TY - JOUR T1 - 1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD JF - Diabetes Y1 - 2020 A1 - Mukoso N. Ozieh A1 - Emma Garacci A1 - Rebekah J Walker A1 - Leonard E Egede KW - Diabetes Mellitus KW - Expenditures KW - Food security KW - Health Services Utilization KW - Kidney diseases KW - Medical Sciences–Endocrinology KW - Neighborhoods KW - Regression Analysis KW - Social interactions KW - United States–US AB - Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD). Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes. Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41). Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD. VL - 69 SN - 00121797 ER - TY - JOUR T1 - Caregiver stressors and depressive symptoms among older husbands and wives in the United States. JF - J Women Aging Y1 - 2017 A1 - Kim, Min Hee A1 - Ruth E Dunkle A1 - Amanda J Lehning A1 - Shen, Huei-Wern A1 - Sheila Feld A1 - Angela K Perone KW - Activities of Daily Living KW - Aged KW - Caregivers KW - depression KW - Female KW - Humans KW - Independent Living KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prospective Studies KW - Regression Analysis KW - Sex Factors KW - Spouses KW - Stress, Psychological KW - United States AB -

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

VL - 29 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27673406?dopt=Abstract ER - TY - JOUR T1 - Associations between health literacy and preventive health behaviors among older adults: findings from the health and retirement study. JF - BMC Public Health Y1 - 2016 A1 - Dena M. Fernandez A1 - Janet L. Larson A1 - Brian J Zikmund-Fisher KW - Aged KW - Aged, 80 and over KW - Female KW - Health Behavior KW - Health Knowledge, Attitudes, Practice KW - Health Literacy KW - Health Promotion KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Odds Ratio KW - Preventive Health Services KW - Regression Analysis KW - Retirement KW - United States AB -

BACKGROUND: While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors.

METHODS: We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs.

RESULTS: In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2 years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002).

CONCLUSION: In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.

VL - 16 UR - https://www.ncbi.nlm.nih.gov/pubmed/27430477 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27430477?dopt=Abstract ER - TY - JOUR T1 - Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study. JF - Health Econ Y1 - 2016 A1 - Johanna Catherine Maclean A1 - Asia Sikora Kessler A1 - Donald S. Kenkel KW - Age Factors KW - Aged KW - Consumer Behavior KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Smoking KW - Taxes KW - Tobacco Products KW - United States AB -

In this study, we use the Health and Retirement Study to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a $1.00 (131.6%) tax increase leads to a 3.8-5.2% reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population.

PB - 25 VL - 25 UR - http://onlinelibrary.wiley.com/doi/10.1002/hec.3161/epdf IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25721732?dopt=Abstract ER - TY - JOUR T1 - A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. JF - J Aging Health Y1 - 2016 A1 - Chi-Tsun Chiu A1 - Mark D Hayward A1 - Saito, Yasuhiko KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Cause of Death KW - Cross-Cultural Comparison KW - Educational Status KW - Employment KW - Family Characteristics KW - Female KW - Health Status KW - Health Surveys KW - Healthy Lifestyle KW - Humans KW - Japan KW - Life Expectancy KW - Life Tables KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Sex Distribution KW - United States AB -

OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION: Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

VL - 28 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract ER - TY - JOUR T1 - Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study. JF - Soc Sci Med Y1 - 2016 A1 - Sander K. R. van Zon A1 - Bültmann, Ute A1 - Reijneveld, Sijmen A A1 - Carlos F. Mendes de Leon KW - Aged KW - Aging KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Social Class KW - United States AB -

OBJECTIVES: The aims of this study are to examine the pattern of pre- and post-retirement changes in functional health and to examine the degree to which socioeconomic position (SEP) modifies pre- and post-retirement changes in functional health.

METHOD: This longitudinal study was conducted using data from the Health and Retirement Study from 1992 to 2012. Piecewise linear regression analyses with generalised estimating equations were used to calculate trajectories of limitations in mobility and large muscle functions before and after retirement spanning a time period of 16 years. Interaction terms of three indicators of SEP with time before and after retirement were examined to investigate the modifying effect of SEP on changes in functional health before and after retirement.

RESULTS: Average levels of limitations in mobility and large muscle functions increased significantly in the years prior to retirement. This increase slowed down after retirement, most prominently for limitations in large muscle functions. Higher SEP was associated with a slower increase of functional limitations prior to retirement. After retirement, a less clear pattern was found as only wealth modified the increase of limitations in mobility functions.

DISCUSSION: Prevention of functional decline in older working adults may be essential in achieving longer and healthier working lives. Such strategies may have to give special consideration to lower SEP adults, as they tend to experience functional health declines prior to retirement at a greater rate than higher SEP adults.

VL - 170 UR - http://www.sciencedirect.com/science/article/pii/S0277953616305615 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27741444?dopt=Abstract ER - TY - JOUR T1 - Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - O'Shea, Deirdre M A1 - Vonetta M Dotson A1 - Fieo, Robert A A1 - Tsapanou, Angeliki A1 - Laura B Zahodne A1 - Stern, Yaakov KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Humans KW - Male KW - Memory KW - Middle Aged KW - Regression Analysis KW - Self Efficacy KW - Surveys and Questionnaires AB -

OBJECTIVE: To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory.

METHODS: Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list.

RESULTS: Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196).

CONCLUSION: Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one's mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.

VL - 31 UR - http://www.ncbi.nlm.nih.gov/pubmed/26679474 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26679474?dopt=Abstract U4 - Depression Depressive symptoms Self-rated memory Memory Self-efficacy ER - TY - JOUR T1 - Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults. JF - Int Psychogeriatr Y1 - 2016 A1 - Namkee G Choi A1 - DiNitto, Diana M A1 - Marti, C Nathan A1 - Bryan Y Choi KW - Age Distribution KW - Aged KW - Cannabis KW - Cross-Sectional Studies KW - depression KW - Depressive Disorder, Major KW - Female KW - Health Surveys KW - Humans KW - Illicit Drugs KW - Male KW - Marijuana Abuse KW - Marijuana Smoking KW - Middle Aged KW - Regression Analysis KW - Self Report KW - Substance-Related Disorders KW - Suicidal Ideation KW - Suicide, Attempted KW - United States AB -

BACKGROUND: Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA.

METHODS: The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts.

RESULTS: Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE.

CONCLUSIONS: Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

VL - 28 UR - https://www.ncbi.nlm.nih.gov/pubmed/26542746 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26542746?dopt=Abstract ER - TY - JOUR T1 - Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - Celia F. Hybel A1 - Joan M. Bennett A1 - Lawrence R Landerman A1 - Jersey Liang A1 - Brenda L Plassman A1 - Bei Wu KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Depressive Disorder KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Oral Health KW - Regression Analysis AB -

OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

METHODS: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.

RESULTS: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.

