TY - JOUR T1 - Chronic Disease and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19 JF - medRxiv Y1 - Forthcoming A1 - Rodlescia S. Sneed A1 - Stubblefield, Alexander A1 - Gardner, Graham A1 - Jordan, Tamara A1 - Briana Mezuk KW - Chronic disease KW - COVID-19 KW - health policy KW - Medicaid AB - As the COVID-19 pandemic wanes, states may reintroduce Medicaid work requirements to reduce enrollment. Using the Health and Retirement Study, we evaluated chronic disease burden among beneficiaries aged >50 (n=1460) who might be impacted by work requirements (i.e. working <20 hours per week). Seven of eight chronic conditions evaluated were associated with reduced workforce participation, including history of stroke (OR: 7.35; 95% CI: 2.98-18.14) and lung disease (OR: 4.39; 95% CI: 2.97-7.47). Those with more severe disease were also more likely to work fewer hours. Medicaid work requirements would likely have great impact on older beneficiaries with significant disease burden.Key PointsChronic disease linked to reduced work among older Medicaid beneficiaries.Work requirements would greatly impact those aged >50 with chronic conditions.Coverage loss would have negative implications for long-term disease management.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis work was supported by the Robert Wood Johnson Foundation’s (RWJF) Policies for Action program under grant number 77342. This is a secondary analysis that uses data from the Health and Retirement Study, (2016 HRS Core and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging under grant number NIA U01AG009740 and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study involved only openly available human data, which can be obtained from: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-coreI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018 and https://hrsdata.isr.umich.edu/data-products/2016-hrs-core ER - TY - JOUR T1 - Chronic Disease, Functional Limitations, and Workforce Participation Among Medicaid Enrollees Over 50: The Potential Impact of Medicaid Work Requirements Post-COVID-19. JF - J Aging Soc Policy Y1 - 2023 A1 - Sneed, Rodlescia S A1 - Stubblefield, Alexander A1 - Gardner, Graham A1 - Jordan, Tamara A1 - Mezuk, Briana KW - Chronic disease KW - Medicaid work requirements KW - workforce participation AB -

From 2018-2020, 19 states enacted Medicaid work requirements as a strategy for reducing program enrollment and overall cost. While these requirements were later rescinded, strategies to reduce Medicaid costs are likely to reemerge as states attempt to recover economically from the COVID-19 pandemic. Here, we evaluated the impact of Medicaid work requirements on adults aged > 50, a group that likely faces significant age-related chronic disease burden. Using 2016 Health and Retirement Study data, we evaluated the chronic disease burden of adult Medicaid beneficiaries aged 51-64 years ( = 1460) who would be at risk of losing their Medicaid coverage due to work requirements. We compared Medicaid beneficiaries working <20 hours per week (i.e. those at risk of coverage loss) to those working at least 20 hours per week on eight chronic health conditions, adjusting for demographic characteristics. Among those with chronic health conditions, we also evaluated differences in disease severity based on hours worked per week. Among those working fewer than 20 hours per week, odds of disease were greater for seven of eight chronic conditions, including history of stroke (OR: 5.66; 95% CI: 2.22-14.43) and lung disease (OR: 3.79; 95% CI: 2.10-6.85). Further, those with greater disease severity were likely to work fewer hours. Thus, the introduction of Medicaid work requirements would likely result in coverage loss and lower access to care among older Medicaid beneficiaries with multiple chronic health conditions.

ER - TY - JOUR T1 - History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. JF - JAMA Network Open Y1 - 2023 A1 - Garcia-Grossman, Ilana R A1 - Cenzer, Irena A1 - Steinman, Michael A A1 - Williams, Brie A KW - Activities of Daily Living KW - Chronic disease KW - Diabetes Mellitus KW - Health Care KW - Lung Diseases KW - Outcome Assessment AB -

IMPORTANCE: Although incarcerated older adults experience higher rates of chronic disease and geriatric syndromes, it is unknown whether community-dwelling older adults with a history of incarceration are also at risk for worse health outcomes.

OBJECTIVE: To evaluate the association between a history of incarceration and health outcomes, including chronic health conditions and geriatric syndromes, in older age.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study using population-based data from the nationally representative Health and Retirement Study included US community-dwelling adults aged 50 years or older who completed the 2012 or 2014 survey waves assessing self-reported history of incarceration. Statistical analysis was completed from December 2021 to July 2022.

EXPOSURES: Self-reported history of incarceration.

MAIN OUTCOMES AND MEASURES: Geriatric health outcomes included cognitive impairment, mobility impairment, vision impairment, hearing impairment, urinary incontinence, and impairment of activities of daily living (ADLs). Chronic health outcomes included high blood pressure, diabetes, chronic lung disease, heart disease, stroke, mental health conditions, heavy alcohol use, and self-reported health. Survey weights were applied to adjust for the survey design.

RESULTS: Among 13 462 participants, 946 (7.6%) had experienced incarceration (mean [SD] age, 62.4 [7.8] years); compared with 12 516 people with no prior incarceration (mean [SD] age, 66.7 [10.0] years), previously incarcerated adults were more likely to be male (83.0% vs 42.8%; P < .001) and in the lowest quartile of wealth (44.1% vs 21.4%; overall P < .001). After adjusting for age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, a history of incarceration was associated with a 20% to 80% increased risk of all geriatric syndromes evaluated, including impairment of ADLs (relative risk [RR], 1.62; 95% CI, 1.40-1.88) and hearing impairment (RR, 1.22; 95% CI, 1.04-1.44). Incarceration was also associated with increased risk of some chronic diseases, including chronic lung disease (RR, 1.56; 95% CI, 1.27-1.91), mental health conditions (RR, 1.80; 95% CI, 1.55-2.08), and heavy alcohol use (RR, 2.13; 95% CI, 1.59-2.84). Prior incarceration was not associated with diabetes or cardiovascular conditions.

CONCLUSIONS AND RELEVANCE: In this study, at least 1 in 15 older US adults reported a history of incarceration in their lifetime. Past incarceration was associated with many chronic diseases and geriatric syndromes even after accounting for socioeconomic status. These findings suggest that attention to incarceration history may be an important consideration in understanding and mitigating health risks in older age.

VL - 6 IS - 1 ER - TY - JOUR T1 - Receptive and participatory arts engagement and healthy aging: Longitudinal evidence from the Health and Retirement Study JF - Social Science & Medicine Y1 - 2023 A1 - Rena, Melinda A1 - Fancourt, Daisy A1 - Bu, Feifei A1 - Paul, Elise A1 - Sonke, Jill K A1 - Bone, Jessica K KW - Chronic disease KW - Cognition KW - cognitive impairment KW - Cultural engagement KW - Mental Health KW - physical functioning AB - Background: There is increasing interest in the potential benefits of referring older adults to engage in community-based arts activities to enhance health. The arts have been found to have wide-ranging benefits for older adults including being associated with an increased lifespan. However, it remains unclear whether they are additionally associated with an increase in the portion of people’s lives for which they remain healthy ('healthspan’). Methods: We included 1,269 older adults who completed the 2014 Arts and Culture Supplement of the Health and Retirement Study and were alive in 2016 and 2018. We measured the number of participatory arts activities engaged in (e.g., reading, crafts, dancing) and the frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized using a previously validated definition of no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health. Logistic regression models tested whether receptive and participatory arts engagement were associated with healthy aging two and four years later. Results: After adjusting for demographic and socioeconomic covariates, doing receptive arts activities once a month or more was associated with 84% higher odds of healthy aging two years later compared to never engaging (adjusted OR [AOR]=1.84, 95% CI=1.06-3.19). There was some weak evidence that this association was maintained four years later (AOR=1.68, 95% CI=0.97-2.90). Although doing one participatory arts activity was associated with 53% lower odds of healthy aging four years later compared to no participation (AOR=0.47, 95% CI=0.26-0.87), this association was not present at two years or for higher levels of participatory arts engagement. Conclusions: Expanding on previous studies, which have suggested that receptive arts engagement is related to prolonged longevity, our findings suggest that receptive arts engagement may also be associated with better overall health and function in those who survive. Those with poorer health may have been engaging in participatory arts because they were unable to attend receptive arts or broader leisure activities (indicating reverse causality), or receptive arts activities may contain specifically beneficial active ingredients for healthy aging. These possibilities present promising avenues for future research. VL - 334 ER - TY - JOUR T1 - Association of perceived job security and chronic health conditions with retirement in older UK and US workers. JF - European Journal of Public Health Y1 - 2022 A1 - Mutambudzi, Miriam A1 - Flowers, Paul A1 - Demou, Evangelia KW - attenuation KW - Chronic disease KW - community health centers KW - ELSA KW - epidemiologic studies KW - health outcomes KW - insecurity KW - labor market KW - Safety KW - Sister studies KW - Social Welfare KW - Survival Analysis KW - Workplace AB -

BACKGROUND: The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50-55 years of age at baseline in the UK and USA.

METHODS: We performed Cox proportional hazards regression analysis, using 2006-2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052).

RESULTS: Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95% CI = 0.50-0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95% CI = 1.01-1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence.

CONCLUSIONS: The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.

VL - 32 IS - 1 ER - TY - JOUR T1 - Associations of mental health and chronic physical illness during childhood with major depression in later life. JF - Aging & Mental Health Y1 - 2022 A1 - Rachel S. Bergmans A1 - Jacqui Smith KW - Chronic disease KW - Comorbidity KW - life history KW - major depressive disorder AB -

OBJECTIVES: This study examined whether childhood chronic physical illness burden was associated with major depression in later life (>50 years) and whether this relationship was mediated by childhood mental health status.

METHOD: Data came from the 2016 United States Health and Retirement Study ( = 18,483). Logistic regression tested associations of childhood chronic physical illness burden with childhood mental health status and major depression in later life. Path analysis quantified mediation of the association between chronic physical illness burden and major depression by childhood mental health status.

RESULTS: One standard deviation increase in childhood chronic physical illness burden was associated with 1.34 (95%  = 1.25, 1.43) times higher odds of major depression in later life. Childhood mental health status explained 53.4% (95% : 37.3%, 69.6%) of this association. In follow-up analyses of categorical diagnoses, having difficulty seeing, ear problems or infections, a respiratory disorder, asthma, an allergic condition, epilepsy or seizures, migraines or severe headaches, heart trouble, stomach problems, or a disability lasting ≥6 months was associated with major depression in later life with mediation by childhood mental health status.

CONCLUSION: Findings of this study indicate that children with a higher chronic physical illness burden are more likely to have major depression in later life and poor mental health during childhood mediates this relationship. Further research is needed to determine whether increased screening and treatment of psychiatric symptoms in pediatrics can decrease the burden of major depression across the life course.

VL - 26 IS - 9 ER - TY - ICOMM T1 - Cost of Chronic Disease in Retirement Is Highest for Women and People of Color Y1 - 2022 A1 - National Council on Aging KW - Chronic disease KW - Racial Disparities KW - Retirement JF - PR Newswire UR - https://www.prnewswire.com/news-releases/cost-of-chronic-disease-in-retirement-is-highest-for-women-and-people-of-color-301529730.html ER - TY - JOUR T1 - Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans JF - The Journal of Strength and Conditioning Research Y1 - 2022 A1 - Klawitter, Lukus A1 - Brenda Vincent A1 - Choi, Bong-Jin A1 - Smith, Joseph A1 - Hammer, Kimberly D. A1 - Donald A Jurivich A1 - Lindsey J Dahl A1 - Ryan P McGrath KW - Chronic disease KW - Exercise KW - Mass Screening KW - Risk Factors KW - sarcopenia AB - Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006–2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider–diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04–1.14) and 1.27 (CI: 1.11–1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29–1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk. VL - 36 IS - 1 ER - TY - JOUR T1 - Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. JF - Front Public Health Y1 - 2022 A1 - Ansah, John P A1 - Chiu, Chi-Tsun KW - Adult KW - Aged KW - Chronic disease KW - Cross-Sectional Studies KW - ethnicity KW - Hispanic or Latino KW - Humans KW - Middle Aged KW - United States KW - White People AB -

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

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

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

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

VL - 10 ER - TY - JOUR T1 - Relation of incident chronic disease with changes in muscle function, mobility, and self-reported health: Results from the Health and Retirement Study JF - PLOS Global Public Health Y1 - 2022 A1 - Davis, James A1 - Lim, Eunjung A1 - Taira, Deborah A. A1 - Chen, John KW - Chronic disease KW - mobility KW - muscle function KW - Self-reported health AB - The primary objective was to learn the extent that muscle function, mobility, and self-reported health decline following incident diabetes, stroke, lung problem, and heart problems. A secondary objective was to measure subsequent recovery following the incident events. A longitudinal panel study of the natural history of four major chronic diseases using the Health and Retirement Study, a nationally representative sample of adults over age 50 years. People first interviewed from 1998–2004 were followed across five biannual exams. The study included 5,665 participants who reported not having diabetes, stroke, lung problems, and heart problems at their baseline interview. Their mean age was 57.3 years (SD = 6.0). They were followed for an average of 4.3 biannual interviews. Declines and subsequent recovery in self-reported health, muscle function, and mobility were examined graphically and modeled using negative binomial regression. The study also measured the incidence rates and prevalence of single and multiple chronic diseases across the follow-up years.Self-reported health and muscle function declined significantly following incident stroke, heart problems, lung problems, and multiple chronic diseases. Mobility declined significantly except following incident diabetes. Self-reported health improved following incident multiple chronic conditions, but recovery was limited compared to initial decline. Population prevalence after five follow-up waves reached 9.0% for diabetes, 8.1% for heart problems, 3.4% for lung disease, 2.1% for stroke, and 5.2% for multiple chronic diseases. Significant declines in self-reported health, muscle function, and mobility occurred within two years of chronic disease incidence with only limited subsequent recovery. Incurring a second chronic disease further increased the declines. Early intervention following incident chronic disease seems warranted to prevent declines in strength, mobility, and perceptions of health. VL - 2 IS - 9 ER - TY - JOUR T1 - Socio-demographic, lifestyle and health characteristics as predictors of self-reported Covid-19 history among older adults: 2006-2020 Health and Retirement Study. JF - American Journal of Infection Control Y1 - 2022 A1 - Beydoun, Hind A A1 - Beydoun, May A A1 - Hossain, Sharmin A1 - Alemu, Brook T A1 - Gautam, Rana S A1 - Weiss, Jordan A1 - Zonderman, Alan B KW - Cardiovascular Diseases KW - Chronic disease KW - COVID-19 KW - ethnicity KW - Female KW - Life Style KW - Retirement KW - Self Report AB -

BACKGROUND: To identify key socio-demographic, lifestyle, and health predictors of self-reported coronavirus disease 2019 (Covid-19) history, examine cardiometabolic health characteristics as predictors of self-reported Covid-19 history and compare groups with and without a history of Covid-19 on trajectories in cardiometabolic health and blood pressure measurements over time, among United States (U.S.) older adults.

METHODS: Nationally representative longitudinal data on U.S. older adults from the 2006-2020 Health and Retirement Study were analyzed using logistic and mixed-effects logistic regression models.

RESULTS: Based on logistic regression, number of household members (OR=1.26, 95% CI: 1.05, 1.52), depressive symptoms score (OR = 1.21, 95% CI: 1.04, 1.42) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.27, 95% CI: 0.11, 0.67) were significant predictors of self-reported Covid-19 history. Based on mixed-effects logistic regression, several statistically significant predictors of Covid-19 history were identified, including female sex (OR = 3.06, 95% CI: 1.57, 5.96), other race (OR = 5.85, 95% CI: 2.37, 14.43), Hispanic ethnicity (OR = 2.66, 95% CI: 1.15, 6.17), number of household members (OR = 1.25, 95% CI: 1.10, 1.42), moderate-to-vigorous physical activity (1-4 times per month vs never) (OR = 0.38, 95% CI: 0.18, 0.78) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.34, 95% CI: 0.19, 0.60).

