj.com/cgi/doi/10.1136/oem.2006.026823https://syndication.highwire.org/content/doi/10.1136/oem.2006.026823}, author = {William T Gallo and Teng, H.M. and Tracy Falba and Stanislav V Kasl and Krumholz, H.V. and Elizabeth H Bradley} } @article {7099, title = {The Impact of Late-Career Job Loss on Myocardial Infarction and Stroke: A 10-year follow-up using the Health and Retirement Survey}, journal = {Occupational and Environmental Medicine}, volume = {63}, year = {2006}, pages = {683-7}, publisher = {63}, abstract = {OBJECTIVE: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are elevated risk. Our aim in this study was to assess the 10-year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. METHODS: Analyzing data from the nationally representative U.S. Health and Retirement Survey (HRS), we used Cox proportional hazards analysis to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. Our sample included 4,301 individuals who were employed at the 1992 study baseline. RESULTS: Over the 10-year study frame, 582 individuals (13.5 of the sample) experienced involuntary job loss. After controlling for established predictors of our outcomes, we found that displaced workers had a more than two-fold increase in the risk of subsequent MI (Hazard ratio HR = 2.48; 95 Confidence Interval CI = 1.49, 4.14) and stroke (HR = 2.43; CI = 1.18, 4.98) relative to working persons. CONCLUSION: Our results suggest that the true costs of late-career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and program planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness.}, keywords = {Employment and Labor Force, Health Conditions and Status}, author = {William T Gallo and Teng, H.M. and Tracy Falba and Stanislav V Kasl and Krumholz, H.V. and Elizabeth H Bradley} } @article {5655, title = {The Impact of Misperceptions about Social Security on Saving and Well-Being}, year = {2006}, institution = {The University of Michigan, Michigan Retirement Research Center}, abstract = {Earlier research suggests that many people in their fifties and early sixties are not well informed about their Social Security entitlements. This paper investigates the effect of deviations between predicted and realized Social Security benefits on several measures of well-being in retirement, such as the change in consumption expenditures at retirement, a self-assessed measure of how retirement years compare to the years before retirement, and whether the individual is worried about having enough income to get by in retirement. The analysis is based upon US data from the Health and Retirement Study, following individuals over a long time period from their fifties into retirement. We find clear evidence that people who over estimated their Social Security benefits are worse off according to several measures of well being in retirement. This relationship seems to be more pronounced for respondents who claimed benefits earlier than anticipated than for those who were simply misinformed.}, keywords = {Net Worth and Assets, Social Security}, url = {http://www.mrrc.isr.umich.edu}, author = {Susann Rohwedder and Arthur H.O. vanSoest} } @article {7075, title = {Incidence and Frequency of Falling Accidents among Persons With and Without Stroke: Health and Retirement Study survey 2002}, journal = {Stroke}, volume = {37}, year = {2006}, pages = {631}, publisher = {37}, keywords = {Health Conditions and Status}, author = {A. A. Divani and Hoonjan, A. and Nasar, A. and Dunbar, S. and Hesselbrig, J.} } @article {7092, title = {Increased wealth and income as correlates of self-assessed retirement.}, journal = {J Gerontol Soc Work}, volume = {47}, year = {2006}, month = {2006}, pages = {175-201}, publisher = {47}, abstract = {

This study examined whether retirement implies complete withdrawal from the labor force and the role that increased wealth and income play in regard to the nature of retirement. Data came from the Health \& Retirement Study, Waves 1-5. Findings indicated that most study sample pre-retirees remained in the labor force as they moved into what are considered the normal retirement years. As they moved on average from 50+ years of age to 60+ years of age, increasing percentages of study sample pre-retirees reported themselves as completely retired. Those who viewed themselves as completely retired were far less likely to work than those who did not view themselves as completely retired. Of particular importance was the finding that increased income in 2000 decreased the likelihood of self-reported complete retirement. Equally important was the finding that increased assets had no effect on retirement status with the exception of survey year 1998 when increased assets decreased the likelihood of viewing oneself as completely retired. Findings suggested that pro-work retirement policies aimed at increasing labor force participation among pre-retirees and increasing the normal retirement age can be effective. Five pro-work policies were discussed.

}, keywords = {Aged, Data collection, Employment, Female, Financing, Personal, Humans, Income, Interviews as Topic, Male, Middle Aged, Motivation, Organizational Policy, Pensions, Retirement, Self-Assessment, Social Security, Socioeconomic factors, United States}, issn = {0163-4372}, doi = {10.1300/J083v47n01_11}, author = {Caputo, Richard K.} } @article {8459, title = {Inherit the Wind; There{\textquoteright}s Little Else Left}, journal = {New York Times}, year = {2006}, month = {March 26, 2006}, edition = {Late Edition (East Coast)}, address = {New York, N.Y}, abstract = {The latest numbers confirm that a vast majority of baby boomers cannot count on an inheritance to help them out of their jam. Even as the total pile of wealth passed down the generations has increased sharply, the inheritance received by a typical American has declined. The shift can be explained in part by demographics changes, but also by the changing nature of old age (life expectancy has increased) and retirement financing (rather, the lack of it). [The article quotes a paper by Hurd and Smith, based on the Health and Retirement Study]}, keywords = {Adult children, Consumption and Savings, Demographics, Net Worth and Assets, Retirement Planning and Satisfaction}, author = {Porter, Eduardo} } @article {7089, title = {Insurance coverage and health care use among near-elderly women.}, journal = {Womens Health Issues}, volume = {16}, year = {2006}, note = {Official publication of the Jacobs Institute of Women{\textquoteright}s Health}, month = {2006 May-Jun}, pages = {139-48}, publisher = {16}, abstract = {

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

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

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

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

}, keywords = {Attitude to Health, Female, Health Services Accessibility, Health Services Needs and Demand, Health Status, Humans, Insurance Coverage, Insurance, Health, Medically Uninsured, Middle Aged, Patient Acceptance of Health Care, Socioeconomic factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {1049-3867}, doi = {10.1016/j.whi.2006.02.005}, author = {Xiao Xu and Patel, Divya A. and Vahratian, Anjel and Ransom, Scott B.} } @article {10.1093/aje/kwj177, title = {Invited Commentary: Considerations about Specificity of Associations, Causal Pathways, and Heterogeneity in Multilevel Thinking}, journal = {American Journal of Epidemiology}, volume = {163}, year = {2006}, month = {05}, pages = {1079-1082}, abstract = {During the past decade, there has been a dramatic increase in the use of multilevel modeling in epidemiologic analysis. There were 10 times as many papers in Index Medicus identified by the terms {\textquotedblleft}multilevel{\textquotedblright} and {\textquotedblleft}epidemiology{\textquotedblright} in 2005 than there were in 1995. In recent years, the American Journal of Epidemiology has published papers that use multilevel analyses to consider the associations between group-level characteristics and a range of health indicators (1{\textendash}7). Accompanying these content-specific contributions have been several discussions of the strengths and limitations of multilevel modeling techniques (8, 9) and the rationale for applying these methods to public health (10, 11).}, keywords = {Cognition, Cognition \& Reasoning, Heterogeneity, Thinking}, issn = {0002-9262}, doi = {10.1093/aje/kwj177}, url = {https://doi.org/10.1093/aje/kwj177}, author = {Galea, Sandro and Ahern, Jennifer} } @article {5517, title = {Identification of Probability Distributions with Misclassified Data}, number = {$\#$05-10}, year = {2005}, note = {RDA}, institution = {Cornell University}, address = {Ithaca, NY}, abstract = {This paper addresses the problem of data errors in discrete variables. When data errors occur, the observed variable is a misclassified version of the variable of interest, whose distribution is not identified. For many years econometricians have conceptualized the problem through convolution and mixture models. This paper introduces the direct misclassification approach. The approach is based on the observation that in the presence of classification errors, the relation between the distribution of the true but unobservable variable and its misclassified representation is given by a linear system of simultaneous equations, in which the coe.cient matrix is the matrix of misclassification probabilities. Formalizing the problem in these terms allows one to incorporate any prior information - e.g., validation studies, economic theory, social and cognitive psychology, or knowledge of the circumstances under which the data have been collected - into the analysis through sets of restrictions on the matrix of misclassification probabilities. Such information can have strong identifying power; the direct misclassification approach fully exploits it to derive identification regions for any real functional of the distribution of interest. The method readily extends to drawing inference on parameters of the conditional distribution of an outcome variable when the conditioning variable is misclassified. It is easy to implement and often computationally tractable. A method for estimating the identification regions is given, and illustrated with an empirical analysis of the distribution of pension plan types using data from the Health and Retirement Study.}, keywords = {Methodology}, url = {http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.329.7446\&rep=rep1\&type=pdf}, author = {Molinari, Francesca} } @article {7011, title = {The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Mar}, pages = {S93-S101}, publisher = {60B}, abstract = {

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

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

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

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

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

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

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

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

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

}, keywords = {Diabetes Mellitus, Efficiency, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Odds Ratio, United States, Work}, issn = {0149-5992}, doi = {10.2337/diacare.28.11.2662}, author = {Tunceli, Kaan and Cathy J. Bradley and Nerenz, David and L Keoki Williams and Pladevall, Manel and Elston, Lafata J.} } @mastersthesis {6385, title = {Impact of Food Insecurity and Food Assistance Programs on Nutrition and Health Outcomes in Elders}, year = {2005}, month = {2005}, school = {Cornell University}, abstract = {This research examined the relationship between need and help-seeking behavior over time in elders, looking at the pattern of food insecurity and program participation, which are a part of need and help-seeking behavior. Then, it assessed how a help-seeking behavior (i.e., participation in food assistance programs) among elders in need (i.e., food insecure elders) affected multiple outcomes such as obesity, depression, and health service utilization. For addressing these research questions, secondary data analysis was done using two longitudinal data sets: Health and Retirement Study (HRS 1996, 2002) and the Asset and Health Dynamics Among the Oldest Old (AHEAD 1995, 2002). The finding on patterns of food insecurity and participation in food assistance programs over time showed that need and help-seeking behavior were changeable but the variation over time was small. The relationship between them was monotonic and increasing. Food insecurity was a useful indicator of need for participation in food assistance programs and previous experience of participation was an important indicator of help-seeking behavior. While food insecurity was a part of need for participation in food assistance programs, for health service utilization it appeared to be a barrier that makes food insecure elders be less likely to use health services. While food insecurity increased overweight and depression, participation in food assistance programs had beneficial impacts on poor health outcomes resulting from food insecurity. Food insecure elders who participated in food assistance programs were less overweight, depressed, and admitted to hospital and nursing home than those who did not participate in the programs. Findings of positive impacts on reducing or preventing obesity, depression, and admission to hospital and nursing home implies other benefits of food assistance programs such as decreased health-care expenditures and increased independence of elders, supporting further development of these programs for elders.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Income}, author = {Kim, Kirang} } @mastersthesis {6366, title = {The Impact of Marital Status on the Economic Well-Being of Women in Later Life}, volume = {Doctor of Philosophy}, year = {2005}, month = {2005}, school = {State University of New York - Buffalo}, address = {Buffalo, NY}, abstract = {Although there have been significant improvements in the economic status of the elderly in the United States because of the Social Security retirement program and the Supplemental Security Income (SSI) program, poverty among older women remains high. The economic vulnerability of women in older age has been directly linked to their greater likelihood of being unmarried, with marriage viewed as generally protecting the elderly from poverty. The economic status of older women also has been linked to their employment histories, in that women tend to have discontinuous work histories and often work at jobs that pay lower salaries than men. Moreover, their employment is often tied to marriage and childrearing. These factors mean many women will receive lower income in older age. Hence, a lifetime of weak attachment to the labor force leaves many women ill-prepared for economic security without a spouse. Other characteristics of women may further impact their income security in older age. Minority women, for example, are at an even greater disadvantage than white women; and women with high educational attainment may have strong work histories resulting in more favorable outcomes for income in later life. Within the context of a combination of viewpoints that include the life course, political economy, and feminist perspectives, this dissertation examines the relationship of gender, race, employment histories, number of children, and marital status on the economic security of women in later life. Economic security is measured by total household income and total wealth, or accumulated assets minus debt. A sample of women age 50 and over who are married, divorced, widowed, or have never been married are included in the study. Data are from the Rand Data File of the Health and Retirement Study. The Rand HRS Data File is a longitudinal data set based on the Health and Retirement Study (HRS) data. The HRS is a national panel study sponsored by the National Institute of Aging and conducted by the University of Michigan. From the data analysis, it was found that married women, overall, have greater income and wealth and, therefore, the largest number of sources of income compared to women in the other marital status groups. This was due largely to their access to their spouse{\textquoteright}s income and assets. The widowed women were shown to have the least amount of wage and salary income, but received the most from Social Security retirement. The widows in the study, however, had the least amount of total household income. Those women who had never been married had the strongest employment histories among the women in the four marital status groups, but they had less income and wealth than the married women in the sample. The race and ethnicity of the women were shown to have negative consequences for their economic security, with nonwhite women having fewer sources of income than their white counterparts. Education had a significant positive effect on the incomes and wealth of the women across all the marital status groups, while number of children had no effect on either the income or assets of women in this analysis.}, keywords = {Adult children, Demographics, Income, Net Worth and Assets, Women and Minorities}, url = {https://search.proquest.com/openview/8c849816074ff7095b8942c9c7b78a28/1?cbl=18750\&diss=y\&pq-origsite=gscholar}, author = {Joyce, Joyce Ann} } @article {7026, title = {The impact of obesity on active life expectancy in older American men and women.}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Aug}, pages = {438-44}, publisher = {45}, abstract = {

