TY - JOUR T1 - Reciprocal associations between social media use and self-perception of aging among older adults: Do men and women differ? JF - Soc Sci Med Y1 - 2023 A1 - Wang, Kun A1 - Gu, Danan KW - Adult KW - Age Factors KW - Aged KW - Aging KW - Female KW - Humans KW - Male KW - Retirement KW - Self Concept KW - Social media AB -

PURPOSE: Despite the positive impact of social media use in late adulthood, social media use is still low among older adults. Research in technology adoption and utilization indicates the importance of age-specific factors, such as self-perception of aging (SPA). As it is unclear whether SPA facilitates social media use or social media use promotes SPA, reverse causality has emerged as a major point of contention within this literature, with several studies reporting conflicting results. Thus, in this study, we aim to contribute unique insight by examining (1) whether positive and negative SPAs demonstrate unique associations with social media use and (2) whether these reciprocal associations differ by gender.

METHODS: Using two waves (2014 and 2018) from the Health and Retirement Study, 4101 older Americans (age ≥65 years) with normal baseline cognition were included in this study. Autoregressive cross-lagged analyses were conducted to assess reciprocal associations between SPA and social media use among the total sample and by gender subgroups.

RESULTS: Controlling for covariates, we found that more frequent social media use marginally predicted higher positive SPA four years later (B = 0.02, p = .07), and higher negative SPA marginally predicted less frequent social media use four years later (B = -0.07, p = .08). However, the by-gender analysis showed that the positive effect of social media use on positive SPA was only significant among older men (B = 0.04, p < .05), whereas the negative impact of negative SPA on social media use only existed among older women (B = -0.13, p < .01).

CONCLUSIONS: The reciprocal associations between SPA and social media use differ by the valence of SPA (positive/negative) and gender. Future interventions for SPA and digital technology use among older adults should be gender-tailored.

VL - 321 ER - TY - JOUR T1 - Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. JF - Journal of Alzheimer's Disease Y1 - 2022 A1 - Wu, Benson A1 - Toseef, Mohammad Usama A1 - Stickel, Ariana M A1 - González, Hector M A1 - Tarraf, Wassim KW - Activities of Daily Living KW - Age Factors KW - Cognitive Dysfunction KW - ethnicity KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Neuropsychological tests KW - Psychomotor Performance KW - Retirement KW - Risk Factors KW - Self Report KW - Surveys and Questionnaires AB -

BACKGROUND: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS: We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

VL - 85 IS - 4 ER - TY - JOUR T1 - Genomics of 1 million parent lifespans implicates novel pathways and common diseases and distinguishes survival chances. JF - Elife Y1 - 2019 A1 - Paul Rhj Timmers A1 - Mounier, Ninon A1 - Lall, Kristi A1 - Fischer, Krista A1 - Ning, Zheng A1 - Feng, Xiao A1 - Bretherick, Andrew D A1 - Clark, David W A1 - Shen, Xia A1 - Tõnu Esko A1 - Kutalik, Zoltán A1 - James F Wilson A1 - Joshi, Peter K KW - Age Factors KW - Aged KW - Bayes Theorem KW - Disease KW - DNA Methylation KW - Female KW - Genetic Loci KW - Genome-Wide Association Study KW - Genomics KW - Humans KW - Longevity KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Parents KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - Sex Characteristics KW - Signal Transduction KW - Survival Analysis AB -

We use a genome-wide association of 1 million parental lifespans of genotyped subjects and data on mortality risk factors to validate previously unreplicated findings near , , , , , and 13q21.31, and identify and replicate novel findings near , , and . We also validate previous findings near 5q33.3/ and , whilst finding contradictory evidence at other loci. Gene set and cell-specific analyses show that expression in foetal brain cells and adult dorsolateral prefrontal cortex is enriched for lifespan variation, as are gene pathways involving lipid proteins and homeostasis, vesicle-mediated transport, and synaptic function. Individual genetic variants that increase dementia, cardiovascular disease, and lung cancer - but not other cancers - explain the most variance. Resulting polygenic scores show a mean lifespan difference of around five years of life across the deciles.

Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

VL - 8 ER - TY - JOUR T1 - How Does Employment-Based Insurance Coverage Relate to Health After Early Retirement? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2019 A1 - Ben Lennox Kail KW - Activities of Daily Living KW - Age Factors KW - Aged KW - depression KW - Employment KW - Female KW - Health Benefit Plans, Employee KW - Humans KW - Male KW - Middle Aged KW - Retirement KW - United States VL - 74 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/17/geronb.gbw020.short IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26988867?dopt=Abstract U4 - retirement planning/public policy/transitions/insurance Coverage/employee benefits ER - TY - JOUR T1 - Activity Engagement and Activity-Related Experiences: The Role of Personality. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Nicky J Newton A1 - Pladevall-Guyer, Jana A1 - Gonzalez, Richard A1 - Jacqui Smith KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Educational Status KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Marital Status KW - Middle Aged KW - Personality KW - Personality Inventory KW - Sex Factors KW - Social participation KW - Surveys and Questionnaires AB -

Objectives: The associations of personality with activity participation and well-being have been well studied. However, less is known concerning the relationship between personality and specific aspects of activity engagement in older adults. We conducted a fine-grained examination of the effects of extraversion and conscientiousness on reported activity engagement-which we define as participation, time allocated, and affective experience-during 8 everyday activities.

Method: Data were obtained using a day reconstruction measure from a subgroup of participants in the 2012 Health and Retirement Study (HRS: N = 5,484; mean age = 67.98 years).

Results: We found mixed support for hypotheses suggesting that specific personality traits would be associated with activity participation, time allocated, and activity-affective experience. For example, extraverts were more likely to socialize and experienced higher socializing-related positive affect, but did not spend more time socializing.