CONCLUSIONS: Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

PB - 31 VL - 31 IS - 1 N1 - Export Date: 9 September 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25962827?dopt=Abstract U2 - PMC4641817 U4 - Depressive symptoms/Edentulism/Latent class trajectory analysis/Oral health ER - TY - JOUR T1 - The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. JF - Mol Psychiatry Y1 - 2015 A1 - Wouter J Peyrot A1 - Lee, S H A1 - Milaneschi, Y A1 - Abdel Abdellaoui A1 - Byrne, E M A1 - Tõnu Esko A1 - Eco J. C. de Geus A1 - Hemani, G A1 - Jouke-Jan Hottenga A1 - Kloiber, S A1 - Douglas F Levinson A1 - Lucae, S A1 - Nicholas G Martin A1 - Sarah E Medland A1 - Andres Metspalu A1 - Lili Milani A1 - Markus M Nöthen A1 - Potash, J B A1 - Rietschel, M A1 - Cornelius A Rietveld A1 - Ripke, S A1 - Jianxin Shi A1 - Gonneke Willemsen A1 - Zhihong Zhu A1 - Dorret I Boomsma A1 - Naomi R. Wray A1 - Brenda W J H Penninx KW - Adult KW - Aged KW - Cohort Studies KW - Depressive Disorder, Major KW - Educational Status KW - Estonia KW - Female KW - Gene-Environment Interaction KW - Genetic Association Studies KW - Genotype KW - Humans KW - Likelihood Functions KW - Male KW - Middle Aged KW - Netherlands KW - Odds Ratio KW - Polymorphism, Single Nucleotide KW - Psychiatric Status Rating Scales KW - Regression Analysis AB -

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.

VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25917368?dopt=Abstract ER - TY - JOUR T1 - Prostate Cancer Screening Among American Indians and Alaska Natives: The Health and Retirement Survey, 1996-2008. JF - Prev Chronic Dis Y1 - 2015 A1 - R. Turner Goins A1 - Marc B Schure A1 - Carolyn Noonan A1 - Dedra S. Buchwald KW - Aged KW - Alaska KW - Analysis of Variance KW - Black or African American KW - Health Behavior KW - Health Surveys KW - Healthcare Disparities KW - Humans KW - Indians, North American KW - Male KW - Mass Screening KW - Middle Aged KW - Prevalence KW - Prostatic Neoplasms KW - Regression Analysis KW - Retirement KW - Self Report KW - Surveys and Questionnaires KW - United States KW - White People AB -

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

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

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

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

PB - 12 VL - 12 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26247423?dopt=Abstract U2 - PMC4552140 U4 - prostate cancer/Screening/native Americans/african Americans/minorities ER - TY - JOUR T1 - An investigation of activity profiles of older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2014 A1 - Morrow-Howell, Nancy A1 - Putnam, Michelle A1 - Lee, Yung Soo A1 - Jennifer C. Greenfield A1 - Inoue, Megumi A1 - Chen, Huajuan KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Cohort Studies KW - Cross-Sectional Studies KW - Employment KW - Female KW - Florida KW - Health Surveys KW - Hispanic or Latino KW - Human Activities KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Motor Activity KW - Prospective Studies KW - Regression Analysis KW - United States AB -

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.

PB - 69 VL - 69 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24526690?dopt=Abstract U2 - PMC4189653 U4 - Activity/Activity patterns/Engagement/Time use ER - TY - JOUR T1 - Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. JF - Am J Geriatr Psychiatry Y1 - 2013 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - depression KW - Female KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Male KW - Poisson Distribution KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - Sepsis KW - Severity of Illness Index KW - Survivors KW - United States AB -

OBJECTIVES: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims.

RESULTS: The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis.

CONCLUSIONS: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.

PB - 21 VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23567391?dopt=Abstract U2 - PMC3462893 U4 - Critical care/Depression/Outcome assessment (healthcare)/Sepsis/health Care Utilization/HOSPITALIZATION ER - TY - JOUR T1 - Depressive symptoms and psychosocial stress at work among older employees in three continents. JF - Global Health Y1 - 2012 A1 - Johannes Siegrist A1 - Lunau, T. A1 - Morten Wahrendorf A1 - Dragano, N. KW - Asia KW - Cross-Sectional Studies KW - Data collection KW - depression KW - Europe KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - North America KW - Prevalence KW - Regression Analysis KW - Risk Factors KW - Stress, Psychological KW - Work AB -

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

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

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

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

PB - 8 VL - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22818354?dopt=Abstract U4 - psychosocial/Depression/cross-national/labor Force Participation/Older Workers/Stress/workplace ER - TY - JOUR T1 - Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults. JF - J Aging Health Y1 - 2012 A1 - Jiyoung Lyu A1 - SeungAh H. Lee KW - Aged KW - Alcohol Drinking KW - Alcohol-Related Disorders KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Humans KW - Intelligence KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Sex Factors AB -

OBJECTIVE: This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD: Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS: Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION: Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

VL - 24 IS - 8 N1 - . U1 - http://www.ncbi.nlm.nih.gov/pubmed/22992713?dopt=Abstract U3 - 22992713 U4 - alcohol Abuse/intelligence/Cognition/WOMEN/Cognitive ability/gender Differences ER - TY - JOUR T1 - A prospective cohort study of health behavior profiles after age 50 and mortality risk. JF - BMC Public Health Y1 - 2012 A1 - Benjamin A Shaw A1 - Agahi, Neda KW - Aged KW - Alcohol-Related Disorders KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Regression Analysis KW - Risk Assessment KW - Risk-Taking KW - Sedentary Behavior KW - Smoking KW - United States AB -

BACKGROUND: This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors.

METHODS: Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent's smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression.

RESULTS: Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51-65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers.

CONCLUSIONS: In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

PB - 12 VL - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22989155?dopt=Abstract U4 - Alcohol/alcohol Abuse/Alcohol-Related Disorders -- mortality/Regression Analysis/Risk-Taking/Sedentary Lifestyle/Risk Assessment/smoking/Smoking -- mortality/Public Health And Safety/gender Differences ER - TY - JOUR T1 - Anticipatory ex ante moral hazard and the effect of Medicare on prevention. JF - Health Econ Y1 - 2011 A1 - de Preux, Laure B KW - Age Factors KW - Aged KW - Alcohol Drinking KW - Female KW - Health Behavior KW - Health Services KW - Humans KW - Insurance Coverage KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Morals KW - Motor Activity KW - Proportional Hazards Models KW - Regression Analysis KW - Smoking KW - United States AB -

This paper extends the ex ante moral hazard model to allow healthy lifestyles to reduce the probability of illness in future periods, so that current preventive behaviour may be affected by anticipated changes in future insurance coverage. In the United States, Medicare is offered to almost all the population at the age of 65. We use nine waves of the US Health and Retirement Study to compare lifestyles before and after 65 of those insured and not insured pre 65. The double-robust approach, which combines propensity score and regression, is used to compare trends in lifestyle (physical activity, smoking, drinking) of the two groups before and after receiving Medicare, using both difference-in-differences and difference-in-differences-in-differences. There is no clear effect of the receipt of Medicare or its anticipation on alcohol consumption nor smoking behaviour, but the previously uninsured do reduce physical activity just before receiving Medicare.