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

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

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

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

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Health Surveys, Humans, Life Expectancy, Life Tables, Logistic Models, Male, Markov chains, Obesity, Risk Factors, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.4.438}, author = {Sandra L Reynolds and Saito, Yasuhiko and Eileen M. Crimmins} } @article {7019, title = {The impact of own and spouse{\textquoteright}s urinary incontinence on depressive symptoms.}, journal = {Soc Sci Med}, volume = {60}, year = {2005}, month = {2005 Jun}, pages = {2537-48}, publisher = {60}, abstract = {

This study investigated the impact of own and spouse{\textquoteright}s urinary incontinence on depressive symptoms. Attention was paid to the possibility that gender and caregiving might be important factors in understanding significant effects. We used negative binomial regression to analyze survey data for 9974 middle-aged and older respondents to the Health and Retirement Study in the USA. Results supported the hypothesis that the respondents{\textquoteright} own urinary incontinence was associated with depressive symptoms (unadj. IRR = 1.73, 95\% CIs = 1.53, 1.95 for men; unadj. IRR = 1.50, 95\% CIs = 1.38, 1.63 for women). Controlling sociodemographic and health variables reduced this relationship, but it remained statistically significant for both men and women. Having an incontinent wife put men at greater risk for depressive symptoms (unadj. IRR = 1.13, 95\% CIs = 1.02, 1.25), although this relation became nonsignificant with the addition of control variables. No relation between women{\textquoteright}s depressive symptoms and husbands{\textquoteright} (in)continence status was found. Caregiving was not a significant variable in the adjusted analyses, but spouses{\textquoteright} depressive symptoms emerged as a significant predictor of the respondents{\textquoteright} own depressive symptoms. Health care providers must be sensitive to the emotional impact of urinary incontinence. Our findings also suggest the importance of considering the patient{\textquoteright}s mental health within a wider context, particularly including the physical and mental health of the patient{\textquoteright}s spouse.

}, keywords = {Aged, Caregivers, Cohort Studies, depression, Female, Humans, Male, Middle Aged, United States, Urinary incontinence}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2004.11.019}, author = {Fultz, Nancy H. and Kristi Rahrig Jenkins and Truls Ostbye and Donald H. Taylor Jr. and Mohammed U Kabeto and Kenneth M. Langa} } @article {5632, title = {The Impact of SES on Health over the Life Course}, number = {WR-318}, year = {2005}, institution = {RAND Labor and Population Program}, address = {Santa Monica, CA}, abstract = {People of lower socio-economic status (SES) have much worse health outcomes (Marmot (1999), Smith (1999)). But why this is so remains under considerable debate ((Adams et al. (2003), Deaton (2003)). A central question is whether these large differences in health by such SES indicators as income or wealth largely reflect causation from SES to health. But even if SES mainly affects health, what dimensions of SES actually matter financial aspects such as income or wealth or non-financial dimensions like education?}, keywords = {Demographics, Health Conditions and Status, Net Worth and Assets}, doi = {https://doi.org/10.7249/WR318}, author = {James P Smith} } @article {6997, title = {Imperfect Knowledge of Social Security and Pensions}, journal = {Industrial Relations}, volume = {44}, year = {2005}, pages = {373-397}, publisher = {44}, abstract = {Using data from the Health and Retirement Study, this paper creates variables measuring knowledge about future social security and pension benefits by comparing respondent reports of their expected benefits with benefits calculated from social security earnings records and employer provided descriptions of pension plans. The knowledge measures suggest that misinformation, imprecision and lack of information about retirement benefits is the norm. Those who are most dependent on social security are the least well informed about their social security benefits, while those who are most dependent on pensions are best informed about their pension benefits. Women and minorities are less well informed about both types of retirement benefits. Having documented the extent of misinformation, we turn to questions about the production of information, and the consequences of misinformation for real outcomes. Relating measures of information to planning activities, we find that those who plan are somewhat better informed than those who do not, but with the exception of having requested a social security earnings record, the effects of planning activities on knowledge are modest. In descriptive and reduced form equations for planned and actual retirement and saving, there is at best a modest relation of knowledge measures to planned and actual retirement and to nonpension, nonsocial security wealth as a share of lifetime earnings. Individuals who overestimate their benefits are likely to retire sooner than they planned, but the measured effects are relatively modest. Coefficients of measures of the increase in reward from postponed retirement are barely affected by the addition of measures of respondent knowledge of their retirement benefits to standard reduced form retirement and wealth equations.}, keywords = {Education, Pensions, Social Security}, doi = {https://doi.org/10.1111/j.0019-8676.2005.00389.x}, author = {Alan L Gustman and Thomas L. Steinmeier} } @inbook {5181, title = {Individual Subjective Survival Curves}, booktitle = {Analyses in the Economics of Aging}, year = {2005}, note = {RDA ProCite field 6 : In ProCite field 8 : ed.}, pages = {337-412}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, chapter = {12}, address = {Chicago}, abstract = {Testing life-cycle models and other economic models of saving and consumption at micro level requires knowledge of individuals{\textquoteright} subjective believes of their mortality risk. Previous studies have shown that individual responses on subjective survival probabilities are generally consistent with life tables. However, survey responses suffer serious problems caused by focal responses of zero and one. This paper suggests using a Bayesian update model that accounts for the problems encountered in focal responses. We also propose models that help us to identify how much each individual deviates from life table in her subjective belief. The resulting individual subjective survival curves have considerable variations and are readily applicable in testing economic models that require individual subjective life expectancies.}, keywords = {Expectations}, url = {https://www.nber.org/chapters/c10367}, author = {Gan, Li and Michael D Hurd and Daniel McFadden}, editor = {David A Wise} } @inbook {5192, title = {Institutions and Saving for Retirement: Comparing the United States, Italy, and the Netherlands}, booktitle = {Analyses in the Economics of Aging}, year = {2005}, note = {ProCite field 6 : In ProCite field 8 : ed.}, pages = {281-316}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, chapter = {9}, address = {Chicago}, abstract = {This paper analyzes retirement saving and portfolio choice in the United States, Italy, and the Netherlands. In addition to relying on public retirement provisions, households prepare for retirement through tax-sheltered and after-tax savings. They may invest these funds in a wide variety of assets, including housing, stocks, bonds, savings accounts, and so on. These asset types differ in their risk, return, and liquidity characteristics as well as in their fiscal treatment. Economic theory postulates that housholds allocate their portfolios according to their risk aversion, time horizon, uncertain out-of-pocket medical expenditures, income risk, informal (family) risk-sharing arrangements, and more. While the literature has tested various parts of the theory, both testing and quantification of the theory are hampered by the fact that some of the major variables do not exhibit sufficient variation within a country to establish their relative importance for portfolio choice, or, more generally, for retirement saving and investment. This paper partially fills that gap by exploring three countries with widely varying institutional arrangements for retirement income.}, keywords = {Consumption and Savings, Methodology}, url = {https://www.nber.org/chapters/c10364}, author = {Arie Kapteyn and Panis, Constantijn}, editor = {David A Wise} } @inbook {5202, title = {Integrating Biology into the Study of Health Disparities}, booktitle = {Aging, Health, and Public Policy: Demographic and Economic Perspectives}, series = {Population and Development Review}, volume = {30}, year = {2005}, note = {ProCite field 6 : In ProCite field 8 : ed.}, pages = {89-107}, publisher = {Population Council}, organization = {Population Council}, address = {New York}, keywords = {Methodology}, author = {Eileen M. Crimmins and Teresa Seeman}, editor = {Linda J. Waite} } @mastersthesis {6312, title = {Identifying Social Determinants of Old Age Cognitive Function}, year = {2004}, month = {2004}, school = {Harvard University}, keywords = {Demographics, Health Conditions and Status}, author = {M. Maria Glymour} } @article {6912, title = {The impact of diabetes on workforce participation: results from a national household sample.}, journal = {Health Serv Res}, volume = {39}, year = {2004}, note = {Social Security Administration/Michigan Retirement Research Center Grant UM01-11}, month = {2004 Dec}, pages = {1653-69}, publisher = {39}, abstract = {

OBJECTIVE: Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation.

DATA SOURCE: We used the Health and Retirement Study (HRS), a national household sample of adults aged 51-61 in 1992, as a data source.

STUDY DESIGN: We conducted cross-sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow-up. We used two-part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes-related losses in productivity.

PRINCIPAL FINDINGS: Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was 60.0 billion US dollars over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for 4.4 billion US dollars in lost income due to early retirement, 0.5 billion US dollars due to increased sick days, 31.7 billion US dollars due to disability, and 22.0 US dollars billion in lost income due to premature mortality, for a total of 58.6 billion dollars in lost productivity, or 7.3 billion US dollars per year.

CONCLUSIONS: In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.