CONCLUSIONS: Number of household members, depressive symptoms and number of cardiometabolic risk factors or chronic conditions may be key predictors for self-reported Covid-19 history among U.S. older adults. In-depth analyses are needed to confirm preliminary findings.

VL - 50 IS - 5 ER - TY - JOUR T1 - Chronic Disease Burden Among Medicaid Beneficiaries over 50: The Potential Impact of Medicaid Work Requirements JF - Health Services Research Y1 - 2021 A1 - Rodlescia S. Sneed KW - Chronic disease KW - medicaid beneficiaries KW - Workforce AB - Research Objective Since 2018, several states have proposed modifications to their Medicaid programs that require participation in employment or other community engagement activities as a condition of receiving Medicaid benefits. Proponents say that these requirements promote financial independence for families and individuals, while opponents argue that these requirements would disenfranchise the nation's most medically vulnerable citizens. While some studies have evaluated the impact of impact of work requirements on the general Medicaid population, there has been little inquiry into the impact of such policies on Medicaid recipients over 50, who likely have high chronic disease burden and who may face difficulties in maintaining employment. The purpose of our study was to describe the prevalence and burden of chronic disease among Medicaid beneficiaries over 50 who might lose Medicaid benefits based on these new requirements. Study Design To address our research question, we conducted cross-sectional secondary analyses of data from the 2016 wave of the Health and Retirement Study, a large-scale, nationally representative, population-based study of community-dwelling adults aged >50. We used logistic regression models to examine the association between several chronic health conditions and reduced workforce participation (e.g. working <20 hours per week). All analyses adjust for age, race/ethnicity, sex, education level, and marital status. Population Studied Our population of interest included individuals over 50 who were not Medicare-eligible and not receiving Social Security Income. We compared those working >20 hours per week to those working <20 hours per week. We chose <20 hours per week as our employment cutoff, as most states have used this cutoff as the threshold for determining continued Medicaid eligibility. Our sample included 1028 participants who were 47.69% Non-Hispanic White, 23.29% Hispanic, 18.87% Non-Hispanic Black, and 10.14% other racial/ethnic backgrounds. Participants were ages 51–64 (mean age 57.18; SD 0.212) and 55.47% female. Principal Findings Individuals with reduced workforce participation had greater prevalence of several chronic health conditions, including higher rates of diabetes, hypertension, arthritis, and lung disease. Further, among those with chronic health conditions, those working <20 hours per week reported more worsening of their chronic conditions in the past 2 years, greater use of disease-related medications, more hospital and emergency department visits, and more functional limitations than their counterparts working at least 20 hours per week. Conclusions Taken together, these findings suggest that Medicaid work requirements in this population would have great impact on the most medically vulnerable individuals in this age group. Further, they suggest that reduced workforce participation may be a proxy for poor health. Implications for Policy or Practice Policymakers should consider these findings as they enact policies impacting Medicaid eligibility in this population. Enacting work requirements as a condition of Medicaid eligibility among individuals in this age group may have negative impact on chronic disease management. Primary Funding Source The Robert Wood Johnson Foundation. VL - 56 IS - S2 ER - TY - JOUR T1 - The incidence of the healthcare costs of chronic conditions. JF - International Journal of Health Economics and Management Y1 - 2021 A1 - Lee, Kyung Min A1 - Jeung, Chanup KW - Chronic disease KW - Compensating wage differential KW - Employer-sponsored health insurance KW - Wage AB -

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

VL - 21 IS - 4 ER - TY - JOUR T1 - Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity. JF - Experimental Gerontology Y1 - 2021 A1 - Mark D Peterson A1 - Casten, Kimberly A1 - Collins, Stacey A1 - Hassan, Halimah A1 - García-Hermoso, Antonio A1 - Jessica Faul KW - Aging KW - Chronic disease KW - Dementia KW - Disability KW - Grip strength KW - weakness AB -

BACKGROUND: The objective of this study was to use nationally-representative data on Americans greater than 50 years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia.

METHODS: Middle age and older adults (n = 12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia.

RESULTS: The odds of incident disability were 1.25 (95% CI: 1.20-1.30) and 1.31 (95% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95% CI: 1.08-1.20) and 1.14 (95% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR = 1.29; 95% CI: 1.00-1.73) and women (OR = 1.60; 95% CI: 1.26-2.02).

CONCLUSIONS: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.

VL - 152 ER - TY - JOUR T1 - Organic food consumption is associated with inflammatory biomarkers among older adults. JF - Public Health Nutrition Y1 - 2021 A1 - Ludwig-Borycz, Elizabeth A1 - Heidi M Guyer A1 - Aljahdali, Abeer A A1 - Baylin, Ana KW - C-reactive protein KW - Chronic disease KW - Conventional food consumption KW - Cystatin C KW - Organic food consumption KW - Pesticides AB -

OBJECTIVE: The association between organic food consumption and biomarkers of inflammation, C-reactive protein (CRP) and cystatin C (CysC) was explored in this cross-sectional analysis of older adults.

DESIGN: Dietary data and organic food consumption was collected in 2013 from a FFQ. Alternative Mediterranean diet score (A-MedDiet) was calculated as a measure of healthy eating. Biomarkers CRP and CysC were collected in serum or plasma in 2016. We used linear regression models to assess the associations between organic food consumption and CRP and CysC.

SETTING: This cross-sectional analysis uses data from the nationally representative, longitudinal panel study of Americans over 50, the Health and Retirement Study.

PARTICIPANTS: The mean age of the analytic sample (n 3815) was 64·3 (se 0·3) years with 54·4 % being female.

RESULTS: Log CRP and log CysC were inversely associated with consuming organic food after adjusting for potential confounders (CRP: β = -0·096, 95 % CI 0·159, -0·033; CysC: β = -0·033, 95 % CI -0·051, -0·015). Log CRP maintained statistical significance (β = -0·080; 95 % CI -0·144, -0·016) after additional adjustments for the A-MedDiet, while log CysC lost statistical significance (β = -0·019; 95 % CI -0·039, 0·000). The association between organic food consumption and log CRP was driven primarily by milk, fruit, vegetables and cereals, while log CysC was primarily driven by milk, eggs and meat after adjustments for A-MedDiet.

CONCLUSIONS: These findings support the hypothesis that organic food consumption is inversely associated with biomarkers of inflammation CRP and CysC, although residual confounding by healthy eating and socioeconomic status cannot be ruled out.

VL - 24 IS - 14 ER - TY - JOUR T1 - Connectivity of depression symptoms before and after diagnosis of a chronic disease: A network analysis in the U.S. Health and Retirement Study JF - Journal of Affective Disorders Y1 - 2020 A1 - Jaakko Airaksinen A1 - Kia Gluschkoff A1 - Mika Kivimäki A1 - Markus Jokela KW - Chronic disease KW - depression KW - Network analysis AB - Background Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer. Methods Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease. Results Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis. Limitations Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases. Conclusions Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms. VL - 266 UR - http://www.sciencedirect.com/science/article/pii/S0165032719313539 ER - TY - JOUR T1 - Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. JF - PLoS One Y1 - 2020 A1 - Mitchell, Jamie A A1 - Perry, Ramona KW - Adult KW - African Americans KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Communication KW - Cross-Sectional Studies KW - Follow-Up Studies KW - Healthcare Disparities KW - Hispanic Americans KW - Humans KW - Insurance Coverage KW - Male KW - Middle Aged KW - Patient Education as Topic KW - Patient-Centered Care KW - Physician-Patient Relations KW - Prognosis KW - Racism AB -

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

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

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

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

VL - 15 IS - 9 ER - TY - JOUR T1 - Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study JF - Research in Human Development Y1 - 2020 A1 - Byrd, DeAnnah R. A1 - Gonzales, Ernest A1 - Beatty Moody, Danielle L. A1 - Gillian L Marshall A1 - Laura B Zahodne A1 - Roland J. Thorpe Jr. A1 - Keith E Whitfield KW - Chronic disease KW - Cognition KW - Financial hardship AB - Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks. VL - 17 SN - 1542-7609 IS - 1 ER - TY - JOUR T1 - CHRONIC KIDNEY DISEASE, MUSCLE WEAKNESS, AND MOBILITY LIMITATION JF - Innovation in Aging Y1 - 2019 A1 - Kenzie Latham-Mintus A1 - Doshi, Simit A1 - Ranjani N Moorthi KW - Chronic disease KW - chronic kidney disease KW - Kidney disease KW - mobility KW - Mobility Limitation KW - Muscle Strength KW - Muscle Weakness AB - Objectives: Chronic kidney disease (CKD) is associated with increased mobility limitation. Prior research has documented that peripheral nerve abnormalities occur early in CKD and progressively worsen. Loss of balance, impaired muscle strength, and slow gait predispose older adults to falls and frailty. However, the current literature is limited by a lack of nationally representative data that includes objective measures of kidney disease and physical functioning. Thus, this research examines whether CKD is associated with muscle strength, balance, gait, and self-reported mobility limitations. Methods: Data come from the 2016 Health and Retirement Study (HRS). Estimated GFR, a measure of kidney functioning derived from creatinine levels in the blood, was used to classify CKD (i.e, eGFR<45 or Stage 3b CKD). Logistic and linear regression models were generated to examine the association of CKD with physical functioning, net of demographic characteristics (i.e., age, sex, race, and education) and comorbidities (i.e., obesity, pain, and number of diagnosed medical conditions). Results: In unadjusted models, CKD was significantly associated (p<0.05) with more mobility limitations, slower walking speeds, stronger grip strengths, and non-participation in balance tests. After adjusting for covariates, CKD (β=-1.43, p=0.01) was negatively associated with grip strength. In sex-stratified models, CKD was associated with slower walking speeds among men, whereas CKD was associated with more mobility limitations among women. Discussion: In a nationally representative sample of older adults, CKD was associated with poorer physical functioning on multiple measures. After adjusting for demographic characteristics and comorbidities, CKD was associated with increased muscle weakness. VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841557/ IS - Suppl 1 JO - Innov Aging ER - TY - JOUR T1 - Diabetes-multimorbidity combinations and disability among middle-aged and older adults. JF - Journal of General Internal Medicine Y1 - 2019 A1 - Ana R Quiñones A1 - Markwardt, Sheila A1 - Anda Botoseneanu KW - Chronic disease KW - Comorbidity KW - Diabetes KW - Disabilities AB -

BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51 years and older.

MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score ≥ 4).

KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1%); diabetes-hypertension (n = 481, 12.5%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/30815788?dopt=Abstract ER - TY - THES T1 - Modeling the Impact of Chronic Disease on Work Life T2 - Nursing Y1 - 2019 A1 - Allman, Violeta Suzara KW - Chronic disease KW - Disease KW - modeling KW - working AB - This study utilizes historic chronic disease and employment data from the University of Michigan Health and Retirement Study (HRS) to specify a multivariate regression model for forecasting the impact of specific chronic diseases on work life. The purpose of the study is to create a new model for forecasting chronic disease-adjusted work life years, which is a measure of disease burden due to chronic disease. The ability to work may be considered a proxy for quality of life, as it is a means by which a person preserves their financial independence and maintains their financial capacity for self-care. This forecasting model is germane to advanced nursing practice, as it provides practitioners a tool to measure patients’ ability to work given various scenarios of chronic disease – many of which, are preventable. This tool may be useful for motivating patients to adopt healthy lifxestyle behaviors such as smoking cessation, weight loss, exercise, and adopting healthy eating habits so they may change chronic disease trajectories and preserve their ability to work and financially provide for themselves and their families. This advocacy and promotion of patient health through self-care is a cornerstone of advanced nursing practice (Thrasher, 2002). Furthermore, this tool may also be useful for calculating or forecasting disease burden in terms of an individual’s attenuated work years or lost productivity. On a larger scale, this tool may be used to calculate lost labor force participation of a population or group of individuals. These statistics may be used as quality improvement measures, economic forecasting data, or for justifying healthcare policy changes or for the allocation of healthcare resources. JF - Nursing PB - University of Arizona CY - Tucson, AZ VL - Ph.D. in D.N.P. UR - http://hdl.handle.net/10150/633228 N1 - This study utilizes historic chronic disease and employment data from the University of Michigan Health and Retirement Study (HRS) to specify a multivariate regression model for forecasting the impact of specific chronic diseases on work life. The purpose of the study is to create a new model for forecasting chronic disease-adjusted work life years, which is a measure of disease burden due to chronic disease. The ability to work may be considered a proxy for quality of life, as it is a means by which a person preserves their financial independence and maintains their financial capacity for self-care. This forecasting model is germane to advanced nursing practice, as it provides practitioners a tool to measure patients’ ability to work given various scenarios of chronic disease – many of which, are preventable. This tool may be useful for motivating patients to adopt healthy lifxestyle behaviors such as smoking cessation, weight loss, exercise, and adopting healthy eating habits so they may change chronic disease trajectories and preserve their ability to work and financially provide for themselves and their families. This advocacy and promotion of patient health through self-care is a cornerstone of advanced nursing practice (Thrasher, 2002). Furthermore, this tool may also be useful for calculating or forecasting disease burden in terms of an individual’s attenuated work years or lost productivity. On a larger scale, this tool may be used to calculate lost labor force participation of a population or group of individuals. These statistics may be used as quality improvement measures, economic forecasting data, or for justifying healthcare policy changes or for the allocation of healthcare resources. ER - TY - JOUR T1 - Chronic illnesses and depressive symptoms among older people: Functional limitations as a mediator and self-perceptions of aging as a moderator. JF - Journal of Aging and Health Y1 - 2018 A1 - Jina Han KW - Chronic disease KW - Depressive symptoms KW - Self-perception AB -

OBJECTIVE: This research examined the mediation of functional limitations in the relationship between chronic illnesses and depressive symptoms among older Americans along with tests for the moderation of self-perceptions of aging.

METHOD: Data from the Health and Retirement Study (2008, 2010, and 2012) were used. Longitudinal mediation models were tested using a sample of 3,382 Americans who responded to psychosocial questions and were over 65 years old in 2008.

RESULTS: Functional limitations mediated the linkage between chronic illnesses and depressive symptoms. Negative self-perceptions of aging exacerbated the effects of chronic illnesses on depressive symptoms.

DISCUSSION: Health care professionals should be aware of depressive symptoms in older adults reporting chronic illnesses and particularly in those reporting functional limitations. To decrease the risk of depressive symptoms caused by chronic illnesses, negative self-perceptions of aging may need to be challenged.