PB - 20 VL - 20 IS - 9 N1 - de Preux, Laure B Comparative Study England Health economics Health Econ. 2011 Sep;20(9):1056-72. doi: 10.1002/hec.1778. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21830252?dopt=Abstract U3 - 21830252 U4 - Age Factors/Alcohol Drinking/epidemiology/Alcohol Drinking/epidemiology/Female/Health Behavior/Health Services/economics/ethics/ utilization/Health Services/economics/ethics/ utilization/Humans/Insurance Coverage/economics/ethics/ statistics/Insurance Coverage/economics/ethics/ statistics/numerical data/Medically Uninsured/ statistics/Medically Uninsured/ statistics/numerical data/Medicare/economics/ statistics/Medicare/economics/ statistics/numerical data/Middle Aged/moral hazard/Motor Activity/Motor Activity/Proportional Hazards Models/Regression Analysis/Smoking/epidemiology/Smoking/epidemiology/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Can Food Stamps help to reduce Medicare spending on diabetes? JF - Econ Hum Biol Y1 - 2011 A1 - Lauren Hersch Nicholas KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - Confidence Intervals KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Female KW - Glycated Hemoglobin KW - Health Care Costs KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Odds Ratio KW - Outpatients KW - Poverty KW - Prevalence KW - Public Assistance KW - Regression Analysis KW - Social Welfare KW - Treatment Outcome KW - United States AB -

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

PB - 9 VL - 9 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21112260?dopt=Abstract U2 - PMC3032985 U4 - Diabetes/Food Stamps/biomarker data/elderly/Medicare spending/HbA1c/Public Policy ER - TY - JOUR T1 - Determinants of medical expenditures in the last 6 months of life. JF - Annals of Internal Medicine Y1 - 2011 A1 - Amy Kelley A1 - Susan L Ettner A1 - R Sean Morrison A1 - Qingling Du A1 - Neil S. Wenger A1 - Catherine A Sarkisian KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Ethnic Groups KW - Female KW - Health Expenditures KW - Humans KW - Income KW - Independent Living KW - Male KW - Medicare KW - Regression Analysis KW - Social Support KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs.

OBJECTIVE: To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation.

DESIGN: Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics.

SETTING: United States, 2000 to 2006.

PARTICIPANTS: 2394 Health and Retirement Study decedents aged 65.5 years or older.

MEASUREMENTS: Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics.

RESULTS: Decline in function (rate ratio [RR], 1.64 [95% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for.

LIMITATION: The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation.

CONCLUSION: Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics.

PRIMARY FUNDING SOURCE: The Brookdale Foundation.

VL - 154 IS - 4 ER - TY - JOUR T1 - Gender, marital power, and marital quality in later life. JF - J Women Aging Y1 - 2011 A1 - Jennifer R. Bulanda KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Interpersonal Relations KW - Male KW - Marriage KW - Middle Aged KW - Power, Psychological KW - Quality of Life KW - Regression Analysis KW - Sex Distribution KW - Socioeconomic factors KW - United States KW - Women, Working AB -

This study uses data from the 1992 Health and Retirement Study to examine gender differences in marital power and marital quality among older adults and to assess whether there are gender differences in the correlates of marital quality and marital power in later life. Results show that women report lower marital happiness, marital interaction, and marital power than do men, on average. These differences persist even after controlling for a number of life-course events and transitions. Further, results show that gender differences are also evident in the relationship of employment, childrearing, caregiving, and health factors with marital quality and power.

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21271441?dopt=Abstract U3 - 21271441 U4 - marital power/marital quality/gender/marriage ER - TY - JOUR T1 - The impact of private long-term care insurance on the use of long-term care. JF - Inquiry Y1 - 2011 A1 - Yong Li A1 - Gail A Jensen KW - Aged KW - Aged, 80 and over KW - Decision making KW - Female KW - Health Services Accessibility KW - Home Care Services KW - Home Nursing KW - Humans KW - Insurance, Long-Term Care KW - Likelihood Functions KW - Long-term Care KW - Male KW - Models, Econometric KW - Nursing homes KW - Private Sector KW - Regression Analysis KW - United States AB -

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.

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21634261?dopt=Abstract U3 - 21634261 U4 - Life insurance/health insurance/Experiment/theoretical treatment/Long term care insurance/Impact analysis/Long term health care/Elder care/Health services utilization ER - TY - JOUR T1 - A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. JF - BMC Public Health Y1 - 2011 A1 - Frederic D Wolinsky A1 - Suzanne E Bentler A1 - Jason Hockenberry A1 - Michael P Jones A1 - Paula A Weigel A1 - Kaskie, Brian A1 - Robert B Wallace KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition KW - Cognition Disorders KW - Cohort Studies KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Medicare KW - Mental Health KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Regression Analysis KW - Risk Factors KW - United States AB -

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

PB - 11 VL - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract U2 - PMC3190354 U4 - Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale ER - TY - JOUR T1 - Regional variation in the association between advance directives and end-of-life Medicare expenditures. JF - JAMA Y1 - 2011 A1 - Lauren Hersch Nicholas A1 - Kenneth M. Langa A1 - Theodore J Iwashyna A1 - David R Weir KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Data collection KW - Female KW - Health Expenditures KW - Hospice Care KW - Hospital Mortality KW - Hospitals KW - Humans KW - Kidney Failure, Chronic KW - Male KW - Medicare KW - Palliative care KW - Prospective Studies KW - Regression Analysis KW - Terminal Care KW - United States AB -

CONTEXT: It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments.

OBJECTIVE: To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments.

DESIGN, SETTING, AND PATIENTS: Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent's hospital referral region.

MAIN OUTCOME MEASURES: Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life.

RESULTS: Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (-$5585 per decedent; 95% CI, -$10,903 to -$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (-9.8%; 95% CI, -16% to -3% in high-spending regions; -5.3%; 95% CI, -10% to -0.4% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17%; 95% CI, 11% to 23% in high-spending regions, 11%; 95% CI, 6% to 16% in medium-spending regions), but not in low-spending regions.

CONCLUSION: Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.

PB - 112 VL - 306 UR - http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2590187421andFmt=7andclientId=17822andRQT=309andVName=PQD IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21972306?dopt=Abstract U2 - PMC3332047 U4 - Advance directives/Palliative care/Health care expenditures/Medicare ER - TY - JOUR T1 - Volunteering and hypertension risk in later life. JF - J Aging Health Y1 - 2011 A1 - Jeffrey A Burr A1 - Jane Tavares A1 - Jan E Mutchler KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Confidence Intervals KW - Female KW - Health Behavior KW - health policy KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Psychometrics KW - Regression Analysis KW - Risk Factors KW - Social Support KW - Surveys and Questionnaires KW - Volunteers AB -

OBJECTIVE: This study examined the relationship between volunteer activity and hypertension, a risk factor for cardiovascular disease, renal failure, and cognitive impairment.

METHOD: Employing data from the Health and Retirement Study, we estimated regression models of hypertension status that include volunteer activity and psychosocial and health behavior risk factors for middle-aged and older persons.