}, keywords = {Chronic disease, Cohort Studies, Cost of Illness, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Efficiency, Employment, Female, Health Services Research, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2004.00311.x}, author = {Sandeep Vijan and Rodney A. Hayward and Kenneth M. Langa} } @article {5599, title = {The Impact of Divorce on Parent-Adult Child Proximity: A multigenerational perspective}, year = {2004}, institution = {University of Albany-SUNY}, keywords = {Adult children}, author = {Regina M. Bures and Lawton, Leora E. and Spitze, Glenna D.} } @article {6956, title = {The Impact of Health on Employment, Wages and Hours Worked Over the Life Cycle}, journal = {Quarterly Review of Economics and Finance}, volume = {44}, year = {2004}, pages = {102}, publisher = {44}, abstract = {This paper examines the effect of health problems on employment, annual hours worked and hourly wages. The Health and Retirement Study data are used to compile employment and health experience profiles over the lifetimes of respondents. These profiles are used to estimate the impact of temporary and permanent illnesses. Permanent health conditions have negative effects on labor market outcomes. Females are found to have larger reductions in wages, but males have bigger decreases in hours worked. The onset of health problems in the 40s produces the largest negative consequences for males, while for females negative effects peak in the 30s. 2003 Board of Trustees of the University of Illinois. All rights reserved.}, keywords = {Employment and Labor Force, Health Conditions and Status}, doi = {https://doi.org/10.1016/j.qref.2003.08.002}, author = {Pelkowski, J.M. and Mark C. Berger} } @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 {5581, title = {The Impact of New Health Problems on Self-Reported Health Over Time}, year = {2004}, institution = {University of Michigan Population Studies Center, PSC Publications}, abstract = {Background: Many cross-sectional studies have found that self-reported health is highly correlated with physical and functional indicators of health. However, the extent to which self-reported health changes with new health problems and over time has not been well documented. Objectives: To investigate how self-reported health changes over time following a new acute or chronic health problem. Research Design: Using 6 years of longitudinal data for 7388 subjects from the Health and Retirement Study of the US, we assessed self-reported health after a new health problem over 2, 4, and 6 year intervals. Seven health problems (cancer, heart disease, lung disease, diabetes, high blood pressure, psychiatric disorders, and arthritis) were included in logistic regression models to predict the impact of new health problems on self-reported health over time. The probability of recovery of self-reported health was predicted using an interaction between length of time since the new health problem occurred and the new health problem. Results: All seven new health problems examined were associated with a significant decline in self-reported health. People who reported new cancer, heart disease, and lung disease experienced the greatest decline in health status. For most health problems, self-reported health improved over time. Relative to people with no new health problems, people with new cancer and heart disease had the most significant recovery in self-reported health over time. Conclusions: Self-reported health typically gets worse after a new health problem and gradually improves over time. This pattern is particularly true for cancer and heart problems.}, keywords = {Healthcare}, author = {Jun Xu and Werner, R. and Daniel Polsky} } @article {5598, title = {Increases in Wealth Among the Elderly in the Early 1990s: How Much is Due to Survey Design?}, number = {10862}, year = {2004}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The Asset and Health Dynamics Among the Oldest Old (AHEAD) study shows a large increase in reported total wealth between 1993 and 1995. Such an increase is not found in other US household surveys around that period. This paper examines one source of this difference. We find that in AHEAD 1993 ownership rates of stocks, CDs, bonds, and checking and saving accounts were underreported, resulting in under-measurement of wealth in 1993, and a substantial increase in wealth from 1993 to 1995. The explanation for the under-reporting is a combination of question sequence and wording in the AHEAD survey instrument.}, keywords = {Methodology, Net Worth and Assets}, doi = {10.3386/w10862}, author = {Susann Rohwedder and Steven Haider and Michael D Hurd} } @article {6917, title = {Increasing obesity rates and disability trends.}, journal = {Health Aff (Millwood)}, volume = {23}, year = {2004}, month = {2004 Mar-Apr}, pages = {199-205}, publisher = {23}, abstract = {

Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain.

}, keywords = {Aged, Disabled Persons, Female, Humans, Male, Middle Aged, Obesity, Population Surveillance, United States}, issn = {0278-2715}, doi = {10.1377/hlthaff.23.2.199}, author = {Sturm, Roland and Ringel, Jeanne S. and Andreyeva, Tatiana} } @article {6908, title = {Individual Financial Decisions in Retirement Plans: The Role of Participant Direction}, journal = {Journal of Public Economics}, volume = {88}, year = {2004}, pages = {39-61}, publisher = {88}, abstract = {Workers with individual retirement saving accounts often make decisions about contribution rates and asset allocation that affect ultimate retirement income. This paper presents econometric evidence from two data sets on the role that participant investment choice plays in asset allocation, contributions, and account balances. My preferred estimates indicate that participants with investment choice are 36 percent more likely to make an annual contribution. These participants are estimated to invest 13 percentage points more in stocks, contribute between one and three percentage points more of salary, and have at least 9000 more in their account than comparable participants without investment choice.}, keywords = {Retirement Planning and Satisfaction}, doi = {https://doi.org/10.1016/S0047-2727(02)00074-9}, author = {Papke, Leslie E.} } @article {6952, title = {The Influence of Prescription Drug Use on Long-Term Care Insurance Ownership}, journal = {Risk Management and Insurance Review}, volume = {7}, year = {2004}, pages = {107-120}, abstract = {Long-term care insurance (LTCI) can be an effective way of protecting individual assets from nonacute medical costs not covered by traditional health insurance. Prior research suggests a number of economic, health, and family structure factors related to the decision to purchase LTCI. Theories that health and income shocks precipitate precautionary saving introduce the possibility that prescription drug use may also play a role in such decisions. Findings that poor health increases the propensity to insure against risk in asset holdings provide another possible relation to LTCI. This study extends prior research to investigate the link between the routine use of prescription drugs and the decision to purchase LTCI. Using data from the Health and Retirement Survey, logistic regression is employed to test the significance of LTCI policy ownership determinants. In addition to lending empirical support to theories on intrafamily moral hazard, results indicate that there is a positive relationship between routine drug use and LTCI purchase decisions.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance}, doi = {https://doi.org/10.1111/j.1098-1616.2004.00040.x}, author = {Bernet, Patrick Michael} } @article {6976, title = {Informal care and health care use of older adults.}, journal = {J Health Econ}, volume = {23}, year = {2004}, month = {2004 Nov}, pages = {1159-80}, publisher = {23}, abstract = {

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.

}, keywords = {Aged, Female, Health Care Surveys, health policy, Health Services for the Aged, Home Care Services, Home Nursing, Homes for the Aged, Humans, Male, Nursing homes, United States}, issn = {0167-6296}, doi = {10.1016/j.jhealeco.2004.04.008}, author = {Courtney Harold Van Houtven and Edward C Norton} } @article {6951, title = {Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the Health and Retirement Survey.}, journal = {Am J Ind Med}, volume = {45}, year = {2004}, month = {2004 May}, pages = {408-16}, publisher = {45}, abstract = {

BACKGROUND: The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States.

METHODS: We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals.

RESULTS: The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR = 1.89; 95\% CI = 0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR = 2.64; 95\% CI = 1.01, 6.94).

CONCLUSIONS: Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers.

}, keywords = {Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Retirement, Risk Factors, Stress, Psychological, Stroke, Unemployment, United States}, issn = {0271-3586}, doi = {10.1002/ajim.20004}, author = {William T Gallo and Elizabeth H Bradley and Tracy Falba and J. A. Dubin and Cramer, L. and Stanislav V Kasl} } @article {6897, title = {Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 Sep}, pages = {S305-13}, publisher = {58B}, abstract = {

OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants.

METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status.

RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants.

DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations.

}, keywords = {Acculturation, Aged, Cross-Sectional Studies, depression, Emigration and Immigration, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Residence Characteristics}, issn = {1079-5014}, doi = {10.1093/geronb/58.5.s305}, author = {Janet M Wilmoth and Pei-Chun Chen} } @article {5562, title = {The Impact of Financial Education on Savings and Asset Allocation}, year = {2003}, note = {RDA 1998-002}, institution = {Michigan Retirement Research Center, Michigan Retirement Research Center}, abstract = {In this paper, I examine the financial situation of older households. In addition, I examine whether employers initiatives to reduce planning costs via retirement seminars have an effect on workers saving. Using data from the Health and Retirement Study, I first show that many families arrive close to retirement with little or no wealth. Portfolios are also rather simple, and many families, particularly those with low education, hold little or no high-return assets. I further show that seminars foster saving. This is particularly the case for those with low education and those who save little. By offering financial education, both financial and total net worth increase sharply, particularly for families at the bottom of the wealth distribution and those with low education. Retirement seminars also increase total wealth (inclusive of pension and Social Security) for both high and low education families. Taken together, this evidence suggests that retirement seminars can foster wealth accumulation and bolster financial security in retirement.}, keywords = {Education, Net Worth and Assets}, url = {http://www.mrrc.isr.umich.edu/content.cfm?section=researchandcontent=research_detailandpid=UM03-06}, author = {Annamaria Lusardi} } @article {6868, title = {Impact of Husbands{\textquoteright} Involuntary Job Loss on Wives{\textquoteright} Mental Health, Among Older Adults}, journal = {The Journals of Gerontology: Social Sciences}, volume = {58B}, year = {2003}, pages = {S30-S37}, publisher = {58B}, abstract = {Objectives. This study estimates the consequences of older husbands{\textquoteright} involuntary job loss for their wives{\textquoteright} mental healthMethods. Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands{\textquoteright} involuntary job loss on wives{\textquoteright} mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves I and 2 of the Health and Retirement Study and described the 1992-1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994-1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a compar ison group of wives of 425 husbands who were continuously employed from 1994 to 1996.Results. Husbands{\textquoteright} involuntary job loss did not have a statistically significant effect on wives{\textquoteright} mental health. We found no evidence that changes in husbands{\textquoteright} depressive symptoms modified the effect of his job loss on wives{\textquoteright} mental health. In the first period only, the effect of husbands{\textquoteright} job loss on wives{\textquoteright} mental health was more pronounced for wives who were more financially satisfied at baseline.Discussion. There is limited evidence among this cohort that husbands{\textquoteright} job loss increases wives{\textquoteright} subsequent depressive symptoms. However, the effect of husbands{\textquoteright} job loss on wives{\textquoteright} mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.}, keywords = {Employment and Labor Force}, url = {http://psychsoc.gerontologyjournals.org/}, author = {Michele J. Siegel and Elizabeth H Bradley and William T Gallo and Stanislav V Kasl} } @article {6862, title = {Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults}, journal = {Journal of the American Medical Association}, volume = {290}, year = {2003}, pages = {757-764}, publisher = {290}, abstract = {Context Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.Objective To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.Design and Setting Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.Participants A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n=167), intermittently uninsured (n=216), or continuously insured (n=1820) in 1994 and 1996, prior to Medicare eligibility.Main Outcome Measures Individuals{\textquoteright} reports of receiving cholesterol testi ng, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.Results The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4 vs 17.7 ; change of -17.7 95 Cl, -29.3 to -6.2 ; P=.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2 vs 7.7 ; difference of 21.5 95 Cl, 0.2 to 42.9 1; P=.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3 vs 15.0 ; change of -15.3 95 Cl, -29.9 to -0.7 1; P=.04) and prostate examination in men (45.2 vs 20.0 ; change of -25.2 95 Cl, -45.4 to -5.1 ; P=.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.Conclusions Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects.}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Meara, Ellen and John Z. Ayanian} } @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 {6844, title = {The Impact of Technological Change on Older Workers: Evidence from Data on Computer Use}, journal = {Industrial and Labor Relations Review}, volume = {56}, year = {2003}, pages = {511-529}, publisher = {56}, abstract = {New technologies like computers alter skill requirements. This paper explores two related effects of the spread of computers on older workers, using data from the Current Population Survey and the Health and Retirement Study. One conclusion is that impending retirement, rather than age alone, explains why older workers used computers less than prime-age workers did. A second conclusion is that computer users retired later than non-users. Although this pattern may arise because workers planning later retirement decided to acquire computer skills, the empirical analysis suggests that the causation also went in the other direction, with computer users choosing to delay retirement. It will be important to understand these effects as the baby boom cohort nears retirement, while technologies continue to change rapidly.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, author = {Friedberg, Leora} } @inbook {5184, title = {The Impact of the Growth of Defined Contribution Plans on Bequests}, booktitle = {Death and Dollars: The Role of Gifts and Estates in America}, year = {2003}, note = {ProCite field 6 : In ProCite field 8 : eds.}, publisher = {The Brookings Institution Press}, organization = {The Brookings Institution Press}, address = {Washington, DC}, abstract = {This paper explores the shift from defined benefit to defined contribution plans and considers how it might affect bequests and thereby consumption and saving. Our hypothesis is that both intended bequests and unintended bequests will increase as retirees receive more of their pension benefits as lump sums rather than as annuity payments. We also contend that workers recognize that they may not consume their lump-sum payments and react differently to accumulations in defined benefit and defined contribution plans during their lifetime.}, keywords = {Adult children, Consumption and Savings, Pensions}, author = {Alicia H. Munnell and Sund{\'e}n, Annika and Soto, Mauricio and Taylor, Catherine}, editor = {Alicia H. Munnell and Sund{\'e}n, Annika} } @article {5575, title = {Impact of the Social Security Retirement Earnings Test on 62-64 Year-olds}, number = {$\#$2003-15}, year = {2003}, note = {RDA 1998-006}, institution = {The Urban Institute}, address = {Washington, D.C.}, keywords = {Social Security}, doi = {http://dx.doi.org/10.2139/ssrn.2206445}, author = {Ratcliffe, Caroline and Berk, Jillian and Perese, Kevin and Toder, Eric} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6896, title = {Investment Choice in Defined Contribution Plans: the Effects of Retirement Education on Asset Allocation}, journal = {Benefits Quarterly}, volume = {19}, year = {2003}, publisher = {19}, abstract = {The article presents a summary of the research titled "Investment Choice in Defined Contribution Plans: The Effects of Retirement Education on Asset Allocation." Pension plan sponsors and policy makers both have recently become concerned as to whether participants have the financial knowledge to choose how their pension assets are invested. The article provides evidence of the effect of retirement classes on asset allocation in self-directed defined contribution plans.}, keywords = {Net Worth and Assets, Pensions, Retirement Planning and Satisfaction}, url = {http://140.234.252.185/c/articles/9859056/investment-choice-defined-contribution-plans-effects-retirement-education-asset-allocation}, author = {Leslie A. Muller} } @article {5564, title = {Issues in Accessing and Sharing Confidential Survey and Social Science Data}, journal = {Data Science Journal}, volume = {2}, year = {2003}, publisher = {U.S. Department of Transportation, Bureau of Transportation Statistics}, chapter = {66-74}, abstract = {Researchers collect data from both individuals and organizations under pledges of confidentiality. The U.S. Federal statistical system has established practices and procedures that enable others to access the confidential data it collects. The two main methods are to restrict the content of the data (termed "restricted data") prior to release to the general public and to restrict the conditions under which the data can be accessed, i.e., at what locations, for what purposes (termed "restricted access"). This paper reviews restricted data and restricted access practices in several U.S. statistical agencies. It concludes with suggestions for sharing confidential social science data.}, keywords = {Confidentiality, Data access, Data sharing, Disclosure, Identifiability, Microdata, Statistical disclosure limitation, Statistical uses of data, Tabular data}, doi = {http://doi.org/10.2481/dsj.2.66}, author = {DeWolf, Virginia A.} } @article {6803, title = {Individual consequences of volunteer and paid work in old age: health and mortality.}, journal = {J Health Soc Behav}, volume = {43}, year = {2002}, month = {2002 Dec}, pages = {490-509}, publisher = {43}, abstract = {