VL - 30 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28555515?dopt=Abstract ER - TY - JOUR T1 - Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Christine T Cigolle A1 - Corey L Nagel A1 - Caroline S Blaum A1 - Jersey Liang A1 - Ana R Quiñones KW - Aged KW - Chronic disease KW - Data Accuracy KW - Epidemiologic Methods KW - Female KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Self Report AB -

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

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

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

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

VL - 73 UR - https://www.ncbi.nlm.nih.gov/pubmed/27260670 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27260670?dopt=Abstract ER - TY - JOUR T1 - Clinical Trials Targeting Aging and Age-Related Multimorbidity JF - The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2017 A1 - Mark A. Espeland A1 - Eileen M. Crimmins A1 - Brandon R. Grossardt A1 - Jill P. Crandall A1 - Jonathan A. L. Gelfond A1 - Tamara B Harris A1 - Stephen B Kritchevsky A1 - JoAnn E Manson A1 - Jennifer G Robinson A1 - Walter A Rocca A1 - Temprosa, Marinella A1 - Thomas, Fridtjof A1 - Robert B Wallace A1 - Barzilai, Nir KW - Chronic disease KW - Clinical trials KW - Older Adults AB - Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules. VL - 72 UR - https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated IS - 3 JO - GERONA ER - TY - JOUR T1 - Coping With Chronic Stress by Unhealthy Behaviors: A Re-Evaluation Among Older Adults by Race/Ethnicity. JF - Journal of Aging and Health Y1 - 2017 A1 - Rodriquez, Erik J A1 - Gregorich, Steven E A1 - Livaudais-Toman, Jennifer A1 - Eliseo J Perez-Stable KW - Adaptation, Psychological KW - Aged KW - California KW - Chronic disease KW - Continental Population Groups KW - depression KW - Ethnic Groups KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Minority Groups KW - Risk-Taking KW - Stress, Psychological KW - Surveys and Questionnaires AB -

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

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

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

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

VL - 29 IS - 5 ER - TY - JOUR T1 - Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults. JF - Psychosom Med Y1 - 2017 A1 - Mark A Whisman A1 - Emily D Richardson KW - Aged KW - Anxiety Disorders KW - Body Mass Index KW - Chronic disease KW - depression KW - Female KW - Humans KW - Life Style KW - Male KW - Middle Aged KW - Neuroticism KW - Psychological Trauma KW - Saliva KW - Sex Factors KW - Smoking KW - Telomere Shortening AB -

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

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

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

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

VL - 79 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006842-900000000-98910 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28029664?dopt=Abstract JO - Psychosomatic Medicine ER - TY - JOUR T1 - Diabetes and labor market exits: Evidence from the Health & Retirement Study (HRS) JF - The Journal of the Economics of Ageing Y1 - 2017 A1 - Chatterji, Pinka A1 - Heesoo Joo A1 - Kajal Chatterji Lahiri KW - Chronic disease KW - Diabetes KW - Employment and Labor Force KW - Retirement Planning and Satisfaction AB - The objective of this paper is to estimate the effect of diabetes on labor market exit using longitudinal data from the 1992-2010 Health and Retirement Study (HRS). We estimate a discrete time hazard model to test whether diabetes affects the hazard of leaving employment among individuals who were working for pay at the age of 55-56. Using a probit model, we also estimate the effect of having undiagnosed or poorly controlled diabetes on the probability of labor market exit two years later. Our results indicate that diabetes is associated with an increased hazard of exiting the labor market for males, but not for females. This effect for males persists when we include controls for onset of other health conditions, two of which are documented complications of diabetes (stroke and heart conditions). We also find that diagnosed diabetes with medication use, regardless of whether or not it is under control, is associated with large negative effects on the likelihood of employment two years later. (C) 2016 Elsevier B.V. All rights reserved. VL - 9 UR - http://linkinghub.elsevier.com/retrieve/pii/S2212828X16300639http://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/plain JO - The Journal of the Economics of Ageing ER - TY - JOUR T1 - Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? JF - J Occup Environ Med Y1 - 2017 A1 - Maren W Voss A1 - Wendy Church Birmingham A1 - Lori Wadsworth A1 - Wei Chen A1 - Bounsanga, Jerry A1 - Gu, Yushan A1 - Hung, Man KW - Age Factors KW - Aged KW - Chronic disease KW - depression KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Personal Satisfaction KW - Retirement KW - Unemployment KW - United States KW - Work AB -

OBJECTIVE: Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes.

METHODS: A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status.

RESULTS: Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status.

CONCLUSIONS: Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.

VL - 59 UR - http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00043764-900000000-98945 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28002355?dopt=Abstract JO - Journal of Occupational and Environmental Medicine ER - TY - JOUR T1 - Identifying adults aging with disability using existing data: The case of the Health and Retirement Study. JF - Disabil Health J Y1 - 2017 A1 - Caitlin E. Coyle A1 - Putnam, Michelle KW - Activities of Daily Living KW - Adolescent KW - Age of Onset KW - Aged KW - Aged, 80 and over KW - Aging KW - Child KW - Child Health KW - Chronic disease KW - Disabled Persons KW - Female KW - health KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - Self Report KW - Work AB -

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

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

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

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

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

VL - 10 UR - https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28082002?dopt=Abstract ER - TY - JOUR T1 - Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States. JF - BMC Geriatrics Y1 - 2017 A1 - Ana R Quiñones A1 - Corey L Nagel A1 - Jason T Newsom A1 - Nathalie Huguet A1 - Sheridan, Paige A1 - Stephen M Thielke KW - Chronic disease KW - Health Conditions and Status KW - Older Adults KW - Racial/ethnic differences KW - Smoking AB -

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

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

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

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

VL - 17 IS - 1 ER - TY - JOUR T1 - Sociodemographic disparities in chronic pain, based on 12-year longitudinal data. JF - Pain Y1 - 2017 A1 - Grol-Prokopczyk, Hanna KW - Age Distribution KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Ethnic Groups KW - Female KW - Healthcare Disparities KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Sex Factors KW - Social Class AB -

Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally-plateauing of pain above age 60, and lower pain among racial/ethnic minorities-are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3% at baseline, increasing to 36.6% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-à-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

VL - 158 IS - 2 ER - TY - JOUR T1 - Changes in Visual Function in the Elderly Population in the United States: 1995-2010. JF - Ophthalmic Epidemiol Y1 - 2016 A1 - Chen, Yiqun A1 - Hahn, Paul A1 - Frank A Sloan KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Medicare Part B KW - Prevalence KW - Self Report KW - Socioeconomic factors KW - United States KW - Visual Acuity KW - Visually Impaired Persons AB -

PURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).

METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).

RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.

CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.

VL - 23 UR - http://dx.doi.org/10.3109/09286586.2015.1057603 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27142717?dopt=Abstract ER - TY - JOUR T1 - Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes. JF - J Gen Intern Med Y1 - 2016 A1 - Siran M Koroukian A1 - Nicholas K Schiltz A1 - David F Warner A1 - Jiayang Sun A1 - Paul M Bakaki A1 - Kathleen A Smyth A1 - Kurt C Stange A1 - Charles W Given KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Comorbidity KW - Female KW - Geriatric Assessment KW - Health Status KW - Health Status Indicators KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mobility Limitation KW - Prognosis KW - Risk Factors KW - Self Report KW - Sex Distribution KW - Socioeconomic factors KW - Syndrome KW - United States AB -

BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.

OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640).

MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.

KEY RESULTS: Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %).

CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

VL - 31 UR - http://dx.doi.org/10.1007/s11606-016-3590-9 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26902246?dopt=Abstract ER - TY - JOUR T1 - Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? JF - Gerontologist Y1 - 2016 A1 - Lydia K Manning A1 - Dawn C Carr A1 - Ben Lennox Kail KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Resilience, Psychological KW - Retirement KW - Surveys and Questionnaires AB -

PURPOSE OF THE STUDY: In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.

DESIGN AND METHODS: This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.

RESULTS: Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.

IMPLICATIONS: Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.

VL - 56 UR - https://www.ncbi.nlm.nih.gov/pubmed/25063353 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25063353?dopt=Abstract ER - TY - JOUR T1 - Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function. JF - Nat Commun Y1 - 2016 A1 - Pattaro, Cristian A1 - Teumer, Alexander A1 - Gorski, Mathias A1 - Chu, Audrey Y A1 - Li, Man A1 - Mijatovic, Vladan A1 - Garnaas, Maija A1 - Tin, Adrienne A1 - Sorice, Rossella A1 - Yong Li A1 - Taliun, Daniel A1 - Olden, Matthias A1 - Foster, Meredith A1 - Qiong Yang A1 - Chen, Ming-Huei A1 - Pers, Tune H A1 - Andrew D Johnson A1 - Ko, Yi-An A1 - Fuchsberger, Christian A1 - Bamidele O Tayo A1 - Michael A Nalls A1 - Feitosa, Mary F A1 - Isaacs, Aaron A1 - Dehghan, Abbas A1 - d'Adamo, Pio A1 - Adebawole Adeyemo A1 - Dieffenbach, Aida Karina A1 - Alan B Zonderman A1 - Ilja M Nolte A1 - van der Most, Peter J A1 - Alan F Wright A1 - Alan R Shuldiner A1 - Alanna C Morrison A1 - Hofman, Albert A1 - Albert Vernon Smith A1 - Dreisbach, Albert W A1 - Franke, Andre A1 - André G Uitterlinden A1 - Andres Metspalu A1 - Tönjes, Anke A1 - Lupo, Antonio A1 - Robino, Antonietta A1 - Johansson, Åsa A1 - Demirkan, Ayse A1 - Kollerits, Barbara A1 - Freedman, Barry I A1 - Ponte, Belen A1 - Ben A Oostra A1 - Paulweber, Bernhard A1 - Krämer, Bernhard K A1 - Mitchell, Braxton D A1 - Buckley, Brendan M A1 - Peralta, Carmen A A1 - Caroline Hayward A1 - Helmer, Catherine A1 - Charles N Rotimi A1 - Shaffer, Christian M A1 - Müller, Christian A1 - Cinzia Felicita Sala A1 - Cornelia M van Duijn A1 - Saint-Pierre, Aude A1 - Daniel Ackermann A1 - Daniel Shriner A1 - Ruggiero, Daniela A1 - Toniolo, Daniela A1 - Lu, Yingchang A1 - Cusi, Daniele A1 - Czamara, Darina A1 - Ellinghaus, David A1 - David S Siscovick A1 - Ruderfer, Douglas A1 - Gieger, Christian A1 - Grallert, Harald A1 - Rochtchina, Elena A1 - Atkinson, Elizabeth J A1 - Holliday, Elizabeth G A1 - Boerwinkle, Eric A1 - Salvi, Erika A1 - Erwin P Bottinger A1 - Murgia, Federico A1 - Fernando Rivadeneira A1 - Ernst, Florian A1 - Kronenberg, Florian A1 - Hu, Frank B A1 - Navis, Gerjan J A1 - Curhan, Gary C A1 - Georg B Ehret A1 - Homuth, Georg A1 - Coassin, Stefan A1 - Thun, Gian-Andri A1 - Pistis, Giorgio A1 - Gambaro, Giovanni A1 - Malerba, Giovanni A1 - Grant W Montgomery A1 - Guðny Eiríksdóttir A1 - Jacobs, Gunnar A1 - Guo Li A1 - Wichmann, H-Erich A1 - Campbell, Harry A1 - Schmidt, Helena A1 - Wallaschofski, Henri A1 - Völzke, Henry A1 - Brenner, Hermann A1 - Kroemer, Heyo K A1 - Kramer, Holly A1 - Lin, Honghuang A1 - Irene Mateo Leach A1 - Ford, Ian A1 - Guessous, Idris A1 - Rudan, Igor A1 - Prokopenko, Inga A1 - Ingrid B Borecki A1 - Iris M Heid A1 - Kolcic, Ivana A1 - Persico, Ivana A1 - Jukema, J Wouter A1 - James F Wilson A1 - Felix, Janine F A1 - Divers, Jasmin A1 - Lambert, Jean-Charles A1 - Stafford, Jeanette M A1 - Gaspoz, Jean-Michel A1 - Jennifer A Smith A1 - Jessica Faul A1 - Wang, Jie Jin A1 - Ding, Jingzhong A1 - Joel N Hirschhron A1 - John R. Attia A1 - Whitfield, John B A1 - Chalmers, John A1 - Viikari, Jorma A1 - Coresh, Josef A1 - Denny, Joshua C A1 - Karjalainen, Juha A1 - Fernandes, Jyotika K A1 - Endlich, Karlhans A1 - Butterbach, Katja A1 - Keene, Keith L A1 - Kurt Lohman A1 - Portas, Laura A1 - Lenore J Launer A1 - Lyytikäinen, Leo-Pekka A1 - Yengo, Loic A1 - Lude L Franke A1 - Luigi Ferrucci A1 - Rose, Lynda M A1 - Kedenko, Lyudmyla A1 - Rao, Madhumathi A1 - Struchalin, Maksim A1 - Kleber, Marcus E A1 - Cavalieri, Margherita A1 - Haun, Margot A1 - Marilyn C Cornelis A1 - Ciullo, Marina A1 - Pirastu, Mario A1 - de Andrade, Mariza A1 - McEvoy, Mark A A1 - Woodward, Mark A1 - Adam, Martin A1 - Cocca, Massimiliano A1 - Nauck, Matthias A1 - Imboden, Medea A1 - Waldenberger, Melanie A1 - Pruijm, Menno A1 - Metzger, Marie A1 - Stumvoll, Michael A1 - Michele K Evans A1 - Sale, Michele M A1 - Kähönen, Mika A1 - Boban, Mladen A1 - Bochud, Murielle A1 - Rheinberger, Myriam A1 - Verweij, Niek A1 - Bouatia-Naji, Nabila A1 - Nicholas G Martin A1 - Nicholas D Hastie A1 - Nicole M Probst-Hensch A1 - Soranzo, Nicole A1 - Devuyst, Olivier A1 - Olli T Raitakari A1 - Gottesman, Omri A1 - Franco, Oscar H A1 - Polasek, Ozren A1 - Paolo P. Gasparini A1 - Munroe, Patricia B A1 - Ridker, Paul M A1 - Mitchell, Paul A1 - Muntner, Paul A1 - Meisinger, Christa A1 - Johannes H Smit A1 - Kovacs, Peter A1 - Wild, Philipp S A1 - Froguel, Philippe A1 - Rettig, Rainer A1 - Mägi, Reedik A1 - Biffar, Reiner A1 - Schmidt, Reinhold A1 - Middelberg, Rita P S A1 - Carroll, Robert J A1 - Brenda W J H Penninx A1 - Rodney J Scott A1 - Katz, Ronit A1 - Sedaghat, Sanaz A1 - Sarah Wild A1 - Sharon L R Kardia A1 - Ulivi, Sheila A1 - Hwang, Shih-Jen A1 - Enroth, Stefan A1 - Kloiber, Stefan A1 - Trompet, Stella A1 - Stengel, Benedicte A1 - Hancock, Stephen J A1 - Stephen T Turner A1 - Rosas, Sylvia E A1 - Stracke, Sylvia A1 - Tamara B Harris A1 - Zeller, Tanja A1 - Zemunik, Tatijana A1 - Lehtimäki, Terho A1 - Illig, Thomas A1 - Aspelund, Thor A1 - Nikopensius, Tiit A1 - Tõnu Esko A1 - Toshiko Tanaka A1 - Gyllensten, Ulf A1 - Völker, Uwe A1 - Emilsson, Valur A1 - Vitart, Veronique A1 - Aalto, Ville A1 - Gudnason, Vilmundur A1 - Chouraki, Vincent A1 - Chen, Wei-Min A1 - Igl, Wilmar A1 - März, Winfried A1 - Koenig, Wolfgang A1 - Lieb, Wolfgang A1 - Ruth J F Loos A1 - Yongmei Liu A1 - Snieder, Harold A1 - Pramstaller, Peter P A1 - Parsa, Afshin A1 - Jeff O'Connell A1 - Susztak, Katalin A1 - Hamet, Pavel A1 - Tremblay, Johanne A1 - de Boer, Ian H A1 - Böger, Carsten A A1 - Goessling, Wolfram A1 - Daniel I Chasman A1 - Köttgen, Anna A1 - Kao, W H Linda A1 - Caroline S Fox KW - Chronic disease KW - Genome-Wide Association Study KW - Genotype KW - Humans AB -

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.