RESULTS: Multivariate analyses showed volunteers had lower hypertension risk and lower systolic and diastolic blood pressure than nonvolunteers and that a threshold effect was present, whereby a modest amount of volunteer time commitment (but not a high amount) was associated with lower risk of hypertension. We did neither find support that psychosocial and health behaviors mediated this relationship nor find support for a moderating effect of volunteering for the relationships among health behaviors and hypertension.

DISCUSSION: The results of this study indicate that research is needed to determine what mediates the relationship between volunteering and hypertension.

PB - 23 VL - 23 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20971920?dopt=Abstract U3 - 20971920 U4 - Volunteers/Hypertension/Risk factors/Cardiovascular disease/Aging/Geriatrics/Older people ER - TY - JOUR T1 - Causes and consequences of early-life health. JF - Demography Y1 - 2010 A1 - Case, Anne A1 - Paxson, Christina KW - Adolescent KW - Adult KW - Aged KW - Body Height KW - Child KW - Child Development KW - Child, Preschool KW - Educational Status KW - Employment KW - Family Characteristics KW - Female KW - Health Status KW - Humans KW - Income KW - Infant KW - Infant, Newborn KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Pregnancy KW - Prenatal Exposure Delayed Effects KW - Regression Analysis KW - Socioeconomic factors KW - United Kingdom AB -

We examine the consequences of child health for economic and health outcomes in adulthood, using height as a marker of childhood health. After reviewing previous evidence, we present a conceptual framework that highlights data limitations and methodological problems that complicate the study of this topic. We then present estimates of the associations between height and a range of outcomes--including schooling, employment, earnings, health, and cognitive ability--measured in five data sets from early to late adulthood. These results indicate that, on average, taller individuals attain higher levels of education. Height is also positively associated with better economic, health, and cognitive outcomes. These associations are only partially explained by the higher average educational attainment of taller individuals. We then use data from the National Longitudinal Survey of Youth 1979 Children and Young Adults survey to document the associations between health, cognitive development, and growth in childhood. Even among children with the same mother, taller siblings score better on cognitive tests and progress through school more quickly. Part of the differences found between siblings arises from differences in their birth weights and lengths attributable to mother's behaviors while pregnant. Taken together, these results support the hypothesis that childhood health influences health and economic status throughout adulthood.

PB - 47 VL - 47 Suppl IS - Suppl 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21302429?dopt=Abstract U4 - health outcomes/Cognition/cognitive development/childhood health ER - TY - JOUR T1 - Health outcomes of Experience Corps: a high-commitment volunteer program. JF - Soc Sci Med Y1 - 2010 A1 - S I Hong A1 - Morrow-Howell, Nancy KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Promotion KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Program Evaluation KW - Regression Analysis KW - Self Concept KW - Volunteers AB -

Experience Corps (EC) is a high-commitment US volunteer program that brings older adults into public elementary schools to improve academic achievement of students. It is viewed as a health promotion program for the older volunteers. We evaluated the effects of the EC program on older adults' health, using a quasi-experimental design. We included volunteers from 17 EC sites across the US. They were pre-tested before beginning their volunteer work and post-tested after two years of service. We compared changes over time between the EC participants (n = 167) and a matched comparison group of people from the US Health and Retirement Study (2004, 2006). We developed the comparison group by using the nearest available Mahalanobis metric matching within calipers combined with the boosted propensity scores of those participating in the EC. We corrected for clustering effects via survey regression analyses with robust standard errors and calculated adjusted post-test means of health outcomes, controlling for all covariates and the boosted propensity score of EC participants. We found that compared to the comparison group, the EC group reported fewer depressive symptoms and functional limitations after two years of participation in the program, and there was a statistical trend toward the EC group reporting less decline in self-rated health. Results of this study add to the evidence supporting high-intensity volunteering as a social model of health promotion for older adults.

PB - 71 VL - 71 IS - 2 N1 - Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands U1 - http://www.ncbi.nlm.nih.gov/pubmed/20510493?dopt=Abstract U3 - 20510493 U4 - EDUCATION/academic achievement/Volunteering/Experience Corps/methodology/generational transfers ER - TY - JOUR T1 - Health trajectories among older movers. JF - J Aging Health Y1 - 2010 A1 - Janet M Wilmoth KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Regression Analysis KW - Social Class KW - Transients and Migrants AB -

OBJECTIVE: To examine health trajectories among older migrants by reason for move.

METHOD: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves.

RESULTS: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups.

DISCUSSION: The results are consistent with the predictions of Litwak and Longino's (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

PB - 22 VL - 22 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract U3 - 20710006 U4 - Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment ER - TY - JOUR T1 - Predicting positive well-being in older men and women. JF - Int J Aging Hum Dev Y1 - 2010 A1 - Erin L. Waddell A1 - Joy M Jacobs-Lawson KW - Aged KW - Aged, 80 and over KW - Aging KW - depression KW - Female KW - Health Status KW - Humans KW - Male KW - Marriage KW - Middle Aged KW - Personal Satisfaction KW - Predictive Value of Tests KW - Quality of Life KW - Regression Analysis KW - Religion and Psychology KW - Self Concept KW - Sex Distribution KW - Social Behavior KW - Surveys and Questionnaires KW - Volunteers AB -

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults' well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old (M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35% of the variance in women's positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

PB - 70 VL - 70 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20503804?dopt=Abstract U3 - 20503804 U4 - Well Being/Elderly/Women/Health/Depression/Marital Status/Psycho-social ER - TY - JOUR T1 - Surgery as a teachable moment for smoking cessation. JF - Anesthesiology Y1 - 2010 A1 - Yu Shi A1 - David O. Warner KW - Aged KW - Aged, 80 and over KW - Ambulatory Surgical Procedures KW - Analysis of Variance KW - Cohort Studies KW - Female KW - Follow-Up Studies KW - General Surgery KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Patient Education as Topic KW - Regression Analysis KW - Smoking cessation KW - Treatment Outcome KW - United States AB -

BACKGROUND: A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery.

RESULTS: Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8% of all quit events in the United States annually can be attributed to the surgical procedures analyzed.

CONCLUSIONS: Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

PB - 112 VL - 112 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19996946?dopt=Abstract U3 - 19996946 U4 - Smoking/Smoking Cessation ER - TY - JOUR T1 - Socioeconomic differentials in immune response. JF - Epidemiology Y1 - 2009 A1 - Jennifer B Dowd A1 - Allison E Aiello KW - Adult KW - Aged KW - Cytomegalovirus KW - Cytomegalovirus Infections KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Regression Analysis KW - Social Class KW - United States AB -

BACKGROUND: Lower socioeconomic status (SES) is strongly linked to health outcomes, though the mechanisms are poorly understood. Little is known about the role of the immune system in creating and sustaining health disparities. Here we test whether SES is related to cell-mediated immunity, as measured by the host's ability to keep persistent cytomegalovirus (CMV) antibody levels in a quiescent state.

METHODS: Censored regression models were used to test the cross-sectional relationship of education, income, and race/ethnicity with antibody response to CMV, using a nationally representative sample of 9721 respondents aged 25 years and older in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).