The impacts of the productive social activities of volunteer and paid work on health have rarely been investigated among the oldest Americans despite a recent claim for their beneficial effect (Rowe and Kahn 1998). This paper used data from Waves 3 and 4 of the Asset and Health Dynamics among the Oldest Old (AHEAD) Study to (1) investigate the impact of these activities on health measured as self-reported health and activities of daily living (ADL) functioning limitations and to (2) explore possible causal mechanisms. Using multinomial logistic regression analysis, amounts of volunteer and paid work over a minimum of 100 annual hours self-reported at Wave 3 were related to poor health and death as competing risks measured at Wave 4, controlling for health measured at Wave 2 and for other predictors of poor health and death. Findings suggest that performing more than 100 annual hours of volunteer work and of paid work have independent and significant protective effects against subsequent poor health and death. Additional analyses suggest that the quantity of volunteer and paid work beyond 100 annual hours is not related to health outcomes and that physical exercise and mental health measured as cognitive functioning and depressive symptoms explain not entirely overlapping parts of the relationship between productive activities and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Employment, Female, Health Status, Humans, Male, Mortality, Multivariate Analysis, Prospective Studies, United States, Volunteers}, issn = {0022-1465}, doi = {10.2307/3090239}, author = {Luoh, M. and A. Regula Herzog} } @article {6785, title = {Inference on Regressions with Interval Data on a Regressor or Outcome}, journal = {Econometrica}, volume = {70}, year = {2002}, note = {ProCite field 3 : Northwestern U; Princeton U}, pages = {519-46}, publisher = {70}, abstract = {This paper examines inference on regressions when interval data are available on one variable, the other variables being measured precisely. Let a population be characterized by a distribution P(y, x, v, v0, v1), where y ε R1, x ε Rk, and the real variables (v, v0, v1) satisfy v0 <= v <= v1. Let a random sample be drawn from P and the realizations of (y, x, v0, v1) be observed, but not those of v. The problem of interest may be to infer E(y|x, v) or E(v|x). This analysis maintains Interval (I), Monotonicity (M), and Mean Independence (MI) assumptions: (I) P(v0 <= v <= v1) = 1; (M)E(y|x, v) is monotone in v; (MI) E(y|x, v, v0, v1) = E(y|x, v). No restrictions are imposed on the distribution of the unobserved values of v within the observed intervals [v0, v1]. It is found that the IMMI Assumptions alone imply simple nonparametric bounds on E(y|x, v) and E(v|x). These assumptions invoked when y is binary and combined with a semiparametric binary regression model yield an identification region for the parameters that may be estimated consistently by a modified maximum score (MMS) method. The IMMI assumptions combined with a parametric model for E(y|x, v) or E(v|x) yield an identification region that may be estimated consistently by a modified minimum-distance (MMD) method. Monte Carlo methods are used to characterize the finite-sample performance of these estimators. Empirical case studies are performed using interval wealth data in the Health and Retirement Study and interval income data in the Current Population Survey.}, keywords = {Identification, interval data, Regression Analysis}, doi = {https://doi.org/10.1111/1468-0262.00294}, author = {Charles F Manski and Tamer, Elie} } @article {6817, title = {The Influence of Pensions on Behavior: How Much Do We Really Know?}, journal = {TIAA-CREF Research Dialog}, volume = {71}, year = {2002}, publisher = {71}, abstract = {Economists have developed models to explain the impact of pensions and Social Security on various outcomes, such as retirement, worker turnover, and saving. However, some recent research has raised questions about these conventional models. This issue of Research Dialogue summarizes findings from our ongoing research on pensions and Social Security. Using data from the new longitudinal Health and Retirement Study that reports both the respondents{\textquoteright} own knowledge about their pensions and the actual provisions of their pension plans, our research emphasizes how well the conventional model does in describing behavior, answers some of the questions raised by others, and raises some new questions. We also discuss the implications of our findings for researchers and policy makers.}, keywords = {Pensions, Retirement Planning and Satisfaction}, doi = {http://dx.doi.org/10.2139/ssrn.308565}, author = {Alan L Gustman and Thomas L. Steinmeier} } @article {6790, title = {Informal caregiving for diabetes and diabetic complications among elderly americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {57}, year = {2002}, month = {2002 May}, pages = {S177-86}, publisher = {57B}, abstract = {

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Costs and Cost Analysis, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Humans, Hypoglycemic Agents, Insulin, Male, Time Factors}, issn = {1079-5014}, doi = {10.1093/geronb/57.3.s177}, author = {Kenneth M. Langa and Sandeep Vijan and Rodney A. Hayward and M.E. Chernew and Caroline S Blaum and Mohammed U Kabeto and David R Weir and Steven J. Katz and Robert J. Willis and A. Mark Fendrick} } @article {6791, title = {Informal caregiving time and costs for urinary incontinence in older individuals in the United States.}, journal = {J Am Geriatr Soc}, volume = {50}, year = {2002}, month = {2002 Apr}, pages = {733-7}, publisher = {50}, abstract = {

OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals.

DESIGN: Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443).

SETTING: Community-dwelling older people.

PARTICIPANTS: National population-based sample of community-dwelling older people.

MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads.

RESULTS: Thirteen percent of men and 24\% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P <.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P <.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care.

CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.

}, keywords = {Aged, Caregivers, Comorbidity, Confounding Factors, Epidemiologic, Female, Humans, Incontinence Pads, Male, Regression Analysis, Time Factors, United States, Urinary incontinence}, issn = {0002-8614}, doi = {10.1046/j.1532-5415.2002.50170.x}, author = {Kenneth M. Langa and Fultz, Nancy H. and Sanjay Saint and Mohammed U Kabeto and A. Regula Herzog} } @book {5272, title = {Innovations in Retirement Financing}, year = {2002}, note = {ProCite field 8 : eds.}, publisher = {University of Pennsylvania Press}, organization = {University of Pennsylvania Press}, address = {Philadelphia, PA}, keywords = {Consumption and Savings}, url = {https://pensionresearchcouncil.wharton.upenn.edu/publications/books/innovations-in-retirement-financing/}, author = {Zvi Bodie and P. Brett Hammond and Olivia S. Mitchell and Stephen P. Zeldes} } @article {6812, title = {Insuring the Near Elderly: The Potential Role for Medicare Buy-In Plans}, journal = {The Urban Institute}, volume = {The Retirement Project Brief Series}, year = {2002}, publisher = {The Retirement Project Brief Series}, abstract = {A Medicare buy-in allowing persons below the age of full eligibility to purchase Medicare coverage has been discussed as one way to help uninsured near elderly persons obtain insurance coverage. This brief summarizes findings from an Urban Institute report that examined potential participation rates in alternative buy-in plans and measured their potential impact on rates of uninsurance. Many individuals younger than 65 would purchase Medicare coverage, but without subsidies participation would be limited to those who could afford substantial premiums. Buy-ins would reduce uninsurance rates only if they provided subsidies to make the plans affordable to those with limited incomes.}, keywords = {Aging, Demographics, Medicare/Medicaid/Health Insurance}, url = {https://www.urban.org/research/publication/insuring-near-elderly}, author = {Richard W. Johnson and Davidoff, Amy J. and Marilyn Moon} } @article {6822, title = {It takes two: marriage and smoking cessation in the middle years.}, journal = {J Aging Health}, volume = {14}, year = {2002}, month = {2002 Aug}, pages = {336-54}, publisher = {14}, abstract = {

OBJECTIVES: In this prospective study of smoking cessation among married individuals in midlife we examine correspondence in the change of each partner{\textquoteright}s smoking status with that of the other, independent of established psychosocial correlates of smoking cessation.

METHODS: Using longitudinal data from the first two waves of the Health and Retirement Study, 1992-1994, hierarchical logistic regression models were estimated for married male and female smokers separately.

RESULTS: Findings support our hypothesis of correspondence in the smoking cessation of married male and female smokers net of other sociodemographic, health, and health behavior characteristics.

DISCUSSION: These findings suggest that initiation and maintenance of this positive lifestyle change may be more easily achieved when both marital partners are given information and support to quit smoking at the same time.