VL - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26831199?dopt=Abstract ER - TY - THES T1 - Marital biography and chronic disease progression in mid- and late life T2 - Sociology Y1 - 2016 A1 - Yu, Yan-Liang KW - Chronic disease KW - Divorce KW - Longevity KW - Marriage KW - Mortality KW - Older Adults AB - In light of lengthening life expectancy with chronic disease and increasingly diverse marital experiences over the life course among older adults in the US, this dissertation investigates how marital biography is linked to chronic disease progression among older adults aged 50 years old and over in the US. I use three papers to address this overarching research question. The data are from the Health and Retirement Study (HRS), 1994–2012, a national panel sample representative of noninstitutionalized civilian adults aged at least 50 years old in the US. My first paper evaluates how current marital status and current marriage duration are associated with the development of functional limitations among older adults diagnosed with diabetes, using multilevel growth curve models. The findings show that remarried, cohabiting and divorced/separated older adults with diabetes report significantly more functional limitations at age 50 than their peers who stay in their first marriage. Although widowed older adults with diabetes report significantly fewer functional limitations than the first-time married at age 50, they show a faster decline in their functional health over time. The never-married show a similar functional health trajectory as the first-time married. The second paper assesses the link between marital quality and functional limitations among older adults diagnosed with cardiovascular disease. Multilevel models are used to estimate the associations between marital quality and functional health and control for household-level clustering effects. My analyses show that while negative dimensions of marital quality are significantly associated with worse functional health subsequently in two years for both older men and women with cardiovascular disease, positive dimensions of marital quality are significantly linked to better functional health only for men. Additionally, improvements in positive marital quality over a four-year period are significantly associated with better functional health four years later. The third paper examines differential mortality risk by marital trajectories among older adults with cardiovascular disease, focusing on their lifetime exposure to marital losses with Cox regression models. The analyses show that among the remarried, only those who are one-time widowed exhibit a significantly higher mortality risk than the first-time married. Both the currently divorced/separated and widowed experience significant mortality disadvantage compared to their peers in their first marriage. Additionally, older cohabitors with cardiovascular disease also show a heightened mortality risk. The never-married, however, show comparable mortality risk to that of the first-time married. Overall, the findings from this dissertation point to the significance of marriage for maintaining physical functioning for older adults while they manage major chronic illnesses such as diabetes and cardiovascular disease. However, the benefits of marriage for chronic disease management are also contingent upon past marital experience and relationship quality. I expect the findings to have important implications for healthcare professionals working with chronic disease patients and public policies regarding chronic disease management. JF - Sociology PB - Michigan State University CY - East Lansing VL - Ph.D. SN - 9781339966724 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1822210624?accountid=14667 ER - TY - JOUR T1 - Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - Christine E Gould A1 - Ruth O'Hara A1 - Mary K. Goldstein A1 - Sherry A. Beaudreau KW - Aged KW - Aged, 80 and over KW - Anxiety Disorders KW - Chronic disease KW - Depressive Disorder KW - Female KW - Humans KW - Logistic Models KW - Male KW - multimorbidity KW - Retirement KW - United States AB -

OBJECTIVES: The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms.

METHODS: A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models' outcome was elevated anxiety (≥12 on five-item Beck Anxiety Inventory) or depressive symptoms (≥12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses.

RESULTS: Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads.

CONCLUSION: Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

VL - 31 UR - https://www.ncbi.nlm.nih.gov/pubmed/27441851 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27441851?dopt=Abstract ER - TY - JOUR T1 - Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. JF - J Am Geriatr Soc Y1 - 2016 A1 - David C. Currow A1 - Amy P Abernethy A1 - Miriam J Johnson A1 - Yinghui Miao A1 - W John Boscardin A1 - Christine S Ritchie KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Anxiety KW - Chronic disease KW - Comorbidity KW - depression KW - Dyspnea KW - Female KW - Geriatric Assessment KW - Hospitalization KW - Humans KW - Male KW - Prevalence KW - Proportional Hazards Models KW - Risk Assessment KW - Risk Factors KW - Symptom Assessment KW - United States AB -

OBJECTIVES: To determine the prevalence and outcomes of breathlessness in older Americans.

SETTING: Community-dwelling older adults.

PARTICIPANTS: Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).

MEASUREMENTS: Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.

RESULTS: Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63%), multimorbidity (≥2 chronic conditions) (45%), current smokers (38%), heart disease (36%), obesity (body mass index ≥30.0 kg/m ) (33%), and education less than high school (32%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95% CI = 1.32-2.02).

CONCLUSION: One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40% greater risk of worsened function and 60% greater risk of death over the next 5 years.

VL - 64 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27603500?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 - Validating a summary measure of weight history for modeling the health consequences of obesity. JF - Ann Epidemiol Y1 - 2016 A1 - Andrew C. Stokes A1 - Ni, Yu KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Body Weight KW - Chronic disease KW - Female KW - Health Surveys KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Obesity KW - Self Report KW - United States AB -

PURPOSE: Data on weight history may enhance the predictive validity of epidemiologic models of the health risks of obesity, but collecting such data is often not feasible. In this study, we investigate the validity of a summary measure of weight history.

METHODS: We evaluated the quality of reporting of maximum weight in a sample of adults aged 50-84 years using data from the Health and Retirement Study. Recalled max body mass index (BMI, measured in kilogram per square meter) based on recalled weight in 2004 was compared with calculated max BMI based on self-reported weight collected biennially between 1992 and 2004. Logistic regression was used to assess similarity between the measures in predicting prevalent conditions.

RESULTS: The correlation coefficient between recalled and calculated max weight in the overall sample was 0.95. Recalled max BMI value was within three BMI units of the calculated value 91.4% of the time. The proportions of individuals with obese I (BMI: 30.0-34.9), obese II (BMI: 35.0-39.9), and obese III (BMI: 40.0 and above) were 28.8%, 12.7%, and 6.6% using recalled values compared with 27.1%, 10.5%, and 4.9% using calculated values. In multivariate analyses, the two BMI measures similarly predicted disease prevalence across a number of chronic conditions.

CONCLUSIONS: Recalled max BMI was strongly correlated with max BMI calculated over the 12-year period before recall, suggesting that this measure can serve as a reliable summary measure of recent weight status.

VL - 26 UR - http://linkinghub.elsevier.com/retrieve/pii/S1047279716304070http://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/plain IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27894565?dopt=Abstract JO - Annals of Epidemiology ER - TY - JOUR T1 - Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Jennifer A Ailshire A1 - Hiram Beltrán-Sánchez A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Cognition KW - Disability Evaluation KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Status KW - Health Surveys KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Marital Status KW - Prospective Studies KW - Sex Factors KW - United States AB -

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18%). Over half (55%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

PB - 70 VL - 70 UR - http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25136001?dopt=Abstract ER - TY - JOUR T1 - Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Stenholm, Sari A1 - Westerlund, Hugo A1 - Head, Jenny A1 - Hyde, Martin A1 - Ichiro Kawachi A1 - Pentti, Jaana A1 - Mika Kivimäki A1 - Vahtera, Jussi KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Comorbidity KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Socioeconomic factors KW - United States AB -

BACKGROUND: The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.

METHODS: Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline with biennial surveys from 1992 to 2010. Average length of follow-up was 10.3 years ranging from 0 to 18 years. Disease status and physical functioning was asked about at all study phases and 10 items were summed to obtain a physical functioning score (0-10).

RESULTS: Age modified the relationship between number of chronic diseases and physical functioning with older participants having more physical functioning difficulties with increasing number of diseases. An average 70-year-old participant with no diseases had 0.89 (95% CI: 0.85-0.93) physical functioning difficulties, with one disease 1.72 (95% CI: 1.69-1.76) difficulties, with two diseases 2.57 (95% CI: 2.52-2.62) difficulties, and with three or more diseases 3.82 (95% CI: 3.76-3.88) difficulties. Of the individual diseases memory-related diseases, stroke, pulmonary diseases, and arthritis were associated with significantly higher physical functioning difficulties compared with other diseases.

CONCLUSIONS: Comorbidity is associated with greater burden of physical functioning difficulties. Of the studied diseases, memory-related diseases, stroke, pulmonary diseases, and arthritis alone or in combination limit most physical functioning.

PB - 70 VL - 70 UR - http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25060316?dopt=Abstract U2 - PMC4336333 U4 - Aging/Comorbidity/Physical functioning/Disability/Disability ER - TY - JOUR T1 - Disease incidence and mortality among older Americans and Europeans. JF - Demography Y1 - 2015 A1 - Sole-Auro, Aida A1 - Pierre-Carl Michaud A1 - Michael D Hurd A1 - Eileen M. Crimmins KW - Age Distribution KW - Aged KW - Chronic disease KW - Europe KW - Health Behavior KW - Humans KW - Incidence KW - Middle Aged KW - Neoplasms KW - Prevalence KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25715676?dopt=Abstract ER - TY - JOUR T1 - Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population. JF - Health Serv Res Y1 - 2015 A1 - Chen, Yiqun A1 - Frank A Sloan KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Obesity KW - Prevalence KW - Sex Distribution KW - Smoking KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

PB - 50 VL - 50 IS - 5 N1 - Times Cited: 1 0 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25655273?dopt=Abstract U2 - PMC4600360 U4 - ADL/IADL/Disabilities/sociodemographic factors/sociodemographic factors/Chronic Disease/Smoking/Alcohol/obesity ER - TY - JOUR T1 - Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. JF - Prev Chronic Dis Y1 - 2015 A1 - Siran M Koroukian A1 - David F Warner A1 - Owusu, Cynthia A1 - Charles W Given KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Body Mass Index KW - Chronic disease KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Data Interpretation, Statistical KW - ethnicity KW - Female KW - Health Status Indicators KW - Humans KW - Interviews as Topic KW - Male KW - Middle Aged KW - Mobility Limitation KW - Outcome Assessment, Health Care KW - Prospective Studies KW - Recurrence KW - Retirement KW - Self Report KW - Smoking KW - Social Class KW - Syndrome KW - United States KW - Vulnerable Populations AB -

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

PB - 12 VL - 12 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25906436?dopt=Abstract U2 - PMC4415428 U4 - MORBIDITY/health status/health decline/mortality/baseline multimorbidity/health status ER - TY - JOUR T1 - Cohort differences in the marriage-health relationship for midlife women. JF - Soc Sci Med Y1 - 2014 A1 - Nicky J Newton A1 - Lindsay H Ryan A1 - Rachel T King A1 - Jacqui Smith KW - Age Factors KW - Aged KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Marital Status KW - Marriage KW - Middle Aged KW - Mobility Limitation KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

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

PB - 116 VL - 116 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24983699?dopt=Abstract U2 - PMC4625785 U4 - Midlife women/Health/Cohort/Marital status/LIFE EXPECTANCY/MENOPAUSE/divorce/functional limitations/regression Analysis/cohort differences ER - TY - JOUR T1 - Factors influencing the use of intensive procedures at the end of life. JF - J Am Geriatr Soc Y1 - 2014 A1 - Evan C Tschirhart A1 - Qingling Du A1 - Amy Kelley KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cause of Death KW - Chronic disease KW - Critical Care KW - Female KW - Homes for the Aged KW - Humans KW - Life Support Care KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Nursing homes KW - Odds Ratio KW - Terminal Care KW - United States KW - Utilization Review AB -

OBJECTIVES: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.

DESIGN: Retrospective cohort study.

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

PARTICIPANTS: HRS decedents aged 66 and older (N = 3,069).

MEASUREMENTS: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.

RESULTS: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51-0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54-0.94), cancer (AOR = 0.60, 95% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48-3.13) and black race (AOR = 2.02, 95% CI = 1.52-2.69) each doubled one's odds of undergoing an intensive procedure.

CONCLUSION: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.

PB - 62 VL - 62 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25376084?dopt=Abstract U2 - PMC4241150 U4 - end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES ER - TY - JOUR T1 - Longitudinal predictors of self-rated health and mortality in older adults. JF - Prev Chronic Dis Y1 - 2014 A1 - Diane C Wagner A1 - Jerome L Short KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic disease KW - depression KW - Educational Status KW - Female KW - Health Behavior KW - Health Status Indicators KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Recall KW - Middle Aged KW - Proportional Hazards Models KW - Psychometrics KW - Retirement KW - Self Report KW - Survival Analysis KW - United States AB -

INTRODUCTION: Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years.

METHODS: We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50-104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality.

RESULTS: Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health.

CONCLUSION: Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality.

PB - 11 VL - 11 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24901793?dopt=Abstract U2 - PMC4049199 U4 - Self assessed health/depression/mortality/memory decline/psychosocial influences/psychosocial influences ER - TY - JOUR T1 - Satisfaction with aging and use of preventive health services. JF - Prev Med Y1 - 2014 A1 - Eric S Kim A1 - Kyle D Moored A1 - Hannah L. Giasson A1 - Jacqui Smith KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Female KW - Health Behavior KW - Health Knowledge, Attitudes, Practice KW - Humans KW - Influenza Vaccines KW - Logistic Models KW - Male KW - Mammography KW - Middle Aged KW - Patient Acceptance of Health Care KW - Patient Satisfaction KW - Personal Satisfaction KW - Preventive Health Services KW - Prostatic Neoplasms KW - Surveys and Questionnaires KW - United States KW - Vaginal Smears AB -

OBJECTIVE: Preventive health service use is relatively low among older age groups. We hypothesized that aging satisfaction would be associated with increased use of preventive health services four years later.

METHOD: We conducted multiple logistic regression analyses on a sample of 6177 people from the Health and Retirement Study, a nationally representative study of U.S. adults over the age of 50 (M age=70.6; women n=3648; men n=2529).

RESULTS: Aging satisfaction was not associated with obtaining flu shots. However, in fully-adjusted models, each standard deviation increase in aging satisfaction was associated with higher odds of reporting service use for cholesterol tests (OR=1.10, 95% CI=1.00-1.20). Further, women with higher aging satisfaction were more likely to obtain a mammogram/x-ray (OR=1.17, 95% CI=1.06-1.29) or Pap smear (OR=1.10, 95% CI=1.00-1.21). Among men, the odds of obtaining a prostate exam increased with higher aging satisfaction (OR=1.20 95% CI=1.09-1.34).

CONCLUSION: These results suggest that aging satisfaction potentially influences preventive health service use after age 50.

PB - 69 VL - 69 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25240763?dopt=Abstract ER - TY - JOUR T1 - Self-rated health and morbidity onset among late midlife U.S. adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Kenzie Latham A1 - Chuck W Peek KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Morbidity KW - Predictive Value of Tests KW - Self Concept KW - Self Report KW - United States AB -

OBJECTIVES: Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years).

METHOD: Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770).

RESULTS: SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke.