RESULTS: Among CMV-seropositive respondents, those with less education, lower income, and nonwhite race/ethnicity had higher levels of CMV antibodies at all ages. On average, each additional year of age was associated with CMV antibody levels that were 0.03 units higher (95% confidence interval = 0.03 to 0.04), whereas each additional year of education was associated with antibody levels that were 0.05 units lower (0.02 to 0.09). A doubling of family income was associated with antibody levels that were 0.25 units lower (0.11 to 0.39), the equivalent of 8 fewer years of age-related CMV antibody response. These relationships remained strong after controlling for baseline health conditions, smoking status, and BMI.

CONCLUSIONS: SES is associated with an indirect marker of cell-mediated immunity in a nationally representative sample. SES differences in immune control over CMV may have fundamental implications for health disparities over the life course.

PB - 20 VL - 20 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19797966?dopt=Abstract U2 - PMC2765221 U4 - Socioeconomic Differences/immune response ER - TY - JOUR T1 - Predicting the changes in depressive symptomatology in later life: how much do changes in health status, marital and caregiving status, work and volunteering, and health-related behaviors contribute? JF - J Aging Health Y1 - 2007 A1 - Namkee G Choi A1 - Bohman, Thomas M. KW - Aged KW - Caregivers KW - depression KW - Employment KW - Female KW - Forecasting KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Netherlands KW - Regression Analysis KW - Sweden KW - United States KW - Volunteers AB -

This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score.

PB - 19 VL - 19 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17215206?dopt=Abstract U4 - Depression Symptoms/DISABILITY/DISABILITY/Caregiver Status/Marital Status/Work, volunteer ER - TY - JOUR T1 - Processes of cumulative adversity: childhood disadvantage and increased risk of heart attack across the life course. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Angela M O'Rand A1 - Jenifer Hamil-Luker KW - Child KW - Cluster Analysis KW - Family Characteristics KW - Female KW - Human Development KW - Humans KW - Likelihood Functions KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Psychosocial Deprivation KW - Regression Analysis KW - Risk Factors KW - Social Environment KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: This article examines how processes of cumulative adversity shape heart attack risk trajectories across the life course.

METHODS: Our sample includes 9,760 Health and Retirement Study respondents born between 1931 and 1941. Using self-reported retrospective measures of respondents' early background, we first identify three latent classes with differential exposure to childhood disadvantage. Intervening covariates associated with educational attainment, employment status, income attainment, marital history, and health behaviors are added to capture sequential processes of adversity. Final latent-class cluster models estimate the cumulative impact of these covariates on three different heart attack risk trajectories between 1992 and 2002: high, increasing, and low.

RESULTS: Early disadvantage and childhood illness have severe enduring effects and increase the risk for heart attack. Adult pathways, however, differentially influence trajectories of heart attack risk and mediate the effects of early disadvantage.

DISCUSSION: Findings suggest that future research should consider how processes of cumulative adversity initiated in childhood influence health outcomes in older ages.

PB - 60B VL - 60 Spec No 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16251582?dopt=Abstract U4 - Childhood/Heart Diseases/Risk Factors ER - TY - JOUR T1 - Use of complementary medicine in older Americans: results from the Health and Retirement Study. JF - Gerontologist Y1 - 2005 A1 - Ness, Jose A1 - Dominic J Cirillo A1 - David R Weir A1 - Nisly, Nicole L. A1 - Robert B Wallace KW - Activities of Daily Living KW - Aged KW - Chi-Square Distribution KW - Complementary Therapies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Regression Analysis KW - Surveys and Questionnaires KW - United States AB -

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy.

DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices).

RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases.

IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16051914?dopt=Abstract U4 - Medicine/Chiropractic/Dietary Supplements ER - TY - JOUR T1 - When is baseline adjustment useful in analyses of change? An example with education and cognitive change. JF - Am J Epidemiol Y1 - 2005 A1 - M. Maria Glymour A1 - Weuve, Jennifer A1 - Lisa F Berkman A1 - Ichiro Kawachi A1 - Robins, James M. KW - Age Factors KW - Aged KW - Bias KW - Cognition Disorders KW - Educational Status KW - Epidemiologic Methods KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Models, Statistical KW - Neuropsychological tests KW - Regression Analysis KW - United States AB -

In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased.

PB - 162 VL - 162 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15987729?dopt=Abstract U4 - Methodology/EDUCATION/Health-cognitive ability ER - TY - JOUR T1 - The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans. JF - Health Serv Res Y1 - 2004 A1 - Truls Ostbye A1 - Donald H. Taylor Jr. KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Quality of Life KW - Quality-Adjusted Life Years KW - Regression Analysis KW - Sex Distribution KW - Smoking KW - Smoking cessation KW - United States AB -

OBJECTIVE: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

DATA SOURCES/STUDY SETTING: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

STUDY DESIGN: Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.

PRINCIPAL FINDINGS: Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.

CONCLUSIONS: Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.

PB - 39 VL - 39 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15149477?dopt=Abstract U4 - Life Expectancy/Quality of Life/Smoking ER - TY - JOUR T1 - Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity. JF - Gerontologist Y1 - 2003 A1 - Amirkhanyan, Anna A. A1 - Douglas A. Wolf KW - Caregivers KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - Regression Analysis KW - Risk Factors KW - Stress, Psychological AB -

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members.

DESIGN AND METHODS: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings.

RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers.

IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.

PB - 43 VL - 43 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14704381?dopt=Abstract U4 - Caregiving/Stress/Stress Psychology ER - TY - JOUR T1 - The health capital of families: an investigation of the inter-spousal correlation in health status. JF - Soc Sci Med Y1 - 2002 A1 - Sven E. Wilson KW - Activities of Daily Living KW - Chronic disease KW - Decision making KW - Female KW - Health Behavior KW - Health Status Indicators KW - Humans KW - Interviews as Topic KW - Life Style KW - Male KW - Marital Status KW - Middle Aged KW - Regression Analysis KW - Risk Factors KW - Risk-Taking KW - Self Efficacy KW - Sociology, Medical KW - Spouses KW - United States AB -

This study documents and analyzes the inter-spousal correlation in health status (ISCIHS) among married couples in later life. A simple economic theory is developed that integrates standard theories of marriage markets and health capital formation. This theory implies that several causal factors will lead to a positive correlation in the health status of spouses. These include assortative matching in the marriage market along dimensions related to health (such as education); a tendency to share common life-style behaviors such as diet, smoking and exercise; shared environmental risk factors for disease; and a potential for direct effects of the health of one spouse on the health of the other. Empirical estimates using the 1992 Health and Retirement study in the USA demonstrate that ISCIHS is large in magnitude, highly statistically significant, and robust to alternative measures of health status. ISCIHS exists even after controlling for age, education, income, and other socioeconomic and demographic determinants of health status, including behavioral risk factors. These covariates reduce the overall correlation coefficient by 33% to 57%, depending on the health measure, which suggests both that marriage formation and decision making processes systematically affect health in later life and that heretofore unidentified risk factors for disease and disability exist at the household level.