}, keywords = {Female, Health Behavior, Humans, Male, Marital Status, Marriage, Middle Aged, Smoking cessation, Social Support, Spouses}, issn = {0898-2643}, doi = {10.1177/08964302014003002}, author = {Melissa M Franks and Pienta, Amy M. and Linda A. Wray} } @article {6782, title = {The Impact of Age, Gender, and Race on the Relationship Between Depression and Self-Rated Health in Community-Dwelling Older Adults: A longitudinal study}, journal = {Home Health Care Services Quarterly}, volume = {20}, year = {2001}, pages = {27-43}, publisher = {20}, abstract = {Objective: To examine whether the prediction of baseline depression for subsequent changes in self-rated health is consistent across different age cohorts, gender, and racial groups. Data Sources and Study Setting: A total of 6,714 participants who were 65 years old or older and took part in both the first and the second wave of Assets and Health Dynamics among the Oldest-Old (AHEAD) national survey of community-dwelling older adults were examined. Study Design: A two-year prospective cohort study. Principle Findings: Baseline depression was an independent risk factor, which not only decreased the odds of having substantial improvement in self-rated health but also increased the possibility of having substantial decline in self-rated health in older men and women, and in Blacks and Whites of all age groups. Conclusions: Early prevention and treatment of depression among community-dwelling older adults may not only reduce their health decline but also promote their health.}, keywords = {Demographics, Health Conditions and Status}, url = {http://www.haworthpressinc.com/web/HHC/}, author = {Beth Han} } @mastersthesis {6361, title = {The Impact of Body Weight on Physical Functioning Across the Later Years}, year = {2001}, month = {2001}, school = {Wayne State University}, abstract = {An extensive body of literature analyzes the impact of body weight and various health outcomes documenting that extremes in body weight adversely effect health. Much less is known about how body weight specifically impacts physical functioning. Some studies, however, have shown an association between having excessive body weight and heightened risk for certain diseases and functional impairment. With evidence that the population is becoming heavier in greater proportions than in the past, body weight as it contributes to physical functioning remains a critical health problem. The project addresses some of the questions central to body weight and physical functioning. For example, how do certain socioeconomic and demographic characteristics, health behaviors, and health characteristics effect the relationship between body weight and physical functioning? Is the effect of body weight specific to certain functional domains? In addition, is the basic relationship between body weight and physical functioning different in young old populations than in old old populations? Using longitudinal data from the Health and Retirement Study (sample of young old adults) and asset and health dynamics among the oldest old survey (sample of old old adults) logistic regression models on the loss of physical functioning (1 = impaired) over a two year period are estimated for the young old and old old separately. A model comparing the young old and the old old is also estimated. Results indicate that body weight, more specifically obesity, impacts physical functioning across various domains of impairment. When influencing these domains, body weight acts directly but also indirectly with other factors (socioeconomic and demographic characteristics, health behaviors, and health characteristics). In addition, important differences exist by cohort membership. The project concludes by addressing implications and areas for future research.}, keywords = {Adult children, Health Conditions and Status, Healthcare, Net Worth and Assets}, url = {Database ID: DAI-A 62/12, p. 4349, Jun 2002}, author = {Kristi Rahrig Jenkins} } @article {5428, title = {Impact of Displacement on Older Workers}, year = {2001}, institution = {Santa Monica, CA, RAND Corp}, abstract = {We examine the impact of job displacement on older workers. Whereas previous studies focus on the earnings losses associated with displacement, we examine compensation losses more generally. Using the Health and Retirement Study, we measure the impact of a job loss on earnings, pension wealth, and health insurance. When pension and health insurance losses are incorporated to measure the overall impact of a displacement, the estimated total compensation loss increases by nearly 100 percent relative to the standard analysis that only examines earnings losses.}, keywords = {Employment and Labor Force, Health Conditions and Status, Income, Insurance, Other, Retirement Planning and Satisfaction}, author = {Steven Haider} } @article {6753, title = {The Impact of Involuntary Job Loss on Subsequent Alcohol Consumption by Older Workers: Findings from the Health and Retirement Survey}, journal = {The Journals of Gerontology: Social Sciences}, volume = {56B}, year = {2001}, pages = {S3-9}, publisher = {56B}, abstract = {OBJECTIVE: To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. METHODS: Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. RESULTS: After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p .05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06-3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. DISCUSSION: The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Healthcare, Methodology, Other, Retirement Planning and Satisfaction, Risk Taking}, url = {http://psychsoc.gerontologyjournals.org/contents-by-date.0.shtml}, author = {William T Gallo and Elizabeth H Bradley and Michele J. Siegel and Stanislav V Kasl} } @article {5440, title = {The Impact of Own Children on Retirement Portfolio Composition in the United States}, year = {2001}, note = {RDA 1999-001}, institution = {College of William and Mary, Dept. of Economics}, abstract = {We estimate models of retirement portfolio compositions using Wave 1 of the Health and Retirement Survey. The sample consists largely of pre-retirement individuals in their early 50s. Treating number of own children as endogenous, we find little firm evidence that either levels of specific asset holdings or their shares in a portfolio of assets are affected by number of own children. The exception is housing wealth, which also carries a significant consumption component. While some parents may well come to rely on their children for retirement support, we cannot support the notion that it typically is intentional.}, keywords = {Net Worth and Assets}, author = {Jennifer M Mellor and Jensen, Eric R.} } @article {5482, title = {The Impact of the Cost of Long-Term Care on the Saving of the Elderly}, year = {2001}, institution = {University of California, San Diego}, abstract = {One of the predictions of the life-cycle model of savings behavior is that the elderly should dissave at a rate that increases with age. But there is little evidence that significant dissaving takes place at any age. One explanation is that the elderly wish to retain assets to cover the cost of long-term care. I propose a model in which the elderly are informed about both their life expectancy and their likelihood of entering long-term care, and in which the utility of consumption in long-term care differs from that of consumption at home. I consider how the Medicaid rules relating to long-term care might influence the behavior of married couples and single persons whose wealth is above or below Medicaid eligibility limits. I test the predictions on data from the 1993 and 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) dataset, which has information on expectations. I make use of interstate differences in Medicaid financial eligibility rules to investigate the effects of Medicaid on household saving. In accordance with the predictions of my model, I find no evidence that people who are eligible for Medicaid dissave more rapidly if they expect to enter long-term care. On the contrary, married couples save more if they believe it is likely that they will enter long-term care. However, even those households that do not expect to enter long-term care fail to dissave. I find that an increase in the generosity of spousal protection rules leads to a decrease in household saving.}, keywords = {Consumption and Savings, Healthcare}, url = {http://www.nber.org/ confer/2001/si2001/webb.pdf}, author = {Anthony Webb} } @article {5448, title = {The Impact of the Shift to Defined Contribution Plans on Bequests and Living Standards in Retirement}, year = {2001}, institution = {Boston College}, keywords = {Adult children, Consumption and Savings, Pensions}, author = {Alicia H. Munnell and Soto, Mauricio and Sund{\'e}n, Annika and Taylor, Catherine} } @article {5457, title = {Imperfect Knowledge, Retirement and Saving}, number = {8406}, year = {2001}, note = {RDA 1996-005}, institution = {NBER}, address = {Cambridge, MA}, keywords = {Pensions, Retirement Planning and Satisfaction}, url = {https://www.nber.org/papers/w8406}, author = {Alan L Gustman and Thomas L. Steinmeier} } @article {8447, title = {Improving memory among older americans}, year = {2001}, note = {ProCite field[2]: Press Release}, month = {March 19, 2001}, publisher = {Associated Press}, address = {St. Louis, MO}, keywords = {Health Conditions and Status}, author = {Associated Press} } @article {5479, title = {Impute: A SAS Application System for Missing Value Imputations-With Special Reference to HRS Income/Assets}, year = {2001}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Survey questions that ask respondents to report amounts are often subject to high rates of missing data (Heeringa, Hill, and Howell, 1995; Hill, 1999; Juster and Smith, 1998). To avoid losing altogether valuable information from those who are unable or unwilling to provide answers to amount questions, more and more researchers rely on special questionnaire designs to collect bracket information, trying to infer exact amounts from the brackets collected. The work involving an inference of exact amount from bracket information may be called missing value imputation with brackets . When the bracket information is not available, it is reduced to a general type of imputation, called here missing value imputation without brackets . In this document, we describe a SAS application system, IMPUTE, designed for missing value imputation without brackets in general, and for inferring exact amount from bracket information in particular. To navigate our tour, and as a motivation for this project, we shall pay special attention to the Health and Retirement Study (HRS) income and assets imputations. Among many other advantages, the HRS income and asset data sets provide a good example for illustrating the uses of, and the limits to, the system.}, keywords = {Income, Methodology, Net Worth and Assets}, author = {Cao, Honggao} } @mastersthesis {6073, title = {Income and Wealth Differentials of Late Middle-aged United States-born and Foreign-born Households in the United States: Implications for immigrant Social Security and retirement income}, year = {2001}, month = {2001}, school = {Boston College}, abstract = {This study examines the economic resources and retirement outlook of older foreign-born individuals and their families in the United States. Past research indicates that immigrants experience some disadvantages compared to the U.S.-Born in the labor market due to migration and adjustment to a new culture as well as difficulty with the english language. Through the political economy and life course perspectives, stressing the importance of an individual{\textquoteright}s early experiences with the labor force, it is predicted that certain disadvantages will have an impact on retirement prospects as well as issues associated with old age. Nevertheless, there is a scarcity of research on the economic status of aging immigrants in the immigrant and retirement research, including the current research and discussion on social security reform. Research questions and hypotheses are addressed by using the Wave 1 of the Health and Retirement Study (HRS) and the HRS restricted data files. Findings from this study suggest that as a group, immigrants are likely to have low social security wealth and their income, assets and investment profiles are less than those of native-born counterparts are. Immigrants are also less likely to have employer-sponsored pensions and stock investment. If they do own stocks, the value of their holdings is likely to be much less. Recommendations for addressing policy, practice, and research efforts are presented with the goal of improving the economic conditions of aging immigrants who are at risk of poverty in old age.}, keywords = {Demographics, Healthcare, Methodology, Other, Public Policy, Retirement Planning and Satisfaction}, author = {Rojanawon, Wichian} } @article {5467, title = {Inferring Disability Status from Corrupt Data}, year = {2001}, institution = {Iowa State University, Dept. of Economics}, abstract = {We investigate what can be learned about the prevalence of work disability using self-reported assessments of work capacity. Although health status is widely recognized as a crucial determinant of labor supply behavior and participation in public transfer programs, there is a long-standing debate about the reliability of self-reported indicators. Anderson and Burkhauser (1985), in fact, labeled the appropriate use of health controls the major unsettled issue in the empirical literature on the labor supply of older workers, and the debate has only grown stronger over time. Rather than focus on assumptions required to obtain point identification, we take a step back to evaluate what can be inferred about disability rates under a variety of assumptions that are weaker but arguably more credible than those imposed in the existing literature. Extending the work on corrupt samples developed by Horowitz and Manski (1995), we develop a set of nonparametric bounds that, in the most basic setting, require only prior information restricting the fraction of persons who might misreport disability. These bounds inform the ongoing debate by effectively constraining the range of uncertainty regarding the effects of inaccurate reporting on inferences. The results clearly show that the strength of the conclusions one can draw depend directly on the strength of the assumptions one is willing to impose. Under minimal assumptions, the bounds are nearly uninformative. Tighter bounds can be obtained with additional assumptions. Under the assumption that the true disability rate is nondecreasing with age, our results imply that conventional participation models which presume valid self-reports may be misspecifed.}, keywords = {Disabilities, Methodology}, author = {Kreider, Brent and John V Pepper} } @article {5465, title = {An Investigation of the Effect of Informal Insurance on Household Retirement Saving}, year = {2001}, note = {RDA 1999-001}, institution = {College of William and Mary}, abstract = {The literature on wealth accumulation suggests that social insurance programs serve to weaken the precautionary saving motive. Elsewhere, it has been suggested that family members can establish informal insurance arrangements that serve to reduce earnings variation in the same manner as social insurance. Together, these findings imply that another potential explanation for the inadequate retirement saving of many low income U.S. households is the presence of informal insurance, in the form of intervivos transfers to retired family members. In this paper, we describe a set of testable conditions that would support this contention, and examine in turn the empirical support for each. We perform an empirical test of the hypothesis that potential transfers from children crowd out retirement saving, using data from Wave 1 of the Health and Retirement Study. We find no evidence that parents with larger families adjust retirement wealth levels downward. WE find some evidence to suggest that parents{\textquoteright} retirement portfolio composition is affected by family size.}, keywords = {Adult children, Consumption and Savings}, author = {Jensen, Eric R. and Jennifer M Mellor} } @article {5403, title = {The Impact of 401(k) Plans on Retirement}, year = {2000}, note = {ProCite field 8 : U VA and NBER; U CA, San Diego}, institution = {University of California, San Diego}, abstract = {In 1993 38.9 million people were covered by a 401(k) plan, up from 7.1 million in 1983. The rapid growth of 401(k) and other defined contribution pension plans may alter retirement patterns of older workers. Previous research showed that the spread of defined benefit plans, with sharp age-related incentives first discouraging and later encouraging retirement, contributed to the early retirement trend of past decades. Defined contribution plans differ along several dimensions, especially in their smooth rate of pension wealth accrual. We use data from the Health and Retirement Study to show that retirement patterns have begun to change as defined contribution plans have spread. Our estimates indicate that the financial incentives in defined benefit pensions lead people to retire almost two years earlier on average, compared to people with defined contribution plans.}, keywords = {Employment and Labor Force, Pensions, Retirement Planning and Satisfaction}, url = {https://ideas.repec.org/p/cdl/ucsdec/qt2jr5w8b9.html}, author = {Friedberg, Leora and Anthony Webb} } @article {6703, title = {Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Sep}, pages = {S288-97}, publisher = {55B}, abstract = {