Discussion: Results are discussed in light of the value of including personality in, and its contribution to, studies of activity engagement in later life. In addition, the need to acknowledge the complexity of the concept of activity engagement in future research is highlighted.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/08/12/geronb.gbw098.long IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27520061?dopt=Abstract ER - TY - JOUR T1 - Antecedents of Gray Divorce: A Life Course Perspective. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Lin, I-Fen A1 - Susan L. Brown A1 - Matthew R Wright A1 - Anna M Hammersmith KW - Age Factors KW - Divorce KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Marriage KW - Middle Aged KW - Prospective Studies KW - Retirement KW - Risk Factors KW - Socioeconomic factors KW - Spouses KW - United States AB -

Objectives: Increasingly, older adults are experiencing divorce, yet little is known about the risk factors associated with divorce after age 50 (termed "gray divorce"). Guided by a life course perspective, our study examined whether key later life turning points are related to gray divorce.

Method: We used data from the 1998-2012 Health and Retirement Study to conduct a prospective, couple-level discrete-time event history analysis of the antecedents of gray divorce. Our models incorporated key turning points (empty nest, retirement, and poor health) as well as demographic characteristics and economic resources.

Results: Contrary to our expectations, the onset of an empty nest, the wife's or husband's retirement, and the wife's or husband's chronic conditions were unrelated to the likelihood of gray divorce. Rather, factors traditionally associated with divorce among younger adults were also salient for older adults. Marital duration, marital quality, home ownership, and wealth were negatively related to the risk of gray divorce.

Discussion: Gray divorce is especially likely to occur among couples who are socially and economically disadvantaged, raising new questions about the consequences of gray divorce for individual health and well-being.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw164 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27986850?dopt=Abstract JO - GERONB ER - TY - JOUR T1 - Association Between Obesity, Age, and Functional Decline in Survivors of Cardiac Surgery JF - Journal of the American Geriatrics Society Y1 - 2018 A1 - Timothy G. Gaulton A1 - Mark D Neuman KW - Age Factors KW - BMI KW - Cardiac surgery KW - Functional status AB - Background/Objectives: Little is known about the effect of obesity on functional decline after cardiac surgery, especially in elderly adults. Our goal was to determine the association between obesity and functional decline in the 2 years after cardiac surgery and the interaction between obesity and age. Design: Retrospective cohort study. Setting: The Health and Retirement Study, 2004-2014. Participants: U.S. adults aged 50 and older who indicated having cardiac surgery and had a body mass index (BMI) of 18.5 kg/m2 or greater (N = 1,731). Measurements: BMI was classified as normal or overweight (18.5-29.9 kg/m2) and obese (≥30 kg/m2). Primary outcome was decline in ability to perform an activity of daily living (ADL) after surgery. Results: Respondents had a median age of 71, 59.3% were female, and 34.3% were obese. Obese respondents had a higher incidence of ADL decline (22.4%) than those who were not obese (17.1%) (P = .007). In the multivariable analysis of our full cohort, obesity was not associated with ADL decline (odds ratio (OR)=1.20, 95% confidence interval (CI)=0.90-1.59, P = .21) after cardiac surgery, although obese respondents aged 50 to 79 had greater odds of ADL decline (OR=1.45, 95% CI=1.06-2.00, P = .02). Obese respondents aged 80 and older had nonstatistically significantly lower odds of ADL decline (OR=0.61, 95% CI=0.30-1.24, P = .18) compared to non-obese respondents. Conclusion: The association between obesity and postoperative functional decline in survivors of cardiac surgery differed according to age. Additional research is needed to identify interventions to improve outcomes in groups of older adults in whom obesity may increase the risk of postoperative functional decline. VL - 66 UR - http://doi.wiley.com/10.1111/jgs.15160http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15160/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15160 IS - 1 JO - J Am Geriatr Soc ER - TY - JOUR T1 - Differences in the Progression of Disability: A U.S.-Mexico Comparison. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Díaz-Venegas, Carlos A1 - Timothy A Reistetter A1 - Rebeca Wong KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Disabled Persons KW - disease progression KW - Female KW - Humans KW - Male KW - Mexico KW - MHAS AB -

Objectives: This article seeks to document the progression of disability in a developing country by implementing a model to examine how this process compares to a developed country.

Methods: Data come from the Mexican Health and Aging Study (MHAS), including a baseline survey in 2001 and a follow-up in 2003, and from the U.S. Health and Retirement Study (HRS), using the 2000 and 2002 waves. An ordinal logistic regression approach is used to examine a progression of disability that considers (a) no disability, (b) mobility problems, (c) mobility plus limitations with instrumental activities of daily living, (d) mobility plus limitations with activities of daily living (ADLs), (e) limitations in all three areas and (f) death.

Results: In both data sets, approximately 44% of the sample remained in the same level of disability at the 2-year follow-up. However, the progression of limitations with two disabilities differs by gender in the MHAS but is consistent for both men and women in the HRS.

Discussion: Our model reflects the importance of ADLs in the disablement process in Mexico. We speculate that the difference in lifetime risk profiles and cultural context might be responsible for the divergence in the progression of disability by gender.

VL - 73 UR - https://www.ncbi.nlm.nih.gov/pubmed/27436102 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27436102?dopt=Abstract ER - TY - JOUR T1 - Later Life Marital Dissolution and Repartnership Status: A National Portrait. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Susan L. Brown A1 - Lin, I-Fen A1 - Anna M Hammersmith A1 - Matthew R Wright KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Divorce KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Marriage KW - Middle Aged KW - Socioeconomic factors KW - Spouses KW - United States KW - Widowhood AB -

OBJECTIVES: Our study compares two types of later life marital dissolution that occur after age 50-divorce and widowhood-and their associations with repartnership status (i.e., remarried, cohabiting, or unpartnered).

METHOD: We used data from the Health and Retirement Study to provide a portrait of later life divorce and widowhood for women and men. Next, we tested whether marital dissolution type is related to women's and men's repartnered status, distinguishing among remarrieds, cohabitors, and unpartnereds, net of key sociodemographic indicators.

RESULTS: Divorcees are more often repartnered through either remarriage or cohabitation than are widoweds. This gap persists among women net of an array of sociodemographic factors. For men, the differential is reduced to nonsignificance with the inclusion of these factors.