PB - 55 VL - 55 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12365528?dopt=Abstract U4 - Health production/Economics of the family/Marriage markets/Shared risks ER - TY - JOUR T1 - Inference on Regressions with Interval Data on a Regressor or Outcome JF - Econometrica Y1 - 2002 A1 - Charles F Manski A1 - Tamer, Elie KW - Identification KW - interval data KW - Regression Analysis AB - 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. PB - 70 VL - 70 IS - 2 N1 - ProCite field 3 : Northwestern U; Princeton U U4 - Econometric Methods: Single Equation Models: General/Regression ER - TY - JOUR T1 - Informal caregiving time and costs for urinary incontinence in older individuals in the United States. JF - J Am Geriatr Soc Y1 - 2002 A1 - Kenneth M. Langa A1 - Fultz, Nancy H. A1 - Sanjay Saint A1 - Mohammed U Kabeto A1 - A. Regula Herzog KW - Aged KW - Caregivers KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Female KW - Humans KW - Incontinence Pads KW - Male KW - Regression Analysis KW - Time Factors KW - United States KW - Urinary incontinence AB -

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.

PB - 50 VL - 50 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11982676?dopt=Abstract U4 - Caregivers/Comorbidity/Confounding Factors (Epidemiology)/Female/Incontinence Pads/Regression Analysis/Support, U.S. Government--PHS/Time Factors/United States/Epidemiology/Urinary Incontinence ER - TY - JOUR T1 - Loss of health insurance and the risk for a decline in self-reported health and physical functioning. JF - Med Care Y1 - 2002 A1 - David W. Baker A1 - Joseph J Sudano A1 - Jeffrey M. Albert A1 - Elaine A Borawski A1 - Avi Dor KW - Female KW - Health Services Accessibility KW - Health Status KW - Humans KW - Insurance, Health KW - Male KW - Medically Uninsured KW - Middle Aged KW - Regression Analysis KW - Risk KW - Self Efficacy AB -

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported having lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

PB - 40 VL - 40 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12409857?dopt=Abstract ER - TY - JOUR T1 - Estimating the cost of informal caregiving for elderly patients with cancer. JF - J Clin Oncol Y1 - 2001 A1 - Hayman, James A. A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Steven J. Katz A1 - DeMonner, Sonya M. A1 - M.E. Chernew A1 - Slavin, Mitchell B. A1 - A. Mark Fendrick KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Family KW - Female KW - Home Nursing KW - Humans KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Regression Analysis KW - United States AB -

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

PB - 19 VL - 19 IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract U4 - Activities of Daily Living/Aged, 80 and Over/Caregivers/Cost of Illness/Family/Psychology/Female/Home Nursing/Economics/Statistics and Numerical Data/Human/Multivariate Analysis/Neoplasms/Complications/Therapy/Regression Analysis/United States ER - TY - JOUR T1 - National estimates of the quantity and cost of informal caregiving for the elderly with dementia. JF - J Gen Intern Med Y1 - 2001 A1 - Kenneth M. Langa A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - A. Regula Herzog A1 - Mary Beth Ofstedal A1 - Robert J. Willis A1 - Robert B Wallace A1 - Mucha, L.M. A1 - Walter L. Straus A1 - A. Mark Fendrick KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Dementia KW - Female KW - Health Care Costs KW - Humans KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Severity of Illness Index KW - Time Factors KW - United States AB -

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

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

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

PB - 16 VL - 16 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11722692?dopt=Abstract U4 - Aged, 80 and Over/Caregivers/Economics/Cost of Illness/Dementia/Economics/Therapy/Female/Health Care Costs/Multivariate Analysis/Regression Analysis/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS/Time Factors/United States ER - TY - JOUR T1 - Patterns and risk factors of change in somatic and mood symptoms among older adults. JF - Ann Epidemiol Y1 - 2001 A1 - Stephanie J. Fonda A1 - A. Regula Herzog KW - Age Factors KW - Aged KW - Depressive Disorder KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Least-Squares Analysis KW - Longitudinal Studies KW - Male KW - Mood Disorders KW - Regression Analysis KW - Risk Factors KW - Severity of Illness Index KW - Somatoform Disorders KW - United States AB -

PURPOSE: This paper was concerned with patterns of individual-level, longitudinal change in depressive symptoms and factors related to those patterns among Americans 70+ years of age. Two types of depressive symptoms were considered, somatic and mood symptoms. The paper focused on whether the patterns of change and the risk factors for these two types of symptoms differed, as we might expect among old and oldest-old adults.

METHODS: The analytic sample included self-respondents of the 1993--1995 Asset and Health Dynamics among the Oldest Old (AHEAD) study who were born in 1923 or earlier. Depressive symptoms were assessed using an abbreviated Center for Epidemiologic Studies-Depression (CES-D) Scale. The analyses involved examination of respondents' change scores in depressive symptoms and multivariate models using ordinary least squares (OLS) and seemingly unrelated regressions (SUR).

RESULTS: In aggregate, somatic symptoms were more common than mood symptoms initially and over time. Despite differences in aggregate rates, AHEAD respondents' individual-level patterns of change for the two types of symptoms were similar; i.e., stability was the principal trend (53--60%), followed by improvement (21--26%). A number of factors related to change in one aspect of depressive symptoms and not the other, or had greater effects on one aspect of depressive symptoms than the other; e.g., physical health had greater effects on somatic than mood symptoms.

CONCLUSIONS: This study suggests that, in investigations of the course and risk factors for depressive symptoms among people 70+ years of age, it is important to separate somatic symptoms from mood symptoms; their etiology may differ. In general, factors reflecting respondents' social milieu (e.g., bereavement, residential relocation) may have greater effects on mood than somatic symptoms, whereas certain factors representing physical health may have greater effects on somatic symptoms.

PB - 11 VL - 11 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11454494?dopt=Abstract U4 - Age Factors/Depressive Disorder/Diagnosis/Epidemiology/Female/Follow up Studies/Geriatric Assessment/Human/Least Squares Analysis/Longitudinal Studies/Mood Disorders/Diagnosis/Epidemiology/Regression Analysis/Risk Factors/Severity of Illness Index/Somatoform Disorders/Diagnosis/Epidemiology/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Proportional treatment effects for count response panel data: effects of binary exercise on health care demand. JF - Health Econ Y1 - 2001 A1 - Lee, Myoung Jae A1 - Satoru Kobayashi KW - Adult KW - Aged KW - Aged, 80 and over KW - Bias KW - Cost Control KW - Cross-Sectional Studies KW - Data Interpretation, Statistical KW - Effect Modifier, Epidemiologic KW - Exercise Therapy KW - Female KW - Health Promotion KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Needs Assessment KW - Regression Analysis KW - Research Design KW - Treatment Outcome KW - United States AB -

We define conditional and marginal treatment effects appropriate for count data, and then conduct an empirical analysis for the effects of exercise on health care demand using panel data from the Health Retirement Study. The response variables are office visits to doctors and hospitalization days, and the treatments of interest are light and vigorous exercises. We found that short-run light exercise increases health care demand by 3-5%, whereas long-run light exercise decreases it by 3-6%. We also found that short-run vigorous exercise decreases health care demand by 1-2%, whereas long-run vigorous exercise decreases it by 1-3%. However, many of these numbers are not statistically significantly different from zero. These findings suggest that it will be difficult to reduce health care cost much by encouraging people to do more exercise--at least in the short-run.