OBJECTIVES: This study explores the analytic implications of using questions about difficulty with daily activities that do not specify whether to consider assistance.

METHODS: For 1,054 Asset and Health Dynamics of the Oldest Old Study Wave 2 respondents, we compared responses to questions about difficulty without reference to assistance (ambiguous difficulty) to those about difficulty without help or equipment (underlying difficulty) and difficulty with help or equipment, if used (residual difficulty). We modelled predictors of discordance by means of logistic regression.

RESULTS: Discordance exists for 15\% of respondents between summary variables indicating underlying and ambiguous difficulty with one or more activities. Discrepancies are evenly split between respondents reporting (a) underlying but no ambiguous difficulty and (b) ambiguous but no underlying difficulty. Discordance also exists for 15\% of respondents between summary variables indicating residual and ambiguous difficulty with one or more activities: most of these discrepancies involve reports of ambiguous but no residual difficulty. Most respondent characteristics investigated are not significant predictors of discrepancies.

DISCUSSION: Analysts should be aware that (a) ambiguously worded questions appear to be a better proxy for underlying than for residual difficulty, (b) discrepancies seem to be lower for separate activities than for summary variables indicating difficulty with one or more activities, and (c) being Hispanic and receiving help may affect reporting discrepancies.

}, keywords = {Activities of Daily Living, Aged, Cognition, Female, Health Status, Humans, Male, Prospective Studies, Surveys and Questionnaires}, issn = {1079-5014}, doi = {10.1093/geronb/55.5.s288}, author = {Vicki A Freedman} } @mastersthesis {6153, title = {Intergenerational Intervivos Transfers: What is the pattern and level of financial support parents provide their adult children?}, year = {2000}, month = {2000}, school = {Purdue University}, abstract = {Why do parents give their adult children money? What child and parental characteristics influence monetary transfers? Does the effect of these characteristics differ across low, medium, and high transfer dollar amounts? What is the parent{\textquoteright}s motive behind providing their adult child with a financial transfer? Is it based on the child{\textquoteright}s income or a life event experienced by the child (i.e., Altruism or contingent exchange)? This research examines the relationship between financial transfers and characteristics of the adult child. The data used are the 1992-1994 Health and Retirement Study (HRS), which contains a nationally representative sample of adults born between 1931 and 1941. At baseline, financial transfers to 18,463 adult children living independently from their parent{\textquoteright}s household (n = 6,001) are examined. Cross-sectional and longitudinal models are specified to determine the relationship between the financial transfer and characteristics of the adult child, controlling characteristics of the parental household across transfer levels. The motive behind the financial transfer behavior is tested using two competing theories, altruism and contingent exchange. Lastly, the relationship between race and the financial transfer as a percent of total household income is examined. Two variables consistently have the greatest effect on the amount of the financial transfer the adult child}, keywords = {Adult children, Healthcare}, url = {https://docs.lib.purdue.edu/dissertations/AAI3018290/}, author = {Wilkinson, Jody Ann} } @mastersthesis {6188, title = {Intergenerational Transfers and Family Behavior: Children, spouses, siblings, parents and parents-in-law}, year = {2000}, month = {2000}, school = {University of California, Los Angeles}, abstract = {Changes in the age structure of the population have generated concern for maintaining the welfare of a growing elderly population, and have increased the importance of understanding the incentives underlying family assistance. This dissertation analyzes financial and time transfers among family members that include an adult child and her spouse, her and her spouse{\textquoteright}s elderly parents and their siblings. Utilizing the 1992 and 1994 survey waves of the Health and Retirement Study, I generate stylized facts about transfer patterns and use them to understand decision-making within a household and links between households. The data reveal striking asymmetries in transfers from a middle-aged, married couple to a husband{\textquoteright}s and a wife{\textquoteright}s elderly parents. The findings in chapter 1 suggest transfer patterns reflect differences in the opportunity cost of time between husbands and wives, in a spouse{\textquoteright}s productivity in caring for parents and parents-in-law, and the allocation of resources within the household. They also suggest that labor market rigidities may constrain individuals from substituting money for time help. Many children are involved in supporting parents. Chapter 2 explores whether an elderly parent{\textquoteright}s welfare is a pure public good. If so, children may choose to free ride on the contributions of their siblings and will under- provide for parents. The results suggest parent welfare is not a pure public good among siblings and that a parent with one child will receive less support than one with multiple children. Intergenerational transfers raise the question of whether the parents of a married child are contributing to the welfare of the parents of the child{\textquoteright}s spouse. In chapter 3, i find that assortative mating magnifies intergenerational transmissions of wealth, though not sufficiently to keep wealth classes separate through time. I find that financial transfers between parents and married children link the resources of the child{\textquoteright}s parents and parents-in-law.}, keywords = {Adult children, Employment and Labor Force}, author = {Julie M Zissimopoulos} } @mastersthesis {6308, title = {Intervivos Transfers by Elderly At Risk for Nursing Home Placement: Implications for Federal Medicaid Policy}, year = {2000}, month = {2000}, school = {Saint Louis University}, keywords = {Adult children, Healthcare, Public Policy}, author = {Gilchrist, Barbara J.} } @article {8422, title = {Illness and Economic Status: Why are they so closely connected?}, journal = {Business Week}, year = {1999}, month = {June 14, 1999}, pages = {34}, keywords = {Health Conditions and Status, Net Worth and Assets}, author = {Koretz, Gene} } @article {12661, title = {The Importance of Accommodation on the Timing of Disability Insurance Applications: Results from the Survey of Disability and Work and the Health and Retirement Study}, journal = {The Journal of Human Resources}, volume = {34}, year = {1999}, month = {1999}, pages = { - 611589}, abstract = {[Using data from the 1978 Survey of Disability and Work and the 1992 Health and Retirement Study, we test the importance of accommodation and other policy variables on the timing of application for Social Security Disability Insurance benefits following the onset of a work-limiting condition. We correct for choice-based sampling in the Survey of Disability and Work by extending the Manski and Lerman (1977) correction to the likelihood function of our continuous time hazard model, we find that this correction significantly affects the results. Similar findings emerge from these two data sets. Accommodation significantly reduces the speed of application and more generous benefits increase the speed of applying for SSDI.]}, keywords = {Disabilities, Disability, disability insurance, Work, work conditions, work environment}, isbn = {0022166X}, url = {http://www.jstor.org/stable/146381}, author = {R.V. Burkhauser and Butler, J. S. and Kim, Yang-Woo and Weathers, Robert R.} } @article {6656, title = {The Importance of Accommodation on the Timing of Male Disability Insurance Application}, journal = {Journal of Human Resources}, volume = {34}, year = {1999}, note = {RDA}, pages = {589-611}, publisher = {34}, abstract = {Using data from the 1978 Survey of Disability and Work and the 1992 Health and Retirement Study, we test the importance of accommodation and other policy variables on the timing of application for Social Security Disability Insurance benefits following the onset of a work-limiting condition. We correct for choice-based sampling in the Survey of Disability and Work by extending the Manski and Lerman (1977) correction to the likelihood function of our continuous time hazard model, we find that this correction significantly affects the results. Similar findings emerge from these two data sets. Accommodation significantly reduces the speed of application and more generous benefits increase the speed of applying for SSDI.}, keywords = {Disabilities, Employment and Labor Force, Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.2307/146381}, author = {R.V. Burkhauser and Butler, J.S. and Kim, Yang-Woo and Robert R. Weathers II} } @article {6663, title = {The influence of personal care and assistive devices on the measurement of disability.}, journal = {Soc Sci Med}, volume = {48}, year = {1999}, month = {1999 Feb}, pages = {427-43}, publisher = {48}, abstract = {