DISCUSSION: Later life marital dissolution increasingly occurs through divorce rather than widowhood, and divorce is more often followed by repartnership. The results from this study suggest that gerontological research should not solely focus on widowhood but also should pay attention to divorce and repartnering during later life.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/04/29/geronb.gbw051.abstract IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27131167?dopt=Abstract U4 - Cohabitation/Divorce/Marriage/Remarriage/Widowhood ER - TY - JOUR T1 - Perceived Age Discrimination: A Precipitator or a Consequence of Depressive Symptoms? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Liat Ayalon KW - Age Factors KW - Aged KW - Ageism KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - Risk Factors KW - Surveys and Questionnaires AB -

Objectives: The main purpose of the study was to examine a bidirectional temporal relationship between perceived age discrimination and depressive symptoms. A secondary goal was to examine whether the negative effects of perceived age discrimination on one's depressive symptoms are stronger among respondents older than 70 years old, compared with respondents between the ages of 51 and 70.

Methods: The Health and Retirement Study is a U.S. nationally representative sample of individuals over the age of 50 and their spouse of any age. A cross-lagged model was estimated to examine the reciprocal associations of depressive symptoms and perceived age discrimination, controlling for age, gender, education, ethnicity, marital status, employment status, satisfaction with financial status, number of medical conditions, mobility, strength and fine motor skills, and memory functioning.

Results: The baseline model for the overall sample resulted in adequate fit indices: CFI = .945, TLI = .940, RMSEA = .024 (90% CI = .023, .025). The cross-lagged effect of perceived age discrimination on depressive symptoms was nonsignificant (B [SE] = -.01 [.04], p = .82), whereas the cross-lagged effect of depressive symptoms on perceived age discrimination was small, but significant (B [SE] = .04 [.02], p = .03). This implies that higher levels of depressive symptoms precede a greater likelihood of perceived age discrimination, net of sociodemographic and clinical variables. The cross-lagged effects did not vary according to age group (51-70 vs >70 years old).

Discussion: The subjective nature of perceived age discrimination is discussed.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw101 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27540094?dopt=Abstract JO - GERONB ER - TY - JOUR T1 - "Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Kenzie Latham KW - Age Factors KW - Aged KW - Disabled Persons KW - Female KW - Humans KW - Logistic Models KW - Male KW - Mobility Limitation KW - Mortality KW - Recovery of Function KW - Risk Factors KW - Self Report KW - Sex Factors KW - Socioeconomic factors KW - Walking AB -

Objectives: Recovery from self-reported walking limitation may be a turning point in an individual's health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods: Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results: Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion: This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult's functional health trajectory.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw113 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27577051?dopt=Abstract JO - GERONB ER - TY - JOUR T1 - Associations Among Individuals' Perceptions of Future Time, Individual Resources, and Subjective Well-Being in Old Age. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Christiane A Hoppmann A1 - Frank J Infurna A1 - Ram, Nilam A1 - Denis Gerstorf KW - Affect KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Attitude KW - depression KW - Female KW - Forecasting KW - Health Status KW - Humans KW - Male KW - Personal Satisfaction AB -

OBJECTIVES: Perceptions of future time are of key interest to aging research because of their implications for subjective well-being. Interestingly, perceptions about future time are only moderately associated with age when looking at the second half of life, pointing to a vast heterogeneity in future time perceptions among older adults. We examine associations between future time perceptions, age, and subjective well-being across two studies, including moderations by individual resources.

METHOD: Using data from the Berlin Aging Study (N = 516; Mage = 85 years), we link one operationalization (subjective nearness to death) and age to subjective well-being. Using Health and Retirement Study data (N = 2,596; Mage = 77 years), we examine associations of another future time perception indicator (subjective future life expectancy) and age with subjective well-being.

RESULTS: Consistent across studies, perceptions of limited time left were associated with poorer subjective well-being (lower life satisfaction and positive affect; more negative affect and depressive symptoms). Importantly, individual resources moderated future time perception-subjective well-being associations with those of better health exhibiting reduced future time perception-subjective well-being associations.

DISCUSSION: We discuss our findings in the context of the Model of Strength and Vulnerability Integration.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/05/geronb.gbv063.abstract IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26437862?dopt=Abstract ER - TY - JOUR T1 - Associations Between Arthritis and Change in Physical Function in U.S. Retirees. JF - J Gerontol A Biol Sci Med Sci Y1 - 2017 A1 - Nancy A. Baker A1 - Kamil E Barbour A1 - Charles G Helmick A1 - Matthew M. Zack A1 - Soham Al Snih KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Arthritis KW - Case-Control Studies KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Muscle Strength KW - Retirement KW - United States AB -

BACKGROUND: The aims of this study were to determine among retirees: the associations of arthritis with limitations in physical functions, and whether these associations changed differently with age for those with arthritis versus without arthritis.

METHODS: We identified retirees from the Health and Retirement Study, a nationally representative longitudinal panel study of U.S. adults ≥51 years old. We calculated incidence density ratios (IDRs) using Poisson regression modeling with generalized estimating equations to estimate the associations between arthritis and limitations in four physical function measures (large muscle tasks, mobility, activities of daily living, and instrumental activities of daily living) adjusting for age, sex, race/ethnicity, marital status, education, total household income, depression, obesity, smoking, chronic conditions, physical activity, and cohort status. We examined interaction effects between arthritis and age to determine if the rate of change in physical function differed by arthritis status across age.

RESULTS: Over 8 years (2004-2012), significantly more retirees with arthritis had limitations with large muscle tasks (IDR 2.1: 95% confidence interval 1.6, 2.8), mobility (IDR 1.6: 1.2, 2.2), activities of daily living (IDR 2.2: 1.0, 4.7), and instrumental activities of daily living (IDR 3.7: 1.9, 7.4) than retirees without arthritis. Retirees with arthritis did not develop limitations in mobility, activities of daily living, and instrumental activities of daily living at a different rate as they aged compared to those without arthritis.

CONCLUSIONS: Arthritis was associated with a greater prevalence of physical function limitations. Preventing limitations caused by arthritis is a key strategy to prevent disability in retirees.