PB - 10 VL - 10 IS - 5 N1 - ProCite field 3 : Sungkyunkwan U; Mitsubishi Trust and Banking Corp, Tokyo U1 - http://www.ncbi.nlm.nih.gov/pubmed/11466803?dopt=Abstract U4 - Exercise/Econometric Methods: Single Equation Models: Models with Panel Data/Health Care/Health Status/Hospitalization/Panel Data ER - TY - JOUR T1 - The role of job-related rewards in retirement planning. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2001 A1 - Karl Kosloski A1 - David J Ekerdt A1 - Stanley DeViney KW - Career Mobility KW - Decision making KW - Employment KW - Factor Analysis, Statistical KW - Female KW - Florida KW - Health Surveys KW - Humans KW - Interpersonal Relations KW - Job Satisfaction KW - Male KW - Middle Aged KW - Models, Psychological KW - Planning Techniques KW - Regression Analysis KW - Retirement KW - Reward KW - Salaries and Fringe Benefits KW - Sampling Studies AB -

The authors used data from the first wave of the Health and Retirement Study ( F. Juster and R. Suzman 1995) to evaluate whether certain job-related gratifications might reduce retirement planning. Three definitions of retirement planning were evaluated and then regressed separately on a set of variables that included 3 types of job-related satisfactions (intrinsic gratification, positive social relations, and ascendance in the workplace) and 7 covariates: education, age, sex, health, marital status, race, and pension eligibility. Findings indicated that jobs high in ascendance were related to an increase in certain types of retirement planning, but jobs high in intrinsic rewards and positive social relations were related to less planning, regardless of how planning was defined. The findings suggest that information about work-related rewards may be useful in targeting individuals who might benefit from retirement planning programs, in developing planning programs to help workers realize more complex retirement plans, and in assisting employers who hope to retain older workers.

PB - 56B VL - 56 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11316834?dopt=Abstract U4 - Job Satisfaction/Retirement Planning/Health Status ER - TY - JOUR T1 - Gender disparities in the receipt of home care for elderly people with disability in the United States. JF - JAMA Y1 - 2000 A1 - Steven J. Katz A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Disabled Persons KW - Family KW - Female KW - Geriatrics KW - Home Care Services KW - Home Nursing KW - Humans KW - Male KW - Regression Analysis KW - Sex Distribution KW - United States AB -

CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources.

OBJECTIVE: To address gender differences in receipt of informal and formal home care.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.

MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors.

RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4).

CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.

PB - 284 VL - 284 IS - 23 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11122589?dopt=Abstract U4 - Activities of Daily Living/Disabled Persons/Family/Female/Geriatrics/Home Care Services/Utilization/Home Nursing/Utilization/Regression Analysis/Sex Distribution/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Chenoa Flippen A1 - Tienda, Marta KW - Aged KW - Black or African American KW - Cross-Cultural Comparison KW - Employment KW - Female KW - Hispanic or Latino KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Personnel Downsizing KW - Regression Analysis KW - Retirement KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

OBJECTIVES: This study examines the pre-retirement labor force participation behavior of Black, White, and Hispanic men and women to determine how patterns of labor market exit differ among groups.

METHODS: We combine data from the first and second waves of the Health and Retirement Study and apply multinomial logit regression techniques to model labor force status in the first wave of the HRS and change over time.

RESULTS: Black, Hispanic, and female elderly persons experience more involuntary job separation in the years immediately prior to retirement, and the resulting periods of joblessness often eventuate in "retirement" or labor force withdrawal. Minority disadvantage in human capital, health, and employment characteristics accounts for a large part of racial and ethnic differences in labor force withdrawal. Nevertheless, Black men and Hispanic women experience more involuntary labor market exits than Whites with similar socioeconomic and demographic characteristics.

DISCUSSION: Workers most vulnerable to labor market difficulties during their youth confront formidable obstacles maintaining their desired level of labor force attachment as they approach their golden years. This has significant policy implications for the contours of gender and race/ethnic inequality among elderly persons, particularly as life expectancy and the size of the minority elderly population continue to increase.

PB - 55B VL - 55 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10728126?dopt=Abstract U4 - Labor Force Participation/Health Status/Economic Status/Retirement Planning/Basic Demographics ER - TY - JOUR T1 - Characteristics of individuals with integrated pensions. JF - Soc Secur Bull Y1 - 1999 A1 - Bender, K A KW - Bias KW - Data collection KW - Educational Status KW - ethnicity KW - Female KW - Humans KW - Income KW - Labor Unions KW - Male KW - Middle Aged KW - Occupations KW - Pensions KW - Regression Analysis KW - Reproducibility of Results KW - Retirement KW - Sex Factors KW - Social Security KW - Socioeconomic factors KW - United States AB -

Employer pensions that integrate benefits with Social Security have been the focus of relatively little research. Since changes in Social Security benefit levels and other program characteristics can affect the benefit levels and other features of integrated pension plans, it is important to know who is covered by these plans. This article examines the characteristics of workers covered by integrated pension plans, compared to those with nonintegrated plans and those with no pension coverage. Integrated pension plans are those that explicitly adjust their benefit structure to help compensate for the employer's contributions to the Social Security program. There are two basic integration methods used by defined benefit (DB) plans. The offset method causes a reduction in employer pension benefits by up to half of the Social Security retirement benefit; the excess rate method is characterized by an accrual rate that is lower for earnings below the Social Security taxable maximum than above it. Defined contribution (DC) pension plans can be integrated along the lines of the excess rate method. To date, research on integrated pensions has focused on plan characteristics, as reported to the Bureau of Labor Statistics (BLS) through its Employee Benefits Survey (EBS). This research has examined the prevalence of integration among full-time, private sector workers by industry, firm size, and broad occupational categories. However, because the EBS provides virtually no data on worker characteristics, analyses of the effects of pension integration on retirement benefits have used hypothetical workers, varying according to assumed levels of earnings and job tenure. This kind of analysis is not particularly helpful in examining the potential effects of changes in the Social Security program on workers' pension benefits. However, data on pension integration at the individual level are available, most recently from the Health and Retirement Study (HRS), a nationally representative survey of individuals aged 51-61 in 1992. This dataset provides the basis for the analysis presented here. The following are some of the major findings from this analysis. The incidence of pension integration in the HRS sample is 32 percent of all workers with a pension (14 percent of all workers). The HRS can also identify integrated DC plans, a statistic that is not available from BLS data. The rate of integration for workers with only DC plans is 8 percent. After controlling for other variables, several socio-demographic characteristics are significantly related to the incidence of integration. The probability of having an integrated pension is 4.6 percentage points less for men compared to women. Non-Hispanic blacks are 6.4 percentage points less likely than non-Hispanic whites to have integrated pensions. Union members are 14 percentage points less likely to have integrated pensions, while workers with less than a graduate level education are at least 15 percentage points more likely to have a pension that is integrated. Some earnings and pension characteristics are also significantly correlated with pension integration. Earnings are positively related, with the probability of having an integrated pension increasing by 2 percentage points for an increase of $1,000 in annual pay. An even larger effect comes from earning at or above the Social Security taxable maximum. Workers at or above this income level are 10 percentage points more likely to have an integrated plan, but for those with more than one plan the probability of pension integration goes up by 13 percentage points.