The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Life Expectancy, Logistic Models, Long-term Care, Male, Self-Help Devices}, issn = {0277-9536}, doi = {10.1016/s0277-9536(98)00369-4}, author = {Agree, E M} } @article {6657, title = {Influences on the Bridge Employment Decision Among Older USA Workers}, journal = {Journal of Occupational and Organizational Psychology}, volume = {72}, year = {1999}, pages = {317-329}, publisher = {72}, abstract = {This study examines four organizational and personal variables (voluntariness of retirement, organizational flexibility, pre-retirement planning, and anticipated financial rewards) to determine their influence on the retirement decisions of older workers. The retirement decisions being studied are: considering early retirement, continuing to work, or obtaining bridge employment either in the same job or a different job. Results indicate that anticipated financial reward, job flexibility, and voluntariness of retirement are all significant predictors that distinguish older workers in the four retirement decision groups. The implications of these findings for both workers and employers are discussed as well as some of the benefits of utilizing bridge employment as an option when considering early retirement decisions.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, doi = {10.1348/096317999166707}, author = {Weckerle, Joelle R. and Kenneth S. Shultz} } @inbook {5124, title = {Information, Expectations, and Savings for Retirement}, booktitle = {Behavioral Dimensions of Retirement Economics}, year = {1999}, note = {RDA 1998-002ProCite field[3]: U ChicagoProCite field[8]: ed.}, pages = {81-115}, publisher = {Brookings Institution Press and Russell Sage Foundation}, organization = {Brookings Institution Press and Russell Sage Foundation}, address = {Washington, D.C.}, keywords = {Consumption and Savings, Event History/Life Cycle, Retirement Planning and Satisfaction}, author = {Annamaria Lusardi}, editor = {Aaron, Henry J.} } @inbook {5131, title = {Inheritances and Bequests}, booktitle = {Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster}, year = {1999}, note = {ProCite field 3 : RAND Corp ProCite field 8 : eds.}, pages = {121-49}, publisher = {University of Michigan Press}, organization = {University of Michigan Press}, address = {Ann Arbor, MI}, keywords = {Adult children, Consumption and Savings, Methodology}, author = {James P Smith}, editor = {James P Smith and Robert J. Willis} } @article {6625, title = {Inter Vivos Transfers and Intended Bequests}, journal = {Journal of Public Economics}, volume = {73}, year = {1999}, note = {ProCite field 3 : UCLA and NBER}, pages = {321-51}, publisher = {73}, abstract = {Empirical work on intergenerational transfers has focused on distinguishing between altruistic and exchange motivated behavior. However, these two models are unable to explain the strong tendency for inter vivos transfers to be negatively related to the income of the recipient, while bequests bear no relationship to income. This paper presents a new framework for analyzing transfers from parents to children that is more consistent with observed behavior than are the altruistic and exchange models alone. In particular, the model developed here predicts differing behavior with respect to inter vivos transfers and bequests due to liquidity constraints and uncertainty about the recipient{\textquoteright}s permanent income. The empirical work uses data from the Health and Retirement Study and the Asset and Health Dynamics Study. The patterns observed in these data are consistent with earlier findings that inter vivos transfers go disproportionately to less well-off children, while bequests are divided equally across children. Further, the results support the predictions of the model in that differences in inter vivos transfers arise from differences in current income, while differences in bequests result when indicators of the children{\textquoteright}s permanent incomes differ.}, keywords = {Adult children, Consumption and Savings, Event History/Life Cycle}, doi = {10.1016/S0047-2727(99)00017-1}, author = {Kathleen McGarry} } @inbook {5125, title = {Intergenerational Transfers: Blood, Marriage, and Gender Effects on Household Decisions}, booktitle = {Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster.}, year = {1999}, note = {ProCite field[3]: Georgetown U; Center for Policy Research, Syracuse U; U FLProCite field[8]: eds.}, pages = {335-55}, publisher = {University of Michigan Press}, organization = {University of Michigan Press}, address = {Ann Arbor, MI}, keywords = {Adult children, Consumption and Savings, Demographics, Event History/Life Cycle, Methodology}, author = {Beth J Soldo and Douglas A. Wolf and John C Henretta}, editor = {James P Smith and Robert J. Willis} } @mastersthesis {6186, title = {Intergenerational Transfers in the Families of Older Adults}, year = {1999}, month = {1999}, school = {Duke University}, abstract = {This dissertation uses a Nash bargaining model and data on elderly parents and their adult children to explore the intergenerational transfer decisions in extended families of elderly parents. A distinguishing feature of this study is that the parent and the children are both decision makers. The analysis focuses on the joint decisions of child to parent time transfers, parent to child money transfers, and the living arrangement of the elderly parent. Estimation is performed using a sample of 499 families of unmarried elderly parents who have one adult child from the Assets and Health Dynamics of the Oldest Old Survey. Multivariate probit models are estimated to examine the determinants of the aforementioned decisions. The multivariate estimates allow the determination of the extent to which previously estimated single-equation models suffered from failure to recognize the interdependent nature of these decisions. Results from the single equation probit models and the multivariate probit models are similar. The multivariate estimates reveal no significant between equation correlations. We can therefore be more confident of the results from the single equation estimations in the literature and their implications. The results from this analysis confirm the findings of earlier literature. Parental health and income influence family transfer behaviors. In addition to confirming many previous results, the empirical evidence presented shows that relative economic situations between elderly parents and their adult children are important determinants of intergenerational transfers, particularly for the elderly parents{\textquoteright} living arrangement decision. For example, intergenerational coresidence represents a transfer between an elderly parent and the adult child. However it may not necessarily be a response to the increasing care needs of the aging parents: Joint living is not only more likely for low income elderly parents whose children are financially better off than the parents, but also for high income elderly parents whose children are financially worse off than the parents.}, keywords = {Adult children}, author = {Carolyn Wei Zhu} } @article {6609, title = {The Impact of Education and Heart Attack on Smoking Cessation Among Middle-aged Adults}, journal = {Journal of Health and Social Behavior}, volume = {39}, year = {1998}, pages = {271-94}, publisher = {39}, abstract = {Considerable evidence supports the premise that higher levels of education lead to enhanced health, including protective health behaviors. This paper focuses on how education affects one health behavior known to lead to enhanced health: the cessation of smoking. In particular, the authors examine the extent to which education influences the decision by middle-aged adults to quit smoking following a heart attack, a potentially life-threatening health event. We first hypothesize that middle-aged adults with more formal education will stop smoking more readily than people with less formal education following the experience of a heart attack. Second, we ask what other factors might underlie and explain that hypothesized effect. Using longitudinal data, the authors track changes in individual smoking behaviors after a heart attack among preretirement-age Americans. We control for documented correlates of smoking and heart attack plus other factors associated with education, heart attack, and smoking that may also influence whether a person quits smoking. In addition to confirming evidence on the education-health association as well as the documented connection between heart attack and smoking cessation, this study provides a surprising twist on those links: Our results show that the move to quit smoking following the experience of a heart attack among middle-aged adults is significantly and dramatically moderated by their level of educational attainment.}, keywords = {Demographics, Health Conditions and Status, Methodology}, author = {Linda A. Wray and A. Regula Herzog and Robert J. Willis and Robert B Wallace} } @mastersthesis {6049, title = {The Impact of Multiple Caregiving Roles on Well-being: A longitudinal study of middle-aged adults}, year = {1998}, month = {1998}, school = {University of Massachusetts, Amherst}, abstract = {This longitudinal study examined the experience of caregiving among a nationally-representative sample of 10,537 middle-aged adults participating in Wave 1 and Wave 2 of the Health and Retirement Study. Individuals were classified as parent caregivers, child caregivers, and multiple (parent and child) caregivers. The low incidence of multiple caregiving found among these middle-aged adults questions the validity of the phenomenon described as the {\textquoteright}sandwich generation.{\textquoteright} Females comprised the majority of the parent, child, and multiple caregiving groups. Contrary to expectations, black and latina caregivers were not more likely than whites to hold parent and multiple caregiving roles. A high frequency of caregiving role losses and a low frequency of caregiving role assumptions occurred between Wave 1 and Wave 2. Most notable was the finding that 41\% of multiple caregivers and 70\% of parent caregivers in Wave 1 became noncaregivers in Wave 2. In addition, only.4\% And 6.5\% Of women assumed multiple care and parent care, respectively. These findings suggest that the experience of caregiving during the middle-generation years is of short duration and likely to decrease over time. No support was found for the {\textquoteright}caregiving pile up effect{\textquoteright} (Doress-Worters, 1994) among those holding multiple caregiving roles. Rather, female caregivers experienced a decrease in well-being regardless of their caregiving role transitions, while caregivers who gained or maintained caregiving reported better physical health than those who lost caregiving. In addition, caregivers{\textquoteright} well-being did not differ from that of noncaregivers, with the exception of ADLs (better for caregivers). Ethnicity was found to play an important and complex role in predicting transitions in caregiving and well-being. As hypothesized, being a black or latina caregiver who lost parent care predicted worse well-being. With regards to the maintenance or assumption of child care, however, being a minority woman accounted for worse well-being. The negative consequences of child caregiving for latinas is especially intriguing given their greater likelihood to maintain child care. There was some support for the notion that minorities{\textquoteright} traditional family values in support of caregiving predict better well-being for women maintaining child care or for multiple caregivers.}, keywords = {Adult children, Demographics, Health Conditions and Status, Healthcare, Women and Minorities}, url = {Database ID: DAI-B 59/10, p. 5584, Apr 1999}, author = {Perez-Cahill, Danae} } @article {5369, title = {The Impact of Pay Inequality, Occupational Segregation, and Lifetime Work Experience on Retirement Income of Women and Minorities}, year = {1998}, note = {RDA}, abstract = {In this study the researchers review data on earnings and search for differences between men and women, as well as, differences between whites and minorities. Specifically, the researchers examine Social Security, employer-provided pensions, and financial assets, like homes. Observations and analysis of the data show that occupational segregation along with pay differences explain the vast majority of the retirement income differences. Most of the pay difference between men and women is in the form of pension size. Many interesting findings are given with possible explanations and ways of fixing the discrepancies. Cross-tabulations are done to show differences between the married and non-married, as well.}, keywords = {Demographics, Housing, Income, Net Worth and Assets, Pensions, Social Security, Women and Minorities}, author = {Olivia S. Mitchell and Phillip B. Levine and John W R Phillips} } @article {5375, title = {The Impact of Rising 401(k) Pension Coverage on Future Retirement Income}, year = {1998}, institution = {Washington, DC, Department of Labor, Pension and Welfare Benefits Administration}, keywords = {Income, Pensions}, author = {Even, William and David A. Macpherson} } @inbook {5162, title = {Implications of Rising Personal Retirement Saving}, booktitle = {Frontiers in the Economics of Aging}, year = {1998}, note = {RDA 1999-002 ProCite field 8 : ed.}, pages = {125-167}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago, IL}, abstract = {This paper simulates the 401(k) assets of future generations of retirees and compares these assets with the social security and other assets of the households who are approaching retirement now. The accumulation of 401(k) assets at retirement for the cohort that was 25 years old in 1984 and the cohort that was 15 years old in 1984 was projected. Findings based on these projections suggest that 401(k) assets will definitely be a significant component of the retirement wealth of future retirees and could be the dominant component for a large fraction of them.}, keywords = {Employment and Labor Force, Income, Pensions}, author = {James M. Poterba and Steven F Venti and David A Wise}, editor = {David A Wise} } @article {6601, title = {On the Importance of the Precautionary Saving Motive}, journal = {American Economic Review}, volume = {88}, year = {1998}, note = {RDA 1998-002 ProCite field 3 : Dartmouth College}, pages = {449-53}, publisher = {88}, keywords = {Consumption and Savings, Event History/Life Cycle}, author = {Annamaria Lusardi} } @article {6615, title = {The Influence of Push and Pull Factors on Voluntary and Involuntary Early Retirees{\textquoteright} Retirement Decision and Adjustment}, journal = {Journal of Vocational Behavior}, volume = {53}, year = {1998}, pages = {45-57}, publisher = {53}, abstract = {This paper examines early retirees{\textquoteright} decisions to retire, as well as their postretirement adjustment, in terms of both push (negative considerations: e.g., poor health) and pull (positive considerations: e.g., leisure interests) factors. Results confirm the hypothesis that both negative push and positive pull factors differentially influenced those retirees who voluntarily retired and those forced to retire. After retirement, the negative push factors became the more salient differentiators; those forced to retire appeared to have generally lower self ratings of physical and emotional health and lower satisfaction rates. In addition, the findings suggest that the way an individual views their retirement decision is related to their postretirement experience: those who viewed their retirement decision as voluntary reported higher satisfaction and health levels during retirement than those who viewed their retirement as involuntary.}, keywords = {Adult children, Health Conditions and Status, Net Worth and Assets, Retirement Planning and Satisfaction}, author = {Kenneth S. Shultz and Morton, Kelly R. and Weckerle, Joelle R.} } @article {5361, title = {Intergenerational Co-Residence and Children{\textquoteright}s Incomes}, year = {1998}, institution = {Syracuse University}, abstract = {Over the past few decades the number of people over the age of 70 that reside with one of their children has declined steadily. There are a number of factors that may influence this trend like: the declining birth rate that creates a smaller number of possible candidates for the elderly to reside with, increased income of elderly through social security and other pensions, and increased health care offered to the elderly. Here the researchers use the AHEAD study to ascertain living arrangements for elderly with adult children and find attributes that may cause certain people to be more likely to co-reside with their adult children. A model is developed in order to test the data that is received from the AHEAD study with specific variables. The co-residence of an elderly person with their adult children is not very likely if the children are married or have their own children to take care of. Sibling incomes is the key determinate found for deciding which child to live with when the option of co-residence is available. Single children, poorer children, and daughters are the most common people to be living with their elderly parents. Co-residing adult children also have a tendency to inherit items and property from their elderly parents.}, keywords = {Adult children, Housing}, url = {http://www-cpr.maxwell.syr.edu/demogctr/agpapser/aglstcpr.htm}, author = {Dunn, Thomas A. and John W R Phillips} } @article {5372, title = {Intergenerational Mobility, Siblings{\textquoteright} Inequality and Borrowing Constraints}, year = {1998}, institution = {University of California, San Diego}, keywords = {Adult children}, author = {Gaviria, Alejandro} } @article {5371, title = {International Models for Pension Reform}, number = {WP1998-05}, year = {1998}, institution = {University of Pennsylvania}, keywords = {Methodology, Pensions, Public Policy}, url = {https://repository.upenn.edu/prc_papers/525/}, author = {Olivia S. Mitchell} } @inbook {5161, title = {The Impact of Demographics on Housing and Nonhousing Wealth in the United States}, booktitle = {The Economic Effects of Aging in the United States and Japan}, year = {1997}, note = {ProCite field 8 : eds.}, pages = {153-194}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago, IL}, keywords = {Demographics, Housing, Net Worth and Assets}, author = {Daniel McFadden and Hoynes, Hilary}, editor = {Naohiro Yashiro and Michael D Hurd} } @article {6564, title = {Improving the Quality of Economic Data: Lessons from the HRS and AHEAD}, journal = {Journal of the American Statistical Association}, volume = {92}, year = {1997}, note = {ProCite field 3 : Survey Research Center, U MI; RAND}, pages = {1268-78}, publisher = {92}, abstract = {Missing data are an increasingly important problem in economic surveys, especially when trying to measure household wealth. However, some relatively simple new survey methods such as follow-up brackets appear to appreciably improve the quality of household economic data. Brackets represent partial responses to asset questions and apparently significantly reduce item nonresponse. Brackets also provide a remedy to deal with nonignorable nonresponse bias, a critical problem with economic survey data.}, keywords = {Methodology}, url = {https://ideas.repec.org/p/wpa/wuwpla/0402010.html}, author = {Juster, F. Thomas and James P Smith} } @article {6597, title = {Imputation of Multivariate Data on Household Net Worth}, journal = {Proceedings of the American Statistical Association}, volume = {Section on Survey Research Methods}, year = {1997}, pages = {135-140}, publisher = {Section on Survey Research Methods}, abstract = {This paper analyzes the various methods involved in the imputation of multivariate data. The paper investigates methods of imputing amounts for bracketed net worth variables; empirically compares the distributional properties of data imputed by the alternative methods; and estimates the imputation variance that each method adds to the completed data set.}, keywords = {Methodology, Net Worth and Assets}, url = {http://www.asasrms.org/Proceedings/papers/1997_020.pdf}, author = {Steven G Heeringa and Roderick J.A. Little and Trivellore E. Raghunathan} } @inbook {5135, title = {Income and Wealth of Older American Households: Modeling Issues for Public Policy Analysis}, booktitle = {Assessing Knowledge of Retirement Behavior}, year = {1996}, note = {ProCite field 6 : In ProCite field 8 : eds.}, pages = {11-60}, publisher = {National Academy Press}, organization = {National Academy Press}, address = {Washington, DC}, abstract = {This paper evaluates the extent to which current knowledge of retirement, savings, pension and related behavior is sufficient for determining the effects of major policy initiatives on the incomes and wealth of the aged population of the United States. Data are presented from two new surveys, the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Survey, describing the distributions of the major components of income and wealth to be explained by these behavioral models. The data suggest that the amount of wealth had by the older population has been severely understated in earlier surveys. Disagreements and inconsistencies in models of savings indicate that there is no agreed upon behavioral model upon which to base policy analysis. Similar problems characterize the pension literature. Most strikingly, central features of these three major branches of behavioral analysis are mutually inconsistent. Although there are important linkages among the behaviors determining retirement, savings and pension outcomes, research in each area ignores or misspecifies the related behavior from other areas. Consequently, significant advances are required before we can confidently predict the effects of contemplated changes in policies on income and wealth in retirement.}, keywords = {Consumption and Savings, Pensions, Retirement Planning and Satisfaction}, author = {Alan L Gustman and Juster, F. Thomas}, editor = {Eric A. Hanushek and Nancy L. Maritato} } @article {6540, title = {Introduction: Special Issue on the Health and Retirement Survey: Data Quality and Early Results}, journal = {Journal of Human Resources}, volume = {30}, year = {1995}, pages = {S1-S6}, publisher = {30}, keywords = {Methodology}, author = {R.V. Burkhauser and Paul J. Gertler} } @article {5305, title = {The Impact of Demographics on Housing and Non-Housing Wealth in the United States}, number = {4666}, year = {1994}, note = {ProCite field 8 : U CA, Berkeley and NBER; U CA, Berkeley and NBER}, institution = {The National Bureau of Economic Research}, address = {Cambridge}, abstract = {Equity in housing is a major component of household wealth in the United States. Steady gains in housing prices over the last several decades have generated large potential gains in household wealth among homeowners. Mankiw and Weil (1989) and McFadden (1993b) have argued that the aging of the U.S. population is likely to induce substantial declines in housing prices, resulting in capital losses for future elderly generations. However, if households can anticipate changes in housing prices, and if they adjust their non-housing savings accordingly, then welfare losses in retirement could be mitigated. This paper focuses on two questions: (1) Are housing prices forecastable from current information on demographics and housing prices?; and (2) How are household savings decisions affected by capital gains in housing? We use metropolitan statistical area (MSA) level data on housing prices and demographic trends during the 1980{\textquoteright}s and find mixed evidence on the forecastability of housing prices. Further, we use data on five-year savings rates from the Panel Study of Income Dynamics and find no evidence that households engage in changing their non-housing savings in response to expectations about capital gains in housing. Thus, the projected decline in housing prices could result in large welfare losses to current homeowners and large intergenerational equity differences.}, keywords = {Adult children, Consumption and Savings, Demographics, Net Worth and Assets, Public Policy}, url = {https://www.nber.org/papers/w4666}, author = {Hoynes, Hilary and Daniel McFadden} } @article {5302, title = {The Impact of Worker Preferences On Pension Coverage in the HRS}, year = {1993}, institution = {University of Michigan}, abstract = {Heterogenous workers place different valuations on employer-provided pensions, depending upon such factors as the individual{\textquoteright}s degree of risk aversion, life expectancy, personal rates of time preference, earnings and access to alternative sources of retirement income. As a result, workers with relatively strong preferences for deferred compensation may sort themselves into jobs which offer generous pensions. Using primarily experimental data from the first wave of the Health and Retirement Survey, this paper tests the extent to which pension coverage is driven by worker demand. Probit estimates indicate the risk averse workers have significantly higher rates of pension coverage, particularly among those with low earnings. Among workers who recently began their jobs, those expecting to live longer are also more likely to be included in a pension plan. Rates of time preference have a marginally significant impact on pension coverage. There is no evidence that employer pensions substitutes for other forms of retirement saving.}, keywords = {Other, Pensions}, url = {http://www.psc.isr.umich.edu/pubs/series.html}, author = {Richard W. Johnson} } @article {5299, title = {Intergenerational Transfers and Labor Supply: Preliminary Evidence from the HRS}, year = {1993}, institution = {University of Michigan}, abstract = {The HRS data permit more expansive examination of ties between market work and family than heretofore possible. This research focuses on inter-vivos transfers to adult children and how they relate to the labor supply of middle-age married women. The data show a notable and complex association in which the direction of the association varies by type of transfer. The results of our reduced-form, bivariate TOBIT analysis also indicate that the value of correlations between labor supply and transfers imputed for the underlying latent variables tend to be twice the value of the simple correlations. Overall results of the analysis are supportive of the theoretical framework we develop that depicts unanticipated luck and orientation toward giving as important forces in transfers to children.}, keywords = {Adult children, Employment and Labor Force}, url = {http://www.psc.isr.umich.edu/pubs/series.html}, author = {Martha S. Hill and Beth J Soldo and Li, Wei} } @inbook {5157, title = {Intergenerational Transfers: Economic, Demographic, and Social Perspectives}, booktitle = {Annual Review of Gerontology and Geriatrics: Focus on Kinship, Aging, and Social Change}, volume = {Vol. 13}, year = {1993}, note = {ProCite field 8 : eds.}, pages = {187-216}, publisher = {Springer Publishing Company}, organization = {Springer Publishing Company}, address = {New York}, abstract = {Intergenerational transfers can be studied from an economic, social gerontological, or social-psychological perspective. This chapter describes a variety of the social science theories and reviews related empirical research relevant to the major types of intergenerational transfers: a) flows of assistance from parents to children and grandchildren, b) flows of assistance from middle-aged children to elderly parents, c) coresidence of parents and children. While there seems to be remarkable consensus about the factors affecting the probability of exchange, because the various disciplines have focused on different aspects of exchange behavior at different points in the life cycle, the evidence in support of competing theories is not consistent. The chapter then focuses on the upcoming availability of the HRS and AHEAD studies as potentially providing the data necessary to capturing all of the relevant dimensions of transfer behaviors that have been missing for all disciplines.}, keywords = {Adult children, Healthcare, Methodology}, author = {Beth J Soldo and Martha S. Hill}, editor = {Maddox, George L. and Lawton, M. Powell} } @article {7281, title = {Identification of a pathogenic isolate-specific 30,000-Mr antigen of Entamoeba histolytica by using a monoclonal antibody.}, journal = {Infect Immun}, volume = {58}, year = {1990}, month = {1990 Apr}, pages = {955-60}, publisher = {23}, abstract = {