VL - 72 UR - http://biomedgerontology.oxfordjournals.org/content/early/2016/04/26/gerona.glw075.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27121962?dopt=Abstract ER - TY - JOUR T1 - Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study. JF - BMC Geriatr Y1 - 2017 A1 - Wei Duan-Porter A1 - Susan Nicole Hastings A1 - Brian Neelon A1 - Courtney Harold Van Houtven KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Diabetes Mellitus KW - Female KW - Heart Failure KW - Humans KW - Internal-External Control KW - Lung Diseases KW - Male KW - Middle Aged KW - Neoplasms KW - Prospective Studies KW - Risk Factors KW - Self Concept KW - Survival Analysis AB -

BACKGROUND: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.

METHODS: We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50 years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25 kg/m, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4 years of follow-up were determined through interviews with respondents' family and the National Death Index.

RESULTS: After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores odds ratio [OR] 1.37, 95% CI 1.03-1.81; fourth quartile scores OR 1.45, 95% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4% or less); observed mortality for these individuals was 1.8% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.

CONCLUSION: Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

VL - 17 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28077089/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28077089?dopt=Abstract ER - TY - JOUR T1 - The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. JF - Health Serv Res Y1 - 2017 A1 - Geoffrey J Hoffman A1 - Hays, Ron D A1 - Martin F Shapiro A1 - Steven P Wallace A1 - Susan L Ettner KW - Accidental Falls KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Financing, Personal KW - Health Expenditures KW - Health Services KW - Humans KW - Male KW - Medicare KW - Models, Econometric KW - Sex Factors KW - Socioeconomic factors KW - United States KW - Wounds and Injuries AB -

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

VL - 52 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27581952?dopt=Abstract ER - TY - JOUR T1 - Extracting Response Style Bias From Measures of Positive and Negative Affect in Aging Research. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Stefan Schneider KW - Affect KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Bias KW - cognitive aging KW - Geriatrics KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Psychology KW - Reproducibility of Results KW - Research KW - Surveys and Questionnaires AB -

Objectives: This study investigated the role of response style biases in the assessment of positive and negative affect in aging research; it addressed whether response styles (a) are associated with age-related changes in cognitive abilities, (b) lead to distorted conclusions about age differences in affect, and (c) reduce the convergent and predictive validity of affect measures in relation to health outcomes.

Method: A multidimensional item response theory model was used to extract response styles from affect ratings provided by respondents to the psychosocial questionnaire (n = 6,295; aged 50-100 years) in the Health and Retirement Study (HRS).

Results: The likelihood of extreme response styles (disproportionate use of "not at all" and "very much" response categories) increased significantly with age, and this effect was mediated by age-related decreases in HRS cognitive test scores. Removing response styles from affect measures did not alter age patterns in positive and negative affect; however, it consistently enhanced the convergent validity (relationships with concurrent depression and mental health problems) and predictive validity (prospective relationships with hospital visits, physical illness onset) of the affect measures.

Discussion: The results support the importance of detecting and controlling response styles when studying self-reported affect in aging research.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw103 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27543081?dopt=Abstract JO - GERONB ER - TY - JOUR T1 - Foundations of Activity of Daily Living Trajectories of Older Americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2017 A1 - Linda G Martin A1 - Zachary Zimmer A1 - Jinkook Lee KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic pain KW - cognitive aging KW - Disability Evaluation KW - disease progression KW - Female KW - Humans KW - Individuality KW - Male KW - Middle Aged KW - Socioeconomic factors KW - Statistics as Topic KW - United States AB -

OBJECTIVES: The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age.

METHOD: We use data from seven waves of the Health and Retirement Study, 1998 to 2010, to investigate for individuals aged 65-84 years how baseline sociodemographic characteristics and self-reported disease, pain, and functional limitation (physical, cognitive, or sensory) are related to the dynamics of limitations in activities of daily living (ADLs). Our modeling approach jointly estimates multiperiod trajectories of ADL limitation and mortality and yields estimates of the number of, shapes of, and factors associated with the most common trajectories.

RESULTS: Individual probability of ADL limitation can best be described by three common trajectories. In comparison with disease, pain, and functional limitation, sociodemographic characteristics have weak associations with trajectory group membership. Notably, neither sex nor education is strongly associated with group membership in multivariate models.

DISCUSSION: The analysis confirms the importance of the early phases of the disablement process and their relationships with subsequent trajectories of activity limitation.

VL - 72 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/01/geronb.gbv074.abstract IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26333820?dopt=Abstract U4 - Disability/Disability/Functional health status/Health disparities/Mortality/Transition models 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 Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach. JF - Med Care Y1 - 2017 A1 - Nicholas K Schiltz A1 - David F Warner A1 - Jiayang Sun A1 - Paul M Bakaki A1 - Avi Dor A1 - Charles W Given A1 - Kurt C Stange A1 - Siran M Koroukian KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Female KW - Health Behavior KW - Health Expenditures KW - Health Status KW - Humans KW - Machine learning KW - Male KW - Medicare KW - Retrospective Studies KW - Self Report KW - Socioeconomic factors KW - United States AB -

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

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

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

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

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

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

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

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

VL - 55 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27753745?dopt=Abstract ER - TY - JOUR T1 - Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. JF - J Gen Intern Med Y1 - 2017 A1 - Victoria L. Tang A1 - Rebecca L. Sudore A1 - Irena Cenzer A1 - W John Boscardin A1 - Alexander K Smith A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Finlayson, Emily A1 - Petrillo, Laura A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Dementia KW - Female KW - Geriatric Assessment KW - Hip Fractures KW - Humans KW - Longitudinal Studies KW - Male KW - Mobility Limitation KW - Recovery of Function KW - Walking AB -

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

VL - 32 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27605004?dopt=Abstract ER - TY - JOUR T1 - Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer. JF - J Geriatr Oncol Y1 - 2017 A1 - Siran M Koroukian A1 - Nicholas K Schiltz A1 - David F Warner A1 - Charles W Given A1 - Mark Schluchter A1 - Owusu, Cynthia A1 - Nathan A. Berger KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Emergency Service, Hospital KW - Female KW - Health Surveys KW - Hospices KW - Hospital Mortality KW - Humans KW - Logistic Models KW - Male KW - multimorbidity KW - Neoplasms KW - Population Surveillance KW - Quality of Health Care KW - Risk Factors KW - Socioeconomic factors KW - Terminal Care AB -

OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care.

METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders.

RESULTS: While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others.

CONCLUSIONS: To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

VL - 8 UR - http://linkinghub.elsevier.com/retrieve/pii/S1879406816301229http://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/plain IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28029586?dopt=Abstract JO - Journal of Geriatric Oncology ER - TY - JOUR T1 - Social Inequalities in Inflammation: Age Variations in Older Persons. JF - J Aging Health Y1 - 2017 A1 - Uchechi A Mitchell A1 - Carol S Aneshensel KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Biomarkers KW - C-reactive protein KW - Female KW - Health Status Disparities KW - Humans KW - Inflammation KW - Male KW - Middle Aged KW - Racial Groups KW - Self Report KW - Socioeconomic factors AB -

OBJECTIVE: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons.

METHOD: Data are from the 2006/2008 Health and Retirement Study ( n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics.

RESULTS: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age.

DISCUSSION: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.

VL - 29 UR - http://jah.sagepub.com/content/early/2016/04/24/0898264316645546.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27117593?dopt=Abstract U4 - inflammation/health disparities/race/ethnicity/gender/education 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 - Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures. JF - J Aging Health Y1 - 2016 A1 - Daniel O. Clark A1 - Kathleen A Lane A1 - Ambuehl, Roberta A1 - Tu, Wanzhu A1 - Chiung-Ju Liu A1 - Kathleen T. Unroe A1 - Christopher M. Callahan KW - Age Factors KW - Aged KW - Body Mass Index KW - Female KW - Health Expenditures KW - Humans KW - Male KW - Medicare KW - Obesity KW - United States AB -

OBJECTIVE: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period.

METHOD: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above).

RESULTS: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant.

DISCUSSION: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

PB - 28 VL - 28 UR - http://jah.sagepub.com/content/28/1/165 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26112066?dopt=Abstract U2 - PMC4691214 ER - TY - JOUR T1 - Association of a Genetic Risk Score With Body Mass Index Across Different Birth Cohorts. JF - JAMA Y1 - 2016 A1 - Stefan Walter A1 - Mejía-Guevara, Iván A1 - Estrada, Karol A1 - Sze Y Liu A1 - M. Maria Glymour KW - African Continental Ancestry Group KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alleles KW - Body Mass Index KW - Cohort Studies KW - European Continental Ancestry Group KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multilocus Sequence Typing KW - Obesity KW - Polymorphism, Single Nucleotide KW - Risk Factors KW - United States AB -

IMPORTANCE: Many genetic variants are associated with body mass index (BMI). Associations may have changed with the 20th century obesity epidemic and may differ for black vs white individuals.

OBJECTIVE: Using birth cohort as an indicator for exposure to obesogenic environment, to evaluate whether genetic predisposition to higher BMI has a larger magnitude of association among adults from more recent birth cohorts, who were exposed to the obesity epidemic at younger ages.

DESIGN, SETTING, AND PARTICIPANTS: Observational study of 8788 adults in the US national Health and Retirement Study who were aged 50 years and older, born between 1900 and 1958, with as many as 12 BMI assessments from 1992 to 2014.

EXPOSURES: A multilocus genetic risk score for BMI (GRS-BMI), calculated as the weighted sum of alleles of 29 single nucleotide polymorphisms associated with BMI, with weights equal to the published per-allele effects. The GRS-BMI represents how much each person's BMI is expected to differ, based on genetic background (with respect to these 29 loci), from the BMI of a sample member with median genetic risk. The median-centered GRS-BMI ranged from -1.68 to 2.01.

MAIN OUTCOMES AND MEASURES: BMI based on self-reported height and weight.

RESULTS: GRS-BMI was significantly associated with BMI among white participants (n = 7482; mean age at first assessment, 59 years; 3373 [45%] were men; P <.001) and among black participants (n = 1306; mean age at first assessment, 57 years; 505 [39%] were men; P <.001) but accounted for 0.99% of variation in BMI among white participants and 1.37% among black participants. In multilevel models accounting for age, the magnitude of associations of GRS-BMI with BMI were larger for more recent birth cohorts. For example, among white participants, each unit higher GRS-BMI was associated with a difference in BMI of 1.37 (95% CI, 0.93 to 1.80) if born after 1943, and 0.17 (95% CI, -0.55 to 0.89) if born before 1924 (P = .006). For black participants, each unit higher GRS-BMI was associated with a difference in BMI of 3.70 (95% CI, 2.42 to 4.97) if born after 1943, and 1.44 (95% CI, -1.40 to 4.29) if born before 1924.

CONCLUSIONS AND RELEVANCE: For participants born between 1900 and 1958, the magnitude of association between BMI and a genetic risk score for BMI was larger among persons born in later cohorts. This suggests that associations of known genetic variants with BMI may be modified by obesogenic environments.

VL - 316 UR - http://www.ncbi.nlm.nih.gov/pubmed/27380344 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27380344?dopt=Abstract 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 - Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study. JF - Health Econ Y1 - 2016 A1 - Johanna Catherine Maclean A1 - Asia Sikora Kessler A1 - Donald S. Kenkel KW - Age Factors KW - Aged KW - Consumer Behavior KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Smoking KW - Taxes KW - Tobacco Products KW - United States AB -

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

PB - 25 VL - 25 UR - http://onlinelibrary.wiley.com/doi/10.1002/hec.3161/epdf IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25721732?dopt=Abstract ER - TY - JOUR T1 - C-reactive protein level partially mediates the relationship between moderate alcohol use and frailty: the Health and Retirement Study. JF - Age Ageing Y1 - 2016 A1 - Mona Shah A1 - Daniel Paulson KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Alcohol Drinking KW - Biomarkers KW - C-reactive protein KW - Cross-Sectional Studies KW - Female KW - Frail Elderly KW - Frailty KW - Geriatric Assessment KW - Humans KW - Inflammation Mediators KW - Male KW - Protective factors KW - Risk Factors KW - United States AB -

BACKGROUND: frailty is an indicator of late-life decline marked by higher rates of disability and healthcare utilisation. Research has linked health benefits with moderate alcohol use, including frailty risk reduction. Past work suggests inflammation, measured by C-reactive protein (CRP), as one candidate mechanism for this effect.