PB - 49 VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10732369?dopt=Abstract U3 - 10732369 U4 - Pensions/Pension Plans ER - TY - JOUR T1 - A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1999 A1 - Mary Beth Ofstedal A1 - Zachary Zimmer A1 - Hui-Sheng Lin KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cross-Cultural Comparison KW - depression KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Sex Factors KW - Socioeconomic factors KW - Surveys and Questionnaires KW - Taiwan KW - United States AB -

OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States.

METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning.

RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments.

DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.

PB - 54B VL - 54 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10542831?dopt=Abstract U4 - Cognitive Functioning ER - TY - JOUR T1 - Racial differences in the multiple social roles of older women: implications for depressive symptoms. JF - Gerontologist Y1 - 1999 A1 - Cochran, Donna A1 - Brown, Diane R. A1 - McGregor, Karl C. KW - Analysis of Variance KW - Black or African American KW - Chi-Square Distribution KW - Cross-Sectional Studies KW - Demography KW - depression KW - Female KW - Humans KW - Middle Aged KW - Regression Analysis KW - Self Concept KW - Social Environment KW - Social Support KW - White People KW - women AB -

The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles.

PB - 39 VL - 39 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10495585?dopt=Abstract U4 - Analysis of Variance/Blacks/Psychology/Chi Square Distribution/Cross Sectional Studies/Demography/Depression/Ethnology/Etiology/Female/Human/Middle Age/Regression Analysis/Self Concept/Social Environment/Social Support/Whites/Psychology/Women/Psychology ER - TY - JOUR T1 - A comparative analysis of ADL questions in surveys of older people. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1997 A1 - Willard L Rodgers A1 - Baila Miller KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Geriatric Assessment KW - Health Services KW - Health Status KW - Health Surveys KW - Humans KW - Regression Analysis KW - Reproducibility of Results KW - United States AB -

This article describes questions designed to assess limitations with respect to activities of daily living (ADLs) that were asked on the first wave of the AHEAD study, and it assesses their cross-sectional measurement properties. It also provides comparisons between those questions and parallel questions that have been asked on two other surveys of the elderly population in the United States: the 1984 Supplement on Aging (SOA) to the National Health Interview Survey and the screener for the 1982 National Long Term Care Survey (NLTCS). It also compares a single item from the 1990 Census. It then compares the ways in which the same individuals answer these different versions of ADL questions, using data from subsamples of the AHEAD respondents who were also asked the SOA, NLTCS, or Census questions. The analysis shows that there is a substantial amount of measurement error in the answers to ADL questions, and it suggests that this is a major contributor to apparent improvements and declines in functional health observed in longitudinal data.

PB - 52B VL - 52 Spec No U1 - http://www.ncbi.nlm.nih.gov/pubmed/9215355?dopt=Abstract U4 - Health Status--ADL limitations/Basic Demographics/Method of Questioning/Data Collection Procedures ER - TY - JOUR T1 - Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women. JF - Am J Epidemiol Y1 - 1997 A1 - Daniel O. Clark A1 - Mungai, S.M. KW - Activities of Daily Living KW - Black People KW - Body Mass Index KW - Chronic disease KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - Health Behavior KW - Humans KW - Michigan KW - Middle Aged KW - Obesity KW - Prevalence KW - Regression Analysis KW - Severity of Illness Index KW - Socioeconomic factors AB -

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

PB - 145 VL - 145 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9149658?dopt=Abstract U4 - Mobility Difficulty/Health Status/Basic Demographics/Economic Status/Labor ER - TY - JOUR T1 - The health-wealth connection: racial differences. JF - Gerontologist Y1 - 1996 A1 - Dennis G. Shea A1 - Toni Miles A1 - Mark D Hayward KW - Black or African American KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Humans KW - Income KW - Male KW - Middle Aged KW - Models, Theoretical KW - Regression Analysis KW - United States KW - White People AB -

This article examines the theoretical connection between health capital and financial capital in an economic life-cycle model, exploring possible explanations for racial differences in capital accumulation behavior. Using data from the Health and Retirement Survey, detailed descriptive analysis and a comparison of regression models for health and financial capital are presented. The results, although preliminary and based on cross-section data, suggest possible racial differences in the connection between health and wealth and deserve further study.

PB - 36 VL - 36 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8682332?dopt=Abstract U4 - Blacks/Comparative Study/Cross Sectional Studies/Female/Health Status/Economic Status/Income/Middle Age/Models, Theoretical/Regression Analysis/Whites ER - TY - JOUR T1 - Risk factors for occupational injuries among older workers: an analysis of the health and retirement study. JF - Am J Public Health Y1 - 1996 A1 - Zwerling, Craig A1 - Nancy L. Sprince A1 - Robert B Wallace A1 - Charles S. Davis A1 - Paul S. Whitten A1 - Steven G Heeringa KW - Accidents, Occupational KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Occupational Diseases KW - Regression Analysis KW - Retirement KW - Risk Factors KW - Sex Factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVES: This study examined risk factors for occupational injury among older workers.

METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

PB - 86 VL - 86 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8806386?dopt=Abstract U4 - Accidents, Occupational/Educational Status/Health Status/Gender/Middle Age/Occupational Diseases/Regression Analysis/Retirement/Risk Factors/Sex Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Wounds and Injuries ER - TY - JOUR T1 - The role of ethnicity in the disability and work experience of preretirement-age Americans. JF - Gerontologist Y1 - 1996 A1 - Linda A. Wray KW - Activities of Daily Living KW - Analysis of Variance KW - Disabled Persons KW - Employment KW - ethnicity KW - Female KW - Humans KW - Male KW - Middle Aged KW - Odds Ratio KW - Regression Analysis KW - Risk Factors KW - United States AB -

Using the 1992 HRS, this study examines the effects of social and demographic risk factors, including ethnicity, as well as health and job characteristics on disability and work status among 8,701 preretirement-age Americans with work history. Analytic results indicated that non-Anglo ethnicity was not a significant predictor of disability status but that being African American was a strong significant predictor of being a past versus current worker. The primary predictors of disability and work status were health behaviors, effects of health conditions, job characteristics, and workplace adaptations, factors that lend themselves to policy manipulation.

PB - 36 VL - 36 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8682327?dopt=Abstract U4 - Disabled Persons/Employment/Ethnic Groups/Gender/Middle Age/Odds Ratio/Risk Factors/Support, U.S. Government--PHS/Methodology ER -