A monoclonal antibody (MAb) produced against trophozoites of Entamoeba histolytica strain HM-1:IMSS, reacted with all of 42 isolates and 4 clones showing pathogenic zymodeme (Z) patterns, i.e., Z-II, Z-II alpha-, Z-II (glucose phosphate isomerase: gamma +), Z-VII, Z-VII (glucose phosphate isomerase: alpha lack, gamma +), Z-XI, Z-XIV, and Z-XIX, regardless of culture conditions, geographical origins, or host symptoms in an indirect fluorescence antibody test. In contrast, the MAb failed to react with 14 isolates possessing nonpathogenic zymodemes Z-I and Z-VIII and did not react with other enteric protozoan parasites, such as E. histolytica-like Laredo, Entamoeba hartmanni, Entamoeba coli, Endolimax nana, Dientamoeba fragilis, Trichomonas hominis, and Giardia lamblia. Western immunoblotting analysis showed that the molecular weight of the antigenic component recognized by the MAb was exclusively 30,000 in pathogenic isolates of different zymodemes. These results suggest that the 30,000-molecular-weight antigen is a marker of pathogenic isolates and that the indirect fluorescent-antibody test with the MAb is useful for the accurate discrimination of pathogenic amebae.

}, keywords = {Animals, Antibodies, Monoclonal, Antigens, Protozoan, Entamoeba histolytica, Female, Fluorescent Antibody Technique, Mice, Mice, Inbred BALB C, Molecular Weight}, issn = {0019-9567}, doi = {10.1128/iai.58.4.955-960.1990}, url = {https://iai.asm.org/content/58/4/955.long}, author = {Tachibana, H and Satoru Kobayashi and Kato, Y and Nagakura, K and Kaneda, Y and Takeuchi, T} }