OBJECTIVE: this study aims to elucidate a possible mechanism - CRP modulation - by which moderate alcohol consumption may protect against frailty.

METHODS: a cross-sectional study using data from the 2008 wave of the Health and Retirement Study (HRS) conducted by the University of Michigan. The HRS is a cohort study on health, retirement and aging on adults aged 50 and older living in the USA. A final sample of 3,229 stroke-free participants, over the age of 65 years and with complete data, was identified from the 2008 wave. Alcohol use was measured via self-report. Frailty was measured using the Paulson-Lichtenberg Frailty Index. CRP was collected through the HRS protocol.

RESULTS: results from structural equation modelling support the hypothesised model that moderate alcohol use is associated with less frailty and lower CRP levels. Furthermore, the indirect relationship from moderate alcohol use to frailty through CRP was statistically significant.

CONCLUSIONS: overall findings suggest that inflammation measured by CRP is one mechanism by which moderate alcohol use may confer protective effects for frailty. These findings inform future research relating alcohol use and frailty, and suggest inflammation as a possible mechanism in the relationship between moderate alcohol use and other beneficial health outcomes.

VL - 45 UR - http://ageing.oxfordjournals.org/content/early/2016/06/30/ageing.afw103.long IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27496931?dopt=Abstract ER - TY - JOUR T1 - The determinants of presenteeism: a comprehensive investigation of stress-related factors at work, health, and individual factors among the aging workforce. JF - J Occup Health Y1 - 2016 A1 - Tianan Yang A1 - Zhu, Mingjing A1 - Xiyao Xie KW - Age Factors KW - Aged KW - Aging KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Occupational Diseases KW - Presenteeism KW - Stress, Psychological KW - United States KW - Workplace AB -

OBJECTIVES: The aim of this study was to identify the determinants of presenteeism, taking health and individual factors into account.

METHODS: A quantitative analysis applying structural equation modelling analysis was conducted on the basis of secondary data from the Health and Retirement Survey (2008 wave), which measured presenteeism and its determinants.

RESULTS: Stress-related factors at work (β =-0.35, p<0.001), individual factors (α =-0.27, p<0.001), and health (β =0.24, p<0.001) were significantly related to presenteeism. Individual factors were found to be directly correlated with stress-related factors at work (β =0.22, p<0.001). Significant indirect effects between stress-related factors at work and presenteeism (Sobel z=-6.61; p<0.001) and between individual factors and presenteeism (Sobel z=-4.42; p<0.001), which were mediated by health, were also found. Overall, the final model accounted for 37% (R(2)=0.37) of the variance in presenteeism.

CONCLUSIONS: Our study indicates some important and practical guidelines for employers to avoid the burdens of stress-related presenteeism among their employees. These findings could help select target factors in the design and implementation of effective presenteeism interventions in the aging working population.

PB - 58 VL - 58 UR - https://www.jstage.jst.go.jp/article/joh/58/1/58_15-0114-OA/_article IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26490428?dopt=Abstract ER - TY - JOUR T1 - Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study. JF - American Journal of Preventive Medicine Y1 - 2016 A1 - Cleopatra M Abdou A1 - Adam W. Fingerhut A1 - James S Jackson A1 - Felicia V Wheaton KW - Age Factors KW - Aged KW - Ageism KW - Attitude of Health Personnel KW - depression KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Mental Health KW - Middle Aged KW - Overweight KW - Physician-Patient Relations KW - Physicians KW - Prejudice KW - Racism KW - Sex Factors KW - Socioeconomic factors KW - Stereotyping AB -

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

PB - 50 VL - 50 IS - 2 U2 - PMC4755717 U4 - HEALTH CARE/Stereotypes/PHYSICIAN TRUST/Social identity/Social identity ER - TY - JOUR T1 - Marital Histories and Heavy Alcohol Use among Older Adults. JF - J Health Soc Behav Y1 - 2016 A1 - Reczek, Corinne A1 - Tetyana Pudrovska A1 - Deborah Carr A1 - Thomeer, Mieke Beth A1 - Debra Umberson KW - Adult KW - Age Factors KW - Aged KW - Alcohol Drinking KW - Divorce KW - Female KW - Humans KW - Male KW - Marital Status KW - Marriage KW - Middle Aged KW - Models, Psychological KW - Socioeconomic factors AB -

We develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men's but increases women's drinking relative to being never married and previously married, whereas divorce increases men's but decrease women's drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men's and women's heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.

PB - 57 VL - 57 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26957135?dopt=Abstract U2 - PMC4785832 U4 - marital status/alcohol use/drinking trajectories/drinking ER - TY - JOUR T1 - Motoric cognitive risk syndrome and risk of mortality in older adults. JF - Alzheimers Dement Y1 - 2016 A1 - Emmeline Ayers A1 - Joe Verghese KW - Age Factors KW - Aged KW - Cognition Disorders KW - Cohort Studies KW - Dementia KW - Early Diagnosis KW - Female KW - Gait KW - Humans KW - Male KW - Mortality KW - Risk Factors AB -

INTRODUCTION: Cognitive impairment is associated with increased mortality. We examined the association between motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and cognitive complaints, and survival.

METHODS: A total of 11,867 nondemented participants aged >65 years from three established cohort studies in the United States and Europe were screened for MCR. Mortality risk of MCR was assessed with Cox and logistic regression models.

RESULTS: At baseline, 836 (7.0%) participants had MCR. Over a median follow-up of 28 months, 1603 participants died (758 in first 2 years). MCR was associated with increased mortality overall (adjusted hazard ratio, 1.69; 95% confidence interval [CI], 1.46-1.96) and 2-year mortality (adjusted odds ratio, 1.89; 95% CI, 1.50-2.38). The association remained after accounting for established mortality risk factors as well as baseline gait speed and memory performance.

DISCUSSION: MCR is associated with increased mortality. Older adults should be screened for MCR to identify at-risk individuals for dementia and death.