DISCUSSION: This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

PB - 68 VL - 68 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23197340?dopt=Abstract U2 - PMC3605944 U4 - Middle age/Mortality/Chronic illnesses/Morbidity/Self assessed health/Chronic Disease/Stroke ER - TY - JOUR T1 - Association of chronic diseases and impairments with disability in older adults: a decade of change? JF - Med Care Y1 - 2012 A1 - William W. Hung A1 - Joseph S. Ross A1 - Boockvar, Kenneth S A1 - Albert L Siu KW - Activities of Daily Living KW - Aged KW - Aging KW - Cardiovascular Diseases KW - Chronic disease KW - Cognition Disorders KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Surveys KW - Hearing loss KW - Humans KW - Hypertension KW - Male KW - Mobility Limitation KW - Residence Characteristics KW - Respiratory Tract Diseases KW - Self Care KW - Socioeconomic factors KW - United States KW - Vision Disorders AB -

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99% confidence interval (CI), 1.06-1.46; OR = 1.07; 99% CI, 0.90-1.27; OR = 1.00; 99% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99% CI, 1.13-1.54; OR=0.97; 99% CI, 0.82-1.14; OR = 0.99; 99% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99% CI, 1.01-1.46; OR = 1.37; 99% CI, 1.15-1.64; OR = 1.52; 99% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99% CI, 1.33-2.03; OR = 1.63; 99% CI, 1.32-2.01; OR = 2.11; 99% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

PB - 50 VL - 50 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22584885?dopt=Abstract U2 - PMC3353149 U4 - Chronic Disease/DISABILITY/DISABILITY/impairment/impairment/Hypertension/Diabetes/lung disease ER - TY - JOUR T1 - Beware of being unaware: racial/ethnic disparities in chronic illness in the USA. JF - Health Econ Y1 - 2012 A1 - Chatterji, Pinka A1 - Heesoo Joo A1 - Kajal Chatterji Lahiri KW - Aged KW - Biomarkers KW - Black People KW - Chronic disease KW - Data collection KW - Diabetes Mellitus KW - ethnicity KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Hypertension KW - Male KW - Racial Groups KW - Self Report KW - United States KW - White People AB -

We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.

VL - 21 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22764038?dopt=Abstract U3 - 22764038 U4 - African-americans/biomarker data/trivariate probit model/Hispanics/self assessed health/diabetes/Hypertension ER - TY - JOUR T1 - A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults. JF - Medical Care Y1 - 2012 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Tu, Wanzhu A1 - Douglas K Miller KW - Accidental Falls KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Body Mass Index KW - Chronic disease KW - Female KW - Humans KW - Male KW - Mobility Limitation KW - Models, Statistical KW - Risk Assessment KW - Sex Factors AB -

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0% and 7.3% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

VL - 50 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22581013?dopt=Abstract ER - TY - JOUR T1 - Disability and decline in physical function associated with hospital use at end of life. JF - J Gen Intern Med Y1 - 2012 A1 - Amy Kelley A1 - Susan L Ettner A1 - R Sean Morrison A1 - Qingling Du A1 - Catherine A Sarkisian KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Dementia KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Frail Elderly KW - Geriatric Assessment KW - Hospitalization KW - Humans KW - Length of Stay KW - Longitudinal Studies KW - Male KW - Medicare KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions.

OBJECTIVE: To concurrently examine regional and patient factors, including disability and functional decline, associated with end-of-life hospital use.

DESIGN/PARTICIPANTS: We sampled decedents aged 65 and older (n = 2,493) from the Health and Retirement Study (2000-2006), and linked data from individual Medicare claims and the Dartmouth Atlas of Health Care. Two-part regression models estimated the relationship between total hospital days in the last 6 months and patient characteristics including physical function, while adjusting for regional resources and hospital care intensity (HCI).

KEY RESULTS: Median hospital days was 7 (range = 0-183). 53% of respondents had functional decline. Compared with decedents without functional decline, those with severe disability or decline had more regression-adjusted hospital days (range 3.47-9.05, depending on category). Dementia was associated with fewer days (-3.02); while chronic kidney disease (2.37), diabetes (2.40), stroke or transient ischemic attack (2.11), and congestive heart failure (1.74) were associated with more days. African Americans and Hispanics had more days (5.91 and 4.61, respectively). Those with family nearby had 1.62 fewer days and hospice enrollees had 1.88 fewer days. Additional hospital days were associated with urban residence (1.74) and residence in a region with more specialists (1.97) and higher HCI (2.27).

CONCLUSIONS: Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.

PB - 27 VL - 27 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22382455?dopt=Abstract U2 - PMC3378753 U4 - Public Policy/Medicare/end of life/Functional decline/Functional decline/Hospital Care Intensity Index/Hospital Care Intensity Index/end-of-life ER - TY - JOUR T1 - Does retirement trigger ill health? JF - Health Econ Y1 - 2012 A1 - Stefanie Behncke KW - Activities of Daily Living KW - Cardiovascular Diseases KW - Chronic disease KW - England KW - Health Status KW - Humans KW - Longitudinal Studies KW - Models, Econometric KW - Neoplasms KW - Quality of Life KW - Retirement KW - Risk Factors AB -

This paper investigates the effects of retirement on various health outcomes. Data stem from the first three waves of the English Longitudinal Study of Ageing (ELSA). With these informative data, non-parametric matching and instrumental variable (IV) methods are applied to identify causal effects. It is found that retirement significantly increases the risk of being diagnosed with a chronic condition. In particular, it raises the risk of a severe cardiovascular disease and cancer. This is also reflected in increased risk factors (e.g. BMI, cholesterol, blood pressure) and increased problems in physical activities. Furthermore, retirement worsens self-assessed health and an underlying health stock.

PB - 21 VL - 21 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21322085?dopt=Abstract U3 - 21322085 U4 - retirement/health/Cross-national/matching methods/instrumental variable/ELSA_ ER - TY - JOUR T1 - Health behavior change following chronic illness in middle and later life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2012 A1 - Jason T Newsom A1 - Nathalie Huguet A1 - Michael J. McCarthy A1 - Pamela Ramage-Morin A1 - Mark S Kaplan A1 - Julie Bernier A1 - Bentson McFarland A1 - Jillian Oderkirk KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Chi-Square Distribution KW - Chronic disease KW - Diabetes Mellitus KW - Exercise KW - Female KW - Health Behavior KW - Heart Diseases KW - Humans KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Middle Aged KW - Neoplasms KW - Smoking KW - Stroke KW - Time Factors AB -

OBJECTIVES: Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS: Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS: Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION: Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

PB - 67B VL - 67 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21983040?dopt=Abstract U2 - PMC3325087 U4 - Lifestyles/Lifestyles/Health behavior/Intervention/Quality of life/Medical diagnosis/Chronic illnesses/smoking Cessation ER - TY - JOUR T1 - Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults. JF - Am J Epidemiol Y1 - 2012 A1 - Melissa H. Roberts A1 - Douglas W Mapel KW - Activities of Daily Living KW - Aged KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Diabetes Mellitus KW - Female KW - Health Services KW - Health Status KW - Heart Diseases KW - Hospitalization KW - Humans KW - Incidence KW - Logistic Models KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Middle Aged KW - Neoplasms KW - Odds Ratio KW - Peak Expiratory Flow Rate KW - Population Surveillance KW - Stroke KW - United States AB -

The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50% (OR = 1.69, 95% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.

PB - 176 VL - 176 IS - 2 N1 - Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22759722?dopt=Abstract U2 - PMC3493194 U4 - peak expiratory flow/disability/disability/hospitalization/physical fitness ER - TY - JOUR T1 - Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study. JF - J Occup Environ Med Y1 - 2011 A1 - Xiuwen S Dong A1 - Wang, Xuanwen A1 - Daw, Christina A1 - Ringen, Knut KW - Aged KW - Aging KW - Arthritis KW - Chronic disease KW - Disabled Persons KW - Facility Design and Construction KW - Follow-Up Studies KW - Humans KW - Lung Diseases KW - Male KW - Middle Aged KW - Occupational Diseases KW - Occupations KW - United States AB -

OBJECTIVES: To examine the health status of older construction workers in the United States, and how occupation and the aging process affect health in workers' later years.

METHODS: We analyzed six waves (1998 to 2008) of the Health and Retirement Study, a longitudinal survey of US residents age 50+. The study sample totaled 7200 male workers (510 in construction trades) in the baseline. Multiple logistic regression and paired t tests were conducted to compare health outcomes across occupations and within individuals over time.

RESULTS: Compared with white-collar workers, construction workers had increased odds of arthritis, back problems, chronic lung disease, functional limitations, work disability, and work-related injuries after controlling for possible confounders.

CONCLUSIONS: Safety and health interventions, as well as retirement and pension policy, should meet the needs of older construction workers, who face increasingly chronic health conditions over time.

PB - 53 VL - 53 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21407096?dopt=Abstract U3 - 21407096 U4 - Occupation/Aging/DISABILITY/DISABILITY/construction workers/chronic Disease ER - TY - JOUR T1 - Conscientiousness and longevity: an examination of possible mediators. JF - Health Psychol Y1 - 2011 A1 - Patrick L Hill A1 - Nicholas A. Turiano A1 - Michael D Hurd A1 - Daniel K. Mroczek A1 - Brent W Roberts KW - Adult KW - Aged KW - Chronic disease KW - Cognition KW - Educational Status KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personality KW - Proportional Hazards Models KW - Psychological Tests AB -

OBJECTIVE: Conscientious individuals tend to experience a number of health benefits, not the least of which being greater longevity. However, it remains an open question as to why this link with longevity occurs. The current study tested two possible mediators (physical health and cognitive functioning) of the link between conscientiousness and longevity.

METHOD: We tested these mediators using a 10-year longitudinal sample (N = 512), a subset of the long-running Health and Retirement Study of aging adults. Measures included an adjective-rating measure of conscientiousness, self-reported health conditions, and three measures of cognitive functioning (word recall, delayed recall, and vocabulary) included in the 1996 wave of the HRS study.

RESULTS: Our results found that conscientiousness significantly predicted greater longevity, even in a model including the two proposed mediator variables, gender, age, and years of education. Moreover, cognitive functioning appears to partially mediate this relationship.

CONCLUSIONS: This study replicates previous research showing that conscientious individuals tend to lead longer lives, and provides further insight into why this effect occurs. In addition, it underscores the importance of measurement considerations.

PB - 30 VL - 30 IS - 5 N1 - Hill, Patrick L Turiano, Nicholas A Hurd, Michael D Mroczek, Daniel K Roberts, Brent W R01 AG021178-09/AG/NIA NIH HHS/United States United States Health psychology : official journal of the Division of Health Psychology, American Psychological Association Health Psychol. 2011 Sep;30(5):536-41. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21604882?dopt=Abstract U2 - PMC3587967 U4 - Adult/Chronic Disease/mortality/psychology/Chronic Disease/mortality/psychology/Cognition/Educational Status/Female/Health Behavior/Health Status/Humans/Longevity/Longitudinal Studies/Middle Aged/Personality/Personality/Proportional Hazards Models/Psychological Tests ER - TY - JOUR T1 - Depression and the onset of chronic illness in older adults: a 12-year prospective study. JF - J Behav Health Serv Res Y1 - 2011 A1 - Mustafa C. Karakus A1 - Lisa C Patton KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Chronic disease KW - depression KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression.

PB - 38 VL - 38 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21293976?dopt=Abstract U4 - Chronic illnesses/Older people/Correlation analysis/Mental depression/Experiment/theoretical treatment/Health care industry 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 differences in health: results from SHARE, ELSA and HRS. JF - Eur J Public Health Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Sole-Auro, Aida KW - Activities of Daily Living KW - Aged KW - Aging KW - Body Weights and Measures KW - Chronic disease KW - Employment KW - Female KW - Global Health KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Self Report KW - Sex Factors AB -

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

VL - 21 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20237171?dopt=Abstract U2 - PMC3023013 U4 - cross-national comparison/gender Differences/ELSA_/SHARE/SELF-RATED HEALTH/health Behavior/disease prevalence/DISABILITY/DISABILITY ER - TY - JOUR T1 - Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples. JF - J Gerontol Soc Work Y1 - 2011 A1 - Gaines, Jean M A1 - Judith L Poey A1 - Marx, Katherine A A1 - J. M. Parrish A1 - Resnick, Barbara KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Case-Control Studies KW - Chronic disease KW - depression KW - Female KW - Geriatric Assessment KW - Health Services KW - Health Services for the Aged KW - Health Status KW - Home Care Services KW - Hospitalization KW - Humans KW - Interview, Psychological KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Psychometrics KW - Retirement AB -

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

PB - 54 VL - 54 IS - 8 N1 - Gaines, Jean M Poey, Judith L Marx, Katherine A Parrish, John M Resnick, Barbara England Journal of gerontological social work J Gerontol Soc Work. 2011 Nov;54(8):788-802. doi: 10.1080/01634372.2011.595476. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22060005?dopt=Abstract U3 - 22060005 U4 - health Status/Continuing care retirement communities/COMORBIDITY/Self assessed health ER - TY - JOUR T1 - How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Ana R Quiñones A1 - Jersey Liang A1 - Joan M. Bennett A1 - Xiao Xu A1 - Wen Ye KW - Aged KW - Aged, 80 and over KW - Aging KW - Black or African American KW - Chronic disease KW - Female KW - Follow-Up Studies KW - Health Behavior KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States KW - White People AB -

OBJECTIVES: This research examines intra- and interpersonal differences in multiple chronic conditions reported by Americans aged 51 and older for a period up to 11 years. It focuses on how changes in multimorbidity vary across White, Black, and Mexican Americans.

METHODS: Data came from 17,517 respondents of the Health and Retirement Study (1995-2006) with up to 5 repeated observations. Hierarchical linear models were employed to analyze ethnic variations in temporal changes of reported comorbidities.

FINDINGS: Middle-aged and older Americans have on average nearly 2 chronic diseases at the baseline, which increased to almost 3 conditions in 11 years. White Americans differ from Black and Mexican Americans in terms of level and rate of change of multimorbidity. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to Whites. In contrast, Blacks showed an elevated level of multimorbidity throughout the 11-year period of observation, although their rate of change slowed relative to Whites.

DISCUSSION: These results suggest that health differences between Black Americans and other ethnic groups including White and Mexican Americans persist in the trajectory of multimorbidity even when population heterogeneity is adjusted. Further research is needed concerning the impact of health disadvantages and differential mortality that may have occurred before middle age as well as exploring the role of nativity, the nature of self-reported diseases, and heterogeneity underlying the average trajectory of multimorbidity for ethnic elders.

PB - 66 VL - 66 IS - 6 N1 - Quinones, Ana R Liang, Jersey Bennett, Joan M Xu, Xiao Ye, Wen F31-AG029783/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Nov;66(6):739-49. Epub 2011 Oct 3. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21968384?dopt=Abstract U2 - PMC3198247 U4 - African Americans/ statistics/African Americans/ statistics/numerical data/Aged, 80 and over/Aging/Chronic Disease/ ethnology/Chronic Disease/ ethnology/European Continental Ancestry Group/ statistics/European Continental Ancestry Group/ statistics/numerical data/Female/Follow-Up Studies/Follow-Up Studies/Health Behavior/ ethnology/Health Behavior/ ethnology/Health Status Disparities/Hispanic Americans/ statistics/Hispanic Americans/ statistics/numerical data/Humans/Linear Models/Linear Models/Longitudinal Studies/Middle Aged/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Lifecourse socioeconomic circumstances and multimorbidity among older adults. JF - BMC Public Health Y1 - 2011 A1 - Reginald D. Tucker-Seeley A1 - Li, Yi A1 - Sorensen, Glorian A1 - Subramanian, S V KW - Aged KW - Chronic disease KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - Humans KW - Male KW - Middle Aged KW - Social Class KW - United States AB -

BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

PB - 11 VL - 11 N1 - Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21569558?dopt=Abstract U2 - PMC3118239 U4 - Chronic Disease/epidemiology/Chronic Disease/epidemiology/Comorbidity/ trends/Comorbidity/ trends/Cross-Sectional Studies/Female/Humans/Middle Aged/Social Class/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Neighborhoods and chronic disease onset in later life. JF - Am J Public Health Y1 - 2011 A1 - Vicki A Freedman A1 - Irina B Grafova A1 - Jeannette Rogowski KW - Aged KW - Chronic disease KW - Environment Design KW - Factor Analysis, Statistical KW - Female KW - Health Resources KW - Health Status Disparities KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Poverty Areas KW - Residence Characteristics KW - Risk Factors KW - Small-Area Analysis KW - Social Environment KW - Social Problems KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults.

METHODS: Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting the onset of heart problems, hypertension, stroke, diabetes, cancer, and arthritis by 2004 were estimated.

RESULTS: In adjusted models, living in more economically disadvantaged areas predicted the onset of heart problems for women (odds ratio [OR] = 1.20; P < .05). Living in more highly segregated, higher-crime areas was associated with greater chances of developing cancer for men (OR = 1.31; P < .05) and women (OR = 1.25; P < .05).

CONCLUSIONS: The neighborhood economic environment is associated with heart disease onset for women, and neighborhood-level social stressors are associated with cancer onset for men and women. The social and biological mechanisms that underlie these associations require further investigation.

PB - 101 VL - 101 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20299643?dopt=Abstract U2 - PMC2912970 U4 - Chronic Disease/neighborhood Characteristics/Safety/crime/Heart disease/CANCER ER - TY - JOUR T1 - Recent trends in chronic disease, impairment and disability among older adults in the United States. JF - BMC Geriatr Y1 - 2011 A1 - William W. Hung A1 - Joseph S. Ross A1 - Boockvar, Kenneth S A1 - Albert L Siu KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - United States KW - Visually Impaired Persons AB -

BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008.

CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

PB - 11 VL - 11 N1 - Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21851629?dopt=Abstract U2 - PMC3170191 U4 - PREVALENCE/concurrent prevalence trends/concurrent prevalence trends/Chronic Disease/impairment/impairment/DISABILITY/DISABILITY/ADL and IADL Impairments ER - TY - JOUR T1 - Subsidized housing not subsidized health: health status and fatigue among elders in public housing and other community settings. JF - Ethn Dis Y1 - 2011 A1 - Parsons, Pamela L A1 - Briana Mezuk A1 - Scott M Ratliff A1 - Kate L Lapane KW - Aged KW - Chronic disease KW - Comorbidity KW - Cross-Sectional Studies KW - Fatigue KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Poverty KW - Prevalence KW - Public Housing KW - United States AB -

OBJECTIVES: To estimate trends in the prevalence of fatigue among elders living in public housing or in the community; to compare health status of elders living in public housing to their community-dwelling counterparts.

DESIGN: Cross-sectional study.

SETTING: Community-dwelling elders who reported ever residing in public housing were compared to those living in other community settings.

PARTICIPANTS: Participants of the Health and Retirement Study (seven waves of interviews conducted from 1995 through 2006) interviewed in 2006 with complete data on housing status, self-report measures of health status and measures of functioning (n = 16,191).

MEASUREMENTS: Self-reported fatigue, functioning, and other health conditions. We also evaluated four functional indices: overall mobility, large muscle functioning, gross motor functioning, and fine motor functioning.

RESULTS: Those reporting having lived in public housing were twice as likely to rate their health as fair or poor relative to those with no public housing experience (57.3% vs 26.9%, respectively). Cardiac conditions, stroke, hypertension, diabetes, arthritis and psychiatric problems were all more prevalent in those living in public housing relative to community-dwelling elders not living in public housing. Fatigue was more prevalent in persons residing in public housing (26.7%) as compared to other community-dwelling elders (17.8%).

CONCLUSION: The health status of persons residing in public housing is poor. Fatigue and comorbid conditions are highly prevalent and more common in those living in public housing. Developing care models that meet the needs of this oft-neglected population is warranted.

PB - 21 VL - 21 UR - https://pubmed.ncbi.nlm.nih.gov/21462736/ IS - 1 N1 - Parsons, Pamela L Mezuk, Briana Ratliff, Scott Lapane, Kate L K12 HD055881/HD/NICHD NIH HHS/United States UL1 RR031990-01/RR/NCRR NIH HHS/United States UL1RR031990/RR/NCRR NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States Ethnicity and disease Nihms287854 Ethn Dis. 2011 Winter;21(1):85-90. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21462736?dopt=Abstract U2 - PMC3111957 U4 - Chronic Disease/epidemiology/Chronic Disease/epidemiology/Comorbidity/Cross-Sectional Studies/Fatigue/ epidemiology/Fatigue/ epidemiology/Female/Health Status Disparities/Humans/Poverty/Prevalence/Public Housing/Public Housing/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Activities of daily living, social support, and future health of older Americans. JF - J Psychol Y1 - 2010 A1 - Bozo, Ozlem A1 - Charles A Guarnaccia KW - Activities of Daily Living KW - Adaptation, Psychological KW - Aged KW - Aging KW - Caregivers KW - Chronic disease KW - Female KW - Friends KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personal Satisfaction KW - Retirement KW - Risk Factors KW - Sick Role KW - Social Support KW - Spouses AB -

The authors investigated the relation of activities of daily living (ADL) and social support satisfaction to illness status 10 years later among 4,870 married older adults in the Health and Retirement Study (F. Juster & R. Suzman, 1995). The authors tested the direct and indirect effects of 1992 ADL, as well as family and friends support satisfaction and spousal social support satisfaction on 2002 illness status. The hierarchical multiple regressions found, controlling for 1992 illness status, ADL protected against future illness, and family and friends and spousal support satisfaction had small, surprisingly positive, effects on greater 2002 illness. The ADL x Family and Friends Support Satisfaction and the ADL x Spousal Support Satisfaction crossproduct interactions were also small positive predictors of later illness. The authors discuss several possible mechanisms that explained this unexpected result. The authors concluded that, depending on whether the recipient is in need of support and depending on the source of the support, the older adults do or do not benefit from the support.

PB - 144 VL - 144 IS - 1 N1 - Using Smart Source Parsing Jan-Feb Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20092067?dopt=Abstract U3 - 20092067 U4 - Activities of Daily Living/social Support/health care/families/Transfers ER - TY - JOUR T1 - The case for involving adult children outside of the household in the self-management support of older adults with chronic illnesses. JF - Chronic Illn Y1 - 2010 A1 - John D Piette A1 - Ann Marie Rosland A1 - Maria J Silveira A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Adult KW - Chronic disease KW - Family Relations KW - Female KW - Humans KW - Male KW - Middle Aged KW - Self Care KW - Social Support AB -

OBJECTIVES: This study sought to (1) identify barriers to spousal support for chronic illness self-care among community-dwelling older adults; and (2) describe the potential availability of self-care support from adult children living outside of the household.

METHODS: Nationally representative US sample of chronically ill adults aged 51+ were interviewed as part of the Health and Retirement Study (N = 14,862). Both participants and their spouses (when available) reported information about their health and functioning. Participants also reported information about their contact with adult children and the quality of those relationships.

RESULTS: More than one-third (38%) of chronically ill older adults in the US are unmarried; and when spouses are available, the majority of them have multiple chronic diseases and functional limitations. However, the vast majority of chronically ill older adults (93%, representing roughly 60 million Americans) have adult children, with half having children living over 10 miles away. Most respondents with children (78%) reported at least weekly telephone contact and that these relationships were positive. Roughly 19 million older chronically ill Americans have adult children living at a distance but none nearby; these children are in frequent telephone contact and respondents (including those with multiple chronic diseases) report that the relationships are positive.

DISCUSSION: As the gap between available health services for disease management and the need among community-dwelling patients continues to grow, adult children-including those living at a distance-represent an important resource for improving self-care support for people with chronic diseases.

PB - 6 VL - 6 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20308349?dopt=Abstract U2 - PMC2864454 U4 - self-care/Chronic Disease ER - TY - JOUR T1 - Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults. JF - Soc Sci Med Y1 - 2010 A1 - F. Renna A1 - Thakur, Nidhi KW - Chronic disease KW - Disabled Persons KW - Employment KW - Female KW - Humans KW - Male KW - Middle Aged KW - Obesity KW - Retirement KW - Risk Factors KW - Sex Factors KW - United States AB -

In this paper, we study the impact of obesity on labor market decisions of older working age adults in USA. Labor market outcomes are defined as any one of three: working; not working due to a disability; or not working due to an early retirement. Based on existing medical literature, we deduce that obesity can largely impact labor market decisions directly through impairment of bodily functions and indirectly by being a risk factor for various diseases like hypertension, arthritis, etc. We use data from the US Health and Retirement Study on older adults who were no more than 64 years of age in 2002. In our modeling effort, we employ two estimation strategies. We first estimate a model in which employment outcome in 2002 is a function of weight status in 1992. In the second strategy, controlling for time-invariant individual heterogeneity, we first consider the impact of obesity on bodily impairments and chronic illnesses; then, we consider the impact of such impairments and illnesses on labor market outcomes. Our results indicate that, for men, obesity class 2 and 3 increases both the probability of taking an early retirement and the incidence of disability by 1.5 percentage points. For women, we find that obesity class 2 and 3 increases the probability of taking an early retirement by 2.5 percentage points and the incidence of disability by 1.7 percentage points.

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/20488600?dopt=Abstract U3 - 20488600 U4 - Obesity/Retirement/chronic illness/labor Force Participation/Physical handicaps ER - TY - JOUR T1 - The epidemiology of pain during the last 2 years of life. JF - Ann Intern Med Y1 - 2010 A1 - Alexander K Smith A1 - Irena Cenzer A1 - Sara J Knight A1 - Kathleen A Puntillo A1 - Eric W Widera A1 - Brie A Williams A1 - W John Boscardin A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Arthritis KW - Chronic disease KW - Cross-Sectional Studies KW - Death KW - Female KW - Humans KW - Male KW - pain KW - Palliative care KW - Prevalence KW - Quality of Life KW - Socioeconomic factors KW - Terminally Ill KW - Time Factors AB -

BACKGROUND: The epidemiology of pain during the last years of life has not been well described.

OBJECTIVE: To describe the prevalence and correlates of pain during the last 2 years of life.

DESIGN: Observational study. Data from participants who died while enrolled in the Health and Retirement Study were analyzed. The survey interview closest to death was used. Each participant or proxy was interviewed once in the last 24 months of life and was classified into 1 of 24 cohorts on the basis of the number of months between the interview and death. The relationship between time before death and pain was modeled and was adjusted for age, sex, race or ethnicity, education level, net worth, income, terminal diagnosis category, presence of arthritis, and proxy status.

SETTING: The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006).

PARTICIPANTS: Older adult decedents.

MEASUREMENTS: Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity.

RESULTS: The sample included 4703 decedents. Mean age (SD) of participants was 75.7 years (SD, 10.8); 83.1% were white, 10.7% were black, 4.7% were Hispanic; and 52.3% were men. The adjusted prevalence of pain 24 months before death was 26% (95% CI, 23% to 30%). The prevalence remained flat until 4 months before death (28% [CI, 25% to 32%]), then it increased, reaching 46% (CI, 38% to 55%) in the last month of life. The prevalence of pain in the last month of life was 60% among patients with arthritis versus 26% among patients without arthritis (P < 0.001) and did not differ by terminal diagnosis category (cancer [45%], heart disease [48%], frailty [50%], sudden death [42%], or other causes [47%]; P = 0.195).

LIMITATION: Data are cross-sectional; 19% of responses were from proxies; and information about cause, location, and treatment of pain was not available.

CONCLUSION: Although the prevalence of pain increases in the last 4 months of life, pain is present in more than one quarter of elderly persons during the last 2 years of life. Arthritis is strongly associated with pain at the end of life.

PRIMARY FUNDING SOURCE: National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.

PB - 153 VL - 153 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21041575?dopt=Abstract U2 - PMC3150170 ER - TY - JOUR T1 - Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. JF - Value Health Y1 - 2010 A1 - Zivin, Kara A1 - Scott M Ratliff A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - John D Piette KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Medication Adherence KW - Models, Econometric KW - Multivariate Analysis KW - Prescription Fees KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: Although multiple noncost factors likely influence a patient's propensity to forego treatment in the face of cost pressures, little is known about how patients' sociodemographic characteristics, physical and behavioral health comorbidities, and prescription regimens influence cost-related nonadherence (CRN) to medications. We sought to determine both financial and nonfinancial factors associated with CRN in a nationally representative sample of older adults.

METHODS: We used a conceptual model developed by Piette and colleagues that describes financial and nonfinancial factors that could increase someone's risk of CRN, including income, comorbidities, and medication regimen complexity. We used data from the 2004 wave of the Health and Retirement Study and the 2005 HRS Prescription Drug Study to examine the influence of factors within each of these domains on measures of CRN (including not filling, stopping, or skipping doses) in a nationally representative sample of Americans age 65+ in 2005.

RESULTS: Of the 3071 respondents who met study criteria, 20% reported some form of CRN in 2005. As in prior studies, indicators of financial stress such as higher out-of-pocket payments for medications and lower net worth were significantly associated with CRN in multivariable analyses. Controlling for these economic pressures, relatively younger respondents (ages 65-74) and depressive symptoms were consistent independent risk factors for CRN.

CONCLUSIONS: Noncost factors influenced patients' propensity to forego treatment even in the context of cost concerns. Future research encompassing clinician and health system factors should identify additional determinants of CRN beyond patients' cost pressures.

PB - 13 VL - 13 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20070641?dopt=Abstract U2 - PMC3013351 U4 - health Care Costs/socioeconomic Status/cost-related nonadherence/risk factors ER - TY - JOUR T1 - Obesity and excess mortality among the elderly in the United States and Mexico. JF - Demography Y1 - 2010 A1 - Monteverde, Malena A1 - Noronha, Kenya A1 - Alberto Palloni A1 - Beatriz Novak KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic disease KW - Female KW - Humans KW - Logistic Models KW - Male KW - Mexico KW - Middle Aged KW - Mortality KW - Multivariate Analysis KW - Obesity KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

Increasing levels of obesity could compromise future gains in life expectancy in low- and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BAI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U.S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

PB - 47 VL - 47 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20355685?dopt=Abstract U2 - PMC3000005 U4 - health risk/Obesity/Body Mass Index/socioeconomic Status/Cross Cultural Comparison/cross-national comparison/MHAS_ ER - TY - JOUR T1 - Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Brian J Ayotte A1 - Frances Margaret Yang A1 - Richard N Jones KW - Age Factors KW - Aged KW - Chi-Square Distribution KW - Chronic disease KW - Cohort Studies KW - depression KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Least-Squares Analysis KW - Male KW - Marriage KW - Middle Aged KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - Spouses KW - Stroke AB -

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands' stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives' health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20498455?dopt=Abstract U2 - PMC2883871 U4 - Chronic Disease/depression/Stroke/Stress/Sex Differences ER - TY - JOUR T1 - Comparing models of frailty: the Health and Retirement Study. JF - J Am Geriatr Soc Y1 - 2009 A1 - Christine T Cigolle A1 - Mary Beth Ofstedal A1 - Zhiyi Tian A1 - Caroline S Blaum KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cross-Sectional Studies KW - Demography KW - Disability Evaluation KW - Frail Elderly KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Models, Theoretical KW - United States AB -

OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).

DESIGN: Cross-sectional analysis.

SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.

MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.

RESULTS: Almost one-third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95% CI=1.2-2.5), and African-American ethnicity (OR=2.1, % CI=1.0-4.4).

CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.

PB - 57 VL - 57 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19453306?dopt=Abstract U3 - 19453306 U4 - FRAILTY/Models, Theoretical ER - TY - JOUR T1 - Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. JF - Am J Public Health Y1 - 2009 A1 - Mauricio Avendano A1 - M. Maria Glymour A1 - James Banks A1 - Johan P Mackenbach KW - Age Factors KW - Aged KW - Chronic disease KW - Confidence Intervals KW - Disabled Persons KW - Europe KW - Female KW - Health Status Disparities KW - Heart Diseases KW - Humans KW - Male KW - Middle Aged KW - Odds Ratio KW - Poverty KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: We compared the health of older US, English, and other European adults, stratified by wealth.