VL - 12 UR - https://www.ncbi.nlm.nih.gov/pubmed/26545790 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26545790?dopt=Abstract ER - TY - JOUR T1 - Racial and Socioeconomic Variation in Genetic Markers of Telomere Length: A Cross-Sectional Study of U.S. Older Adults. JF - EBioMedicine Y1 - 2016 A1 - Hamad, Rita A1 - Tuljapurkar, Shripad A1 - David Rehkopf KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alleles KW - Cross-Sectional Studies KW - Ethnic Groups KW - Female KW - Gene Frequency KW - Genetic Markers KW - Genome-Wide Association Study KW - Geriatric Assessment KW - Humans KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Population Surveillance KW - Socioeconomic factors KW - Telomere Homeostasis KW - United States AB -

BACKGROUND: Shorter telomere length (TL) has been associated with stress and adverse socioeconomic conditions, yet U.S. blacks have longer TL than whites. The role of genetic versus environmental factors in explaining TL by race and socioeconomic position (SEP) remains unclear.

METHODS: We used data from the U.S. Health and Retirement Study (N=11,934) to test the hypothesis that there are differences in TL-associated SNPs by race and SEP. We constructed a TL polygenic risk score (PRS) and examined its association with race/ethnicity, educational attainment, assets, gender, and age.

RESULTS: U.S. blacks were more likely to have a lower PRS for TL, as were older individuals and men. Racial differences in TL were statistically accounted for when controlling for population structure using genetic principal components. The GWAS-derived SNPs for TL, however, may not have consistent associations with TL across different racial/ethnic groups.

CONCLUSIONS: This study showed that associations of race/ethnicity with TL differed when accounting for population stratification. The role of race/ethnicity for TL remains uncertain, however, as the genetic determinants of TL may differ by race/ethnicity. Future GWAS samples should include racially diverse participants to allow for better characterization of the determinants of TL in human populations.

VL - 11 ER - TY - JOUR T1 - Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care-based studies. JF - Ann Epidemiol Y1 - 2016 A1 - Hales, Craig M A1 - Harpaz, Rafael A1 - Bialek, Stephanie R KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Female KW - Health Surveys KW - Herpes Zoster KW - Humans KW - Independent Living KW - Logistic Models KW - Male KW - Middle Aged KW - Outcome Assessment, Health Care KW - pain KW - Pain Measurement KW - Patient Acceptance of Health Care KW - Reproducibility of Results KW - Retirement KW - Risk Assessment KW - Self Report KW - Severity of Illness Index KW - Sex Factors KW - Treatment Outcome KW - United States AB -

PURPOSE: To describe self-reported herpes zoster (HZ) and explore factors that could impact interpretation of results from health care-based HZ studies.

METHODS: We performed logistic regression using data from the 2008 Health and Retirement Study (HRS) to evaluate risk factors for having a history of HZ and experiencing severe HZ pain, and predictors for seeking health care for HZ.

RESULTS: Among 14,564 respondents aged ≥55 years, women were more likely than men to report a history of HZ (15.7% vs. 11.6%, P < .01). Blacks (6.4% vs. 14.7% in whites, P < .01) and respondents with less than a high school diploma (12.2% vs.14.2% in respondents with at least a high school diploma, P = .01) were less likely to report a history of HZ. Women, blacks, Hispanics, and those with less than a high school diploma were more likely to report severe HZ pain. Most (91.1%) respondents sought health care for HZ; Hispanics (64.2% vs. 92.1% in whites, P < .001) and those with recurrent HZ were less likely to seek health care for HZ, whereas those with severe pain were more likely (95.4% vs. 87.9% in those without severe pain, P < .01).

CONCLUSIONS: HRS provides a new platform for studies of HZ, one which allowed us to uncover issues that warrant particular attention when interpreting results of health care-based studies.

VL - 26 UR - http://www.ncbi.nlm.nih.gov/pubmed/27180114 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27180114?dopt=Abstract ER - TY - JOUR T1 - Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. JF - J Health Soc Behav Y1 - 2016 A1 - Tyson H Brown A1 - Liana J Richardson A1 - Taylor W. Hargrove A1 - Courtney S Thomas KW - Age Factors KW - Aged KW - Aging KW - Continental Population Groups KW - Female KW - Health Status Disparities KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Sex Factors KW - Social Class KW - Socioeconomic factors AB -

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

VL - 57 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905600/ IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27284076?dopt=Abstract ER - TY - JOUR T1 - Childhood and later life stressors and increased inflammatory gene expression at older ages. JF - Soc Sci Med Y1 - 2015 A1 - Morgan E. Levine A1 - Steven W. Cole A1 - David R Weir A1 - Eileen M. Crimmins KW - Adolescent KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Continental Population Groups KW - Cyclooxygenase 2 KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Interleukin-1beta KW - Interleukin-8 KW - Life Change Events KW - Male KW - Middle Aged KW - Obesity KW - RNA KW - Sex Factors KW - Smoking KW - Socioeconomic factors KW - Stress, Psychological AB -

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

PB - 130 VL - 130 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25658624?dopt=Abstract U2 - PMC4394113 U4 - childhood health/adverse events/adverse events/trauma 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 - Disaggregating activities of daily living limitations for predicting nursing home admission. JF - Health Serv Res Y1 - 2015 A1 - Joelle H Fong A1 - Olivia S. Mitchell A1 - Benedict S K Koh KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Geriatric Assessment KW - Homes for the Aged KW - Humans KW - Male KW - Middle Aged KW - Nursing homes KW - Patient Admission KW - Residence Characteristics KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors AB -

OBJECTIVE: To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.

DATA SOURCES: We used panel data from the Health and Retirement Study (HRS) for years 1998-2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801).

STUDY DESIGN: We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables.

PRINCIPAL FINDINGS: Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R(2) s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static.

CONCLUSIONS: Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.

PB - 50 VL - 50 IS - 2 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25256014?dopt=Abstract U2 - PMC4369222 U4 - ADL/IADL/Long Term Care/Nursing home placement ER - TY - JOUR T1 - The effects of income on mental health: evidence from the social security notch. JF - J Ment Health Policy Econ Y1 - 2015 A1 - Ezra Golberstein KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Humans KW - Income KW - Male KW - Mental Health KW - Models, Econometric KW - Retirement KW - Sex Factors KW - Social Security KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Mental health is a key component of overall wellbeing and mental disorders are relatively common, including among older adults. Yet the causal effect of income on mental health status among older adults is poorly understood.

AIMS: This paper considers the effects of a major source of transfer income, Social Security retirement benefits, on the mental health of older adults.

METHODS: The Social Security benefit "Notch" is as a large, permanent, and exogenous shock to Social Security income in retirement. The "Notch" is used to identify the causal effect of Social Security income on mental health among older ages using data from the AHEAD cohort of the Health and Retirement Study.

RESULTS: We find that increases in Social Security income significantly improve mental health status and the likelihood of a psychiatric diagnosis for women, but not for men.

DISCUSSION: The effects of income on mental health for older women are statistically significant and meaningful in magnitude. While this is one of the only studies to use plausibly exogenous variation in household income to identify the effect of income on mental health, a limitation of this work is that the results only directly pertain to lower-education households.

IMPLICATIONS: Public policy proposals that alter retirement benefits for the elderly may have important effects on the mental health of older adults.

PB - 18 VL - 18 IS - 1 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25862202?dopt=Abstract U2 - PMC4494112 U4 - mental Health/social Security/older adults/psychiatric diagnosis/household income ER - TY - JOUR T1 - FASTKD2 is associated with memory and hippocampal structure in older adults. JF - Mol Psychiatry Y1 - 2015 A1 - Vijay K Ramanan A1 - Nho, Kwangsik A1 - Shen, Li A1 - Shannon L Risacher A1 - Brenna C McDonald A1 - Martin R Farlow A1 - Tatiana Foroud A1 - Gao, Sujuan A1 - Soininen, Hilkka A1 - Kloszewska, Iwona A1 - Mecocci, Patrizia A1 - Tsolaki, Magda A1 - Vellas, Bruno A1 - Lovestone, Simon A1 - Aisen, Paul S. A1 - Ronald C Petersen A1 - Jack, Clifford R. A1 - Shaw, Leslie M. A1 - Trojanowski, John Q. A1 - Weiner, Michael W. A1 - Green, Robert C. A1 - Arthur W. Toga A1 - Philip L de Jager A1 - Lei Yu A1 - David A Bennett A1 - Andrew J Saykin KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Female KW - Genetic Association Studies KW - Genome-Wide Association Study KW - Hippocampus KW - Humans KW - Longitudinal Studies KW - Male KW - Memory KW - Memory Disorders KW - Polymorphism, Single Nucleotide KW - Protein-Serine-Threonine Kinases KW - Structure-Activity Relationship AB -

Memory impairment is the cardinal early feature of Alzheimer's disease, a highly prevalent disorder whose causes remain only partially understood. To identify novel genetic predictors, we used an integrative genomics approach to perform the largest study to date of human memory (n=14 781). Using a genome-wide screen, we discovered a novel association of a polymorphism in the pro-apoptotic gene FASTKD2 (fas-activated serine/threonine kinase domains 2; rs7594645-G) with better memory performance and replicated this finding in independent samples. Consistent with a neuroprotective effect, rs7594645-G carriers exhibited increased hippocampal volume and gray matter density and decreased cerebrospinal fluid levels of apoptotic mediators. The MTOR (mechanistic target of rapamycin) gene and pathways related to endocytosis, cholinergic neurotransmission, epidermal growth factor receptor signaling and immune regulation, among others, also displayed association with memory. These findings nominate FASTKD2 as a target for modulating neurodegeneration and suggest potential mechanisms for therapies to combat memory loss in normal cognitive aging and dementia.

PB - 20 VL - 20 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract U2 - PMC4427556 U4 - Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 ER - TY - JOUR T1 - Functional impairment and hospital readmission in Medicare seniors. JF - JAMA Intern Med Y1 - 2015 A1 - S. Ryan Greysen A1 - Irena Cenzer A1 - Andrew D. Auerbach A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Comorbidity KW - Female KW - Heart Failure KW - Humans KW - Income KW - Logistic Models KW - Male KW - Medicare KW - Myocardial Infarction KW - Patient Readmission KW - Pneumonia KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - United States AB -

IMPORTANCE: Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

OBJECTIVE: To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

DESIGN, SETTING, AND PARTICIPANTS: We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010.

MAIN OUTCOMES AND MEASURES: Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission.

RESULTS: Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4% were female, 84.9% were white, 89.6% reported 3 or more comorbidities, and 86.0% had 1 or more hospitalizations in the previous year. Overall, 48.3% had some level of functional impairment before admission, and 15.5% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5% with no functional impairment, 14.3% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95% CI, 0.94-1.20), 14.4% with difficulty with 1 or more ADL (OR, 1.08; 95% CI, 0.96-1.21), 16.5% with dependency in 1 to 2 ADLs (OR, 1.26; 95% CI, 1.11-1.44), and 18.2% with dependency in 3 or more ADLs (OR, 1.42; 95% CI, 1.20-1.69). Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9% readmission rate for no impairment vs 25.7% for dependency in 3 or more ADLs [OR, 1.70; 95% CI, 1.04-2.78]).

CONCLUSIONS AND RELEVANCE: Functional impairment is associated with increased risk of 30-day all-cause hospital readmission in Medicare seniors, especially those admitted for heart failure, myocardial infarction, or pneumonia. Functional impairment may be an important but underaddressed factor in preventing readmissions for Medicare seniors.

PB - 175 VL - 175 IS - 4 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25642907?dopt=Abstract U2 - PMC4388787 U4 - Medicare/Functional impairment/hospital readmission/ADL and IADL Impairments ER - TY - JOUR T1 - Genetic studies of body mass index yield new insights for obesity biology. JF - Nature Y1 - 2015 A1 - Locke, Adam E A1 - Kahali, Bratati A1 - Berndt, Sonja I A1 - Justice, Anne E A1 - Pers, Tune H A1 - Day, Felix R A1 - Powell, Corey A1 - Vedantam, Sailaja A1 - Buchkovich, Martin L A1 - Yang, Jian A1 - Croteau-Chonka, Damien C A1 - Tõnu Esko A1 - Fall, Tove A1 - Ferreira, Teresa A1 - Gustafsson, Stefan