METHODS: Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17,481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.

RESULTS: American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

CONCLUSIONS: American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

PB - 99 VL - 99 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19150903?dopt=Abstract U2 - PMC2661456 U4 - Chronic Disease/cross-national comparison/socioeconomic Factors/Heart disease/health status disparities/risk factors/SHARE/ELSA_ ER - TY - JOUR T1 - Chronic conditions and mortality among the oldest old. JF - Am J Public Health Y1 - 2008 A1 - Sei J. Lee A1 - Alan S Go A1 - Lindquist, Karla A1 - Bertenthal, Daniel A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - Predictive Value of Tests KW - Proportional Hazards Models KW - Reproducibility of Results KW - Risk Adjustment KW - Severity of Illness Index KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

RESULTS: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

CONCLUSIONS: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

PB - 98 VL - 98 IS - 7 N1 - PMID 18511714 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18511714?dopt=Abstract U2 - PMC2424085 U4 - Chronic Disease/Mortality/Age Factors ER - TY - JOUR T1 - Declines in late-life disability: the role of early- and mid-life factors. JF - Soc Sci Med Y1 - 2008 A1 - Vicki A Freedman A1 - Linda G Martin A1 - Robert F. Schoeni A1 - Jennifer C. Cornman KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Cross-Sectional Studies KW - Disabled Persons KW - Female KW - Frail Elderly KW - Health Behavior KW - Health Status KW - Health Surveys KW - Humans KW - Life Style KW - Logistic Models KW - Male KW - Morbidity KW - Population Surveillance KW - Socioeconomic factors KW - United States AB -

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

PB - 66 VL - 66 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18222580?dopt=Abstract U2 - PMC2408829 U4 - aging/DISABILITY/DISABILITY/Health Risk ER - TY - JOUR T1 - Effect of arthritis in middle age on older-age functioning. JF - J Am Geriatr Soc Y1 - 2008 A1 - Kenneth E Covinsky A1 - Lindquist, Karla A1 - Dorothy D Dunlop A1 - Thomas M Gill A1 - Yelin, Edward KW - Activities of Daily Living KW - Arthritis KW - Chronic disease KW - Confidence Intervals KW - Female KW - Follow-Up Studies KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Prognosis KW - Prospective Studies KW - Risk Factors KW - Severity of Illness Index KW - Surveys and Questionnaires KW - Time Factors KW - Walking AB -

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.

DESIGN: Prospective longitudinal study.

SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.

PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.

MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.

RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34% vs 18%, adjusted hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.43-1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30% vs 16%, adjusted HR=1.55, 95% CI=1.41-1.71) and persistent difficulty in ADL function (13% vs 5%, adjusted HR=1.85, 95% CI=1.58-2.16).

CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.

PB - 56 VL - 56 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18184204?dopt=Abstract U2 - PMC2875135 U4 - arthritis/Activities of Daily Living/Mobility ER - TY - JOUR T1 - Health status and health dynamics in an empirical model of expected longevity. JF - J Health Econ Y1 - 2008 A1 - Hugo Benítez-Silva A1 - Ni, Huan KW - Chronic disease KW - Delivery of Health Care KW - Empirical Research KW - Female KW - Health Expenditures KW - Health Status KW - Humans KW - Life Expectancy KW - Longevity KW - Male KW - Models, Econometric AB -

Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

PB - 27 VL - 27 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18187217?dopt=Abstract U2 - PMC2862058 U4 - Longevity/PREDICTIVE MODEL/HEALTH ER - TY - JOUR T1 - Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans. JF - Psychosom Med Y1 - 2008 A1 - Frances Margaret Yang A1 - Richard N Jones KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Comorbidity KW - Confounding Factors, Epidemiologic KW - Culture KW - depression KW - Diabetes Mellitus KW - Educational Status KW - ethnicity KW - Factor Analysis, Statistical KW - Female KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Lung Diseases KW - Male KW - Self-Assessment KW - Sex Factors KW - Stroke KW - United States AB -

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

PB - 70 VL - 70 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18981269?dopt=Abstract U2 - PMC2746732 U4 - Chronic Disease/Demographics/Depressive Symptoms/Psychology ER - TY - JOUR T1 - Work disability associated with cancer survivorship and other chronic conditions. JF - Psychooncology Y1 - 2008 A1 - Pamela F. Short A1 - Joseph J. Vasey A1 - BeLue, Rhonda KW - Adult KW - Aged KW - Chronic disease KW - Disability Evaluation KW - Employment KW - Female KW - Humans KW - Male KW - Maryland KW - Middle Aged KW - Neoplasms KW - Pennsylvania KW - Survivors AB -

The long-term effects of cancer and its treatment on employment and productivity are a major concern for the 40% of cancer survivors in the U.S. who are working age. This study's objectives were (1) to quantify the increase in work disability attributable to cancer in a cohort of adult survivors who were an average of 46 months post-diagnosis and (2) to compare disability rates in cancer survivors to individuals with other chronic conditions. Data from the Penn State Cancer Survivor Study (PSCSS) and the Health and Retirement Study (HRS) were compared. The PSCSS sample included 647 survivors age 55-65, diagnosed at four medical centers in Pennsylvania and Maryland. There were 5988 similarly aged subjects without cancer in the HRS. Adjusted odds ratios for work disability were estimated for cancer survivorship, heart disease, stroke, diabetes, lung disease, and arthritis/rheumatism with multivariate logistic regression. Even for cancer-free survivors, the adjusted disability rate was significantly higher in comparison to adults with no chronic conditions (female OR = 1.94; male OR = 1.89). There were few significant differences between disability rates for cancer and other conditions. The elevated disability rate is another argument for viewing cancer survivorship as a chronic condition potentially requiring a broad range of psychosocial services.

PB - 17 VL - 17 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17429835?dopt=Abstract U3 - 17429835 U4 - CANCER/Chronic Disease/DISABILITY/DISABILITY/Work Behavior ER - TY - JOUR T1 - Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. JF - Gerontologist Y1 - 2007 A1 - Schoenberg, Nancy E. A1 - Hyungsoo Kim A1 - Edwards, William A1 - Fleming, Steven T. KW - Aged KW - Arthritis KW - Chronic disease KW - Comorbidity KW - Cost of Illness KW - Female KW - Financing, Personal KW - Health Expenditures KW - Health Surveys KW - Heart Diseases KW - Humans KW - Hypertension KW - Interviews as Topic KW - Male KW - Middle Aged KW - United States AB -

PURPOSE: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults.

DESIGN AND METHODS: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease.

RESULTS: An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations.

IMPLICATIONS: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

PB - 47 VL - 47 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17766664?dopt=Abstract U4 - Chronic Disease/Morbidity,/Medical Expenditures ER - TY - JOUR T1 - Educational disparities in the prevalence and consequence of physical vulnerability. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Daniel O. Clark A1 - Timothy E. Stump A1 - Douglas K Miller A1 - Long, J. Scott KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cohort Studies KW - Cross-Sectional Studies KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Risk Factors KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States.

METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index.

RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education.

DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507595?dopt=Abstract U4 - Mortality/Physical Vulnerability/Education/ADULT HEALTH/DISABILITY/DISABILITY ER - TY - JOUR T1 - Geriatric conditions and disability: the Health and Retirement Study. JF - Ann Intern Med Y1 - 2007 A1 - Christine T Cigolle A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Zhiyi Tian A1 - Caroline S Blaum KW - Accidental Falls KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Chronic disease KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Disability Evaluation KW - Dizziness KW - Female KW - Geriatric Assessment KW - Geriatrics KW - Hearing Disorders KW - Humans KW - Male KW - Prevalence KW - Retirement KW - Urinary incontinence KW - Vision Disorders AB -

BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

DESIGN: Cross-sectional analysis.

SETTING: Health and Retirement Study survey administered in 2000.

PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

RESULTS: Of adults age 65 years or older, 49.9% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions).

LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

PB - 147 VL - 147 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17679703?dopt=Abstract U4 - ADL and IADL Impairments/Geriatrics/Chronic Disease/Health care ER - TY - JOUR T1 - The long-term effects of poor childhood health: an assessment and application of retrospective reports. JF - Demography Y1 - 2007 A1 - Steven A Haas KW - Adolescent KW - Adult KW - Age Factors KW - Aged KW - Child KW - Child Welfare KW - Child, Preschool KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Status KW - Humans KW - Infant KW - Infant, Newborn KW - Male KW - Middle Aged KW - Reproducibility of Results KW - Retrospective Studies KW - Risk Assessment KW - Risk Factors KW - Socioeconomic factors KW - Time KW - United States AB -

This study assesses retrospective childhood health reports and examines childhood health as a predictor of adult health. The results suggest that such reports are of reasonable reliability as to warrant their judicious use in population research. They also demonstrate a large positive relationship between childhood and adult health. Compared with excellent, very good, or good childhood health, poor childhood health is associated with more than three times greater odds of having poor adult self-rated health and twice the risk of a work-limiting disability or a chronic health condition. These associations are independent of childhood and current socioeconomic position and health-related risk behaviors.

PB - 44 VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17461339?dopt=Abstract U4 - childhood conditions/HEALTH/SELF-RATED HEALTH ER - TY - JOUR T1 - Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics. JF - J Pain Y1 - 2007 A1 - Reyes-Gibby, Cielito C. A1 - Aday, Lu Ann A1 - Todd, Knox H. A1 - Cleeland, Charles S. A1 - Anderson, Karen O. KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Black People KW - Chronic disease KW - Data collection KW - ethnicity KW - Female KW - Hispanic or Latino KW - Humans KW - Insurance, Health KW - Logistic Models KW - Male KW - Middle Aged KW - pain KW - Pain Measurement KW - Population KW - Socioeconomic factors KW - United States KW - White People AB -

UNLABELLED: Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.

PERSPECTIVE: This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.

PB - 8 VL - 8 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16949874?dopt=Abstract U4 - Health Care/Racial Differences/Ethnicity ER - TY - JOUR T1 - The effect of private insurance on the health of older, working age adults: evidence from the health and retirement study. JF - Health Serv Res Y1 - 2006 A1 - Avi Dor A1 - Joseph J Sudano A1 - David W. Baker KW - Chronic disease KW - Data collection KW - Female KW - Health Status KW - Humans KW - Insurance, Health KW - Male KW - Medically Uninsured KW - Middle Aged KW - Private Sector KW - United States AB -

OBJECTIVE: Primarily, to determine if the presence of private insurance leads to improved health status, as measured by a survey-based health score. Secondarily, to explore sensitivity of estimates to adjustments for endogeneity. The study focuses on adults in late middle age who are nearing entry into Medicare.

DATA SOURCES: The analysis file is drawn from the Health and Retirement Study, a national survey of relatively older adults in the labor force. The dependent variable, an index of 5 health outcome items, was obtained from the 1996 survey. Independent variables were obtained from the 1992 survey. State-level instrumental variables were obtained from the Area Resources File and the TAXSIM file. The final sample consists of 9,034 individuals of which 1,540 were uninsured.

STUDY DESIGN: Estimation addresses endogeneity of the insurance participation decision in health score regressions. In addition to ordinary least squares (OLS), two models are tested: an instrumental variables (IV) model, and a model with endogenous treatment effects due to Heckman (1978). Insurance participation and health behaviors enter with a lag to allow their effects to dissipate over time. Separate regressions were run for groupings of chronic conditions.

PRINCIPAL FINDINGS: The OLS model results in statistically significant albeit small effects of insurance on the computed health score, but the results may be downward biased. Adjusting for endogeneity using state-level instrumental variables yields up to a six-fold increase in the insurance effect. Results are consistent across IV and treatment effects models, and for major groupings of medical conditions. The insurance effect appears to be in the range of about 2-11 percent. There appear to be no significant differences in the insurance effect for subgroups with and without major chronic conditions.

CONCLUSIONS: Extending insurance coverage to working age adults may result in improved health. By conjecture, policies aimed at expanding coverage to this population may lead to improved health at retirement and entry to Medicare, potentially leading to savings. However, further research is needed to determine whether similar results are found when alternative measures of overall health or health scores are used. Future research should also explore the use of alternative instrumental variables. Preliminary results provide no justification for targeting certain subgroups with susceptibility to certain chronic conditions rather than broad policy interventions.

PB - 41 VL - 41 IS - 3 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16704511?dopt=Abstract U4 - aging/Health Insurance/health status ER - TY - JOUR T1 - Functional impairment as a risk factor for urinary incontinence among older Americans. JF - Neurourol Urodyn Y1 - 2005 A1 - Kristi Rahrig Jenkins A1 - Fultz, Nancy H. KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disability Evaluation KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Risk Factors KW - Socioeconomic factors KW - Urinary incontinence AB -

AIMS: Using a large nationally representative sample of older Americans we investigate four domains of functional impairment as possible risk factors for the subsequent development of urinary incontinence (UI) symptoms.

METHODS: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics among the Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UI symptoms.

RESULTS: A greater number of serious chronic conditions and functional impairment in the lower body mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors that contributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, being represented by a proxy respondent, and functional impairment in the strength domain.

CONCLUSIONS: Understanding the possible relationship between functional impairment and UI is an important step toward developing appropriate interventions for the prevention, treatment, or management of urine loss.

PB - 24 VL - 24 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15578629?dopt=Abstract U4 - WOMEN/Epidemiology/DISABILITY/DISABILITY ER - TY - JOUR T1 - Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2005 A1 - Karl Kosloski A1 - Stull, Donald E. A1 - Kercher, Kyle A1 - VanDussen, Daniel J. KW - Aged KW - Analysis of Variance KW - Attitude to Health KW - Chronic disease KW - depression KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Personality Inventory KW - Psychometrics KW - Reproducibility of Results KW - Self-Assessment KW - Statistics as Topic AB -

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

PB - 60 VL - 60 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16260703?dopt=Abstract U4 - Depressive Symptoms/Subjective/Health ER - TY - JOUR T1 - Long-term risk for depressive symptoms after a medical diagnosis. JF - Arch Intern Med Y1 - 2005 A1 - Daniel Polsky A1 - Jalpa A Doshi A1 - Marcus, Steven A1 - Oslin, David A1 - Rothbard, Aileen A1 - Thomas, Niku A1 - Thompson, Christy L. KW - Chronic disease KW - Comorbidity KW - Depressive Disorder KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Risk KW - Time Factors AB -

BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke.

METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions.

RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95% CI, 1.64-2.79) and heart disease (HR, 1.45; 95% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95% CI, 1.11-1.92).

CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.

PB - 165 VL - 165 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15956005?dopt=Abstract U4 - Depressive Symptoms/Disease/Diagnosis ER - TY - JOUR T1 - Physical and mental health status of older long-term cancer survivors. JF - J Am Geriatr Soc Y1 - 2005 A1 - Nancy L. Keating A1 - Norredam, Marie A1 - Landrum, Mary Beth A1 - Haiden A. Huskamp A1 - Meara, Ellen KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Chronic disease KW - Cohort Studies KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Middle Aged KW - Neoplasms KW - Survivors KW - United States AB -

OBJECTIVES: To assess the physical and mental health status of older long-term cancer survivors.

DESIGN: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls.

SETTING: General community population in the United States.

PARTICIPANTS: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study.

MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy.

RESULTS: Cancer survivors reported higher rates of lung disease (13.9% vs 9.6%; P=.001), heart condition (29.3% vs 22.9%; P<.001), arthritis (69.4% vs 59.4%; P<.001), incontinence (26.6% vs 19.7%; P=.001), frequent pain (36.4% vs 29.4%; P=.005), and obesity (27.0% vs 24.2%; P=.001) than individuals without cancer but lower rates of smoking (12.0% vs 14.8%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2% vs 44.6%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004).

CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

PB - 53 VL - 53 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16398900?dopt=Abstract U4 - Survivors/Mental Health/Health Physical ER - TY - JOUR T1 - Profiles of self-rated health in midlife adults with chronic illnesses. JF - Nurs Res Y1 - 2005 A1 - Finnegan, Lorna A1 - Marion, Lucy A1 - Cox, Cheryl KW - Chronic disease KW - Comorbidity KW - Data collection KW - Educational Status KW - Exercise KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Nursing Research KW - Smoking AB -

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time.

OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time.

METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time.

RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes.

DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

PB - 54 VL - 54 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15897792?dopt=Abstract U4 - Health Behavior/Chronic Illness ER - TY - JOUR T1 - Setting eligibility criteria for a care-coordination benefit. JF - J Am Geriatr Soc Y1 - 2005 A1 - Christine T Cigolle A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Caroline S Blaum KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Case Management KW - Chronic disease KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Disability Evaluation KW - Disease Management KW - Eligibility Determination KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Retirement KW - United States AB -

OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served.

DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older.

SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries).

MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency.

RESULTS: A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population.

CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.

PB - 53 VL - 53 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16398887?dopt=Abstract U4 - Chronic Disease/Cognition Disorders/ADL and IADL Impairments/Caregiving ER - TY - JOUR T1 - The health effects of restricting prescription medication use because of cost. JF - Med Care Y1 - 2004 A1 - Michele M Heisler A1 - Kenneth M. Langa A1 - Eby, Elizabeth L. A1 - A. Mark Fendrick A1 - Mohammed U Kabeto A1 - John D Piette KW - Aged KW - Chronic disease KW - Female KW - Financing, Personal KW - Health Services Accessibility KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Patient Compliance KW - Prospective Studies KW - Risk KW - United States AB -

BACKGROUND: High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known.

METHODS: We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression.

RESULTS: In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort.

CONCLUSIONS: Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.

PB - 42 VL - 42 IS - 7 N1 - Comment in: Med Care. 2004 Jul;42(7):623-5 AN=15213485 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15213486?dopt=Abstract U4 - Health Insurance/Health Care Costs/Prescription Fees/Female/Multivariate Analysis/Prospective Studies/United States/Health Status/Health Services ER - TY - JOUR T1 - Heart disease, comorbidity, and activity limitation in community-dwelling elderly. JF - Eur J Cardiovasc Prev Rehabil Y1 - 2004 A1 - Oldrige, Neil B. A1 - Timothy E. Stump KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Cross-Sectional Studies KW - Female KW - Health Status KW - Heart Diseases KW - Humans KW - Male KW - Middle Aged KW - Motor Activity KW - Residence Characteristics KW - Self Concept KW - Socioeconomic factors AB -

PURPOSE: The purpose of this study was to describe the impact of self-report heart disease, other chronic comorbidities, and perceived health status on activity limitation among community dwelling persons older than 50 years of age.

METHODS: Odds ratios for activity limitation in activities of daily living, mobility, and other activities were estimated for respondents with self-report heart disease, eight other chronic comorbid conditions, and perceived health status using data generated in two nationally representative cross-sectional surveys, the Health and Retirement Survey (HRS; respondents aged 51 to 60 years) and the Assets and Health Dynamics of the Oldest Old study (AHEAD; respondents aged 70 years and older).

RESULTS: The prevalence of activity limitation increased significantly across the spectrum from activities of daily living to mobility to other activities in both surveys in respondents with and without heart disease. There was a significantly increased likelihood of mobility and other activity limitation among those with heart disease. Among the HRS respondents with heart disease, five or more of the eight comorbid conditions plus poor or fair perceived health were associated with a significantly increased limitation in each activity category. Among the AHEAD respondents with heart disease, three comorbid conditions plus perceived health were associated with a significantly increased limitation in activities of daily living whereas six comorbid conditions plus perceived health were associated with a significantly increased limitation in mobility and in other activities.

CONCLUSIONS: As a prime objective of cardiac rehabilitation is to reduce activity limitation, the strong associations between comorbidity and activity limitation observed in this study among persons older than 50 years with heart disease suggest that the burden of comorbidity-associated is considerable but should not be an automatic exclusion criterion for referral to cardiac rehabilitation. The lack of rigorous scientific information on how these associations may influence clinicians who refer patients to rehabilitation and those who manage these programs strongly reinforces the need for more research to explore the real-world spectrum of comorbidity among persons with heart disease and the impact on activity limitation.

PB - 11 VL - 11 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15616418?dopt=Abstract U4 - quality of life/Elderly/COMORBIDITY/risk factors ER - TY - JOUR T1 - The impact of diabetes on workforce participation: results from a national household sample. JF - Health Serv Res Y1 - 2004 A1 - Sandeep Vijan A1 - Rodney A. Hayward A1 - Kenneth M. Langa KW - Chronic disease KW - Cohort Studies KW - Cost of Illness KW - Cross-Sectional Studies KW - Diabetes Mellitus KW - Disabled Persons KW - Efficiency KW - Employment KW - Female KW - Health Services Research KW - Health Status Indicators KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

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

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

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

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

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

PB - 39 VL - 39 IS - 6 Pt 1 N1 - Social Security Administration/Michigan Retirement Research Center Grant UM01-11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15533180?dopt=Abstract U4 - diabetes/Labor Supply ER - TY - JOUR T1 - Nonmetro residence and impaired vision among elderly Americans. JF - J Rural Health Y1 - 2004 A1 - Nan E. Johnson KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Cataract KW - Chronic disease KW - Comorbidity KW - Diabetes Mellitus KW - Humans KW - Hypertension KW - Prevalence KW - Risk Assessment KW - Rural Health KW - United States KW - Urban Health KW - Vision Disorders AB -

PURPOSE: Nonmetro and metro elderly people are contrasted in their risk of having (relative to lacking) an impairment in distance vision and in near vision.

METHODS: Using the 1995-1996 panel (Wave 2) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey, the prevalence of 5 eye-threatening conditions (cardiovascular disease, cataract, diabetes, glaucoma, and hypertension), a variety of medical treatments for these conditions, the number of talks/visits with doctors in the 2 years before Wave 2, and several relevant demographic characteristics of the 6,817 respondents were controlled.

FINDINGS: Nonmetro and metro elders have the same risk of impairment in distance vision. After controlling for other factors, nonmetro elders have a higher risk than their metro peers of an uncorrected impairment in near vision (probably presbyopia).

CONCLUSIONS: Nonmetro elders may confront more impediments to updating their corrective lenses for presbyopia. Implications for public health policy are discussed.

PB - 20 VL - 20 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15085628?dopt=Abstract U4 - Visually Impaired Persons/Residential Segregation ER - TY - JOUR T1 - Obesity's effects on the onset of functional impairment among older adults. JF - Gerontologist Y1 - 2004 A1 - Kristi Rahrig Jenkins KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Body Weight KW - Chronic disease KW - Disabled Persons KW - Exercise KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Motor Activity KW - Movement KW - Obesity KW - Risk-Taking KW - United States AB -

PURPOSE: This study has two purposes. First, it determines if there is a relationship between body weight and the onset of functional impairment across time among this sample of older adults. More specifically, it examines if obese older adults are more likely to experience the onset of functional impairment. Second, it explores how health behaviors and health conditions may explain the relationship between body weight and the onset of functional impairment.

DESIGN AND METHODS: With the use of longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, logistic regression models on the onset of functional impairment over two time points are estimated for older adults.

RESULTS: Results indicate that body weight (more specifically being overweight or obese) makes one more likely to experience the onset of functional impairment across various domains of impairment. Outside of health behaviors and health conditions, obesity has an independent effect on the onset of impairment in strength, lower body mobility, and activities of daily living.

IMPLICATIONS: Study findings support the active treatment of weight problems in older adults. Future directions for research in this area should address effective weight management interventions targeting issues related to older individuals.

PB - 44 VL - 44 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15075417?dopt=Abstract U4 - Obesity/Health Status--ADL limitations ER - TY - JOUR T1 - Resolving inconsistencies in trends in old-age disability: report from a technical working group. JF - Demography Y1 - 2004 A1 - Vicki A Freedman A1 - Eileen M. Crimmins A1 - Robert F. Schoeni A1 - Brenda C Spillman A1 - Aykan, Hakan A1 - Kramarow, Ellen A1 - Land, Kenneth A1 - Lubitz, James A1 - Kenneth G. Manton A1 - Linda G Martin A1 - Shinberg, Diane A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Surveys KW - Homemaker Services KW - Humans KW - Male KW - Models, Statistical KW - Self-Help Devices KW - United States AB -

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

PB - 41 VL - 41 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract U4 - Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving ER - TY - JOUR T1 - Medication costs, adherence, and health outcomes among Medicare beneficiaries. JF - Health Aff (Millwood) Y1 - 2003 A1 - Ramin Mojtabai A1 - Mark Olfson KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Continuity of Patient Care KW - Family Characteristics KW - Female KW - Financing, Personal KW - Health Services Research KW - Humans KW - Income KW - Insurance, Pharmaceutical Services KW - Longitudinal Studies KW - Male KW - Medicare KW - Patient Compliance KW - Prevalence KW - Probability KW - Self Administration KW - Treatment Outcome KW - United States AB -

In a two-year period more than two million elderly Medicare beneficiaries did not adhere to drug treatment regimens because of cost. This poor adherence tended to be more common among beneficiaries with no or partial medication coverage and was associated with poorer health and higher rates of hospitalization. The risk for cost-related poor adherence was especially pronounced among lower-income beneficiaries with high out-of-pocket drug spending. We argue that this pattern of cost-related poor medication adherence should inform the design of Medicare prescription drug benefit legislation.

PB - 22 VL - 22 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12889771?dopt=Abstract U4 - Medicare ER - TY - JOUR T1 - Trends in Medication Use And Functioning Before Retirement Age: Are They Linked? JF - Health Affairs Y1 - 2003 A1 - Vicki A Freedman A1 - Aykan, Hakan KW - Chronic disease KW - Drug use KW - Pharmaceuticals AB - This paper explores the extent to which changes in medication use during the 1990s are linked to improvements in functioning among Americans before they reach retirement age. Using two cross-sections from a survey of Americans ages 51 61, we examined changes between 1992 and 1998 in the prevalence of functional limitations and medication use associated with five chronic conditions: hypertension, diabetes, lung disease, stroke, and arthritis. We found no evidence linking increases in medication use to improvements in functioning. Instead, increases in educational attainment offset the negative effects of increases in obesity and arthritis over this period. Findings underscore the need for caution in projecting forward improvements in old-age functioning when considering the future of Medicare, Medicaid, and other programs that serve the elderly with disabilities. PB - 22 VL - 22 IS - 4 U4 - Health Physical 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 - The explosion in paid home health care in the 1990s: who received the additional services? JF - Med Care Y1 - 2001 A1 - Kenneth M. Langa A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - Steven J. Katz KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Family Characteristics KW - Female KW - Financing, Government KW - Frail Elderly KW - Geriatric Assessment KW - Health Care Surveys KW - Health Expenditures KW - health policy KW - Home Care Services KW - Home Nursing KW - Humans KW - Longitudinal Studies KW - Male KW - Marital Status KW - Multivariate Analysis KW - Social Support KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States KW - Utilization Review AB -

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

PB - 39 VL - 39 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11176552?dopt=Abstract U4 - Activities of Daily Living/Classification/Aged, 80 and Over/Chronic Disease/Family Characteristics/Female/Financing, Government/Frail Elderly/Geriatric Assessment/Health Care Surveys/Health Expenditures/Health Policy/Home Care Services/Home Nursing/Longitudinal Studies/Marital Status/Multivariate Analysis/Questionnaires/Social Support/Socioeconomic Factors/Support, Non U.S. Government/United States/Utilization Review ER - TY - JOUR T1 - Predictors of transitions in disease and disability in pre- and early-retirement populations. JF - J Aging Health Y1 - 2001 A1 - Namkee G Choi A1 - Schlichting-Ray, L. KW - Activities of Daily Living KW - Aged KW - Black or African American KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

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

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

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

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

PB - 13 VL - 13 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11813732?dopt=Abstract U4 - Activities of Daily Living/Blacks/Chronic Disease/Epidemiology/Disabled Persons/Female/Health Status/Hispanic Americans/Human/Middle Age/Retirement/Risk Factors/Sex Factors/Socioeconomic Factors/Support, U.S. Government--PHS/United States/Whites ER - TY - JOUR T1 - Measuring morbidity: disease counts, binary variables, and statistical power. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Kenneth F Ferraro A1 - Janet M Wilmoth KW - Adult KW - Aged KW - Chronic disease KW - Cross-Sectional Studies KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - United States AB -

OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach.

METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses.

RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable.

DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.

PB - 55B VL - 55 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11833985?dopt=Abstract U4 - Disease/Morbidity/Subjective Probabilities ER - TY - JOUR T1 - The racial crossover in comorbidity, disability, and mortality. JF - Demography Y1 - 2000 A1 - Nan E. Johnson KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Birth Certificates KW - Black People KW - Chronic disease KW - Comorbidity KW - Cross-Over Studies KW - Death Certificates KW - Disabled Persons KW - Female KW - Humans KW - Male KW - United States KW - White People AB -

This study analyzed one respondent per household who was age 70 or more at the time of the household's inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.

PB - 37 VL - 37 IS - 3 N1 - RDA 2002-016 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10953803?dopt=Abstract U4 - Activities of Daily Living/Classification/Age Factors/Aged, 80 and Over/Birth Certificates/Chronic Disease/Mortality/Comorbidity/Cross Over Studies/Death Certificates/Disabled Persons/Classification/Statistics and Numerical Data/Female/Whites/Blacks/Support, Non U.S. Government/Support, U.S. Government--non PHS/United States/Epidemiology ER - TY - JOUR T1 - Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994. JF - Arthritis Rheum Y1 - 1999 A1 - Yelin, Edward A1 - Laura S. Trupin A1 - Sebesta, D.S. KW - Chronic disease KW - Disability Evaluation KW - Disabled Persons KW - Employment KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Morbidity KW - Musculoskeletal Diseases KW - Prevalence KW - Retirement KW - United States AB -

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time.

METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994.

RESULTS: In 1992, 62.4% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5% by 1994. More than 40% of persons with musculoskeletal conditions reported disability, which was almost 90% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences.

CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

PB - 42 VL - 42 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10211893?dopt=Abstract U4 - Chronic Disease/Disability Evaluation/Disabled Persons/Employment/Retirement/Musculoskeletal Diseases 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 - Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. JF - J Gerontol A Biol Sci Med Sci Y1 - 1997 A1 - Daniel O. Clark A1 - Mungai, S.M. A1 - Timothy E. Stump A1 - Frederic D Wolinsky KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Chronic disease KW - Cohort Studies KW - Disabled Persons KW - Disease KW - Female KW - Health Behavior KW - Humans KW - Male KW - Memory Disorders KW - Mexican Americans KW - Middle Aged KW - Prevalence KW - Risk Factors KW - Socioeconomic factors KW - White People AB -

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites.

METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups.

RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group.

CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.

PB - 52A VL - 52 UR - http://biomed.gerontologyjournals.org/contents-by-date.0.shtml IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9060977?dopt=Abstract U4 - Aged, 80 and Over/Blacks/Chronic Disease/Cohort Studies/Disabled Persons/Disease/Female/Health Behavior/Human/Memory Disorders/Mexican Americans/Middle Age/Prevalence/Risk Factors/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Whites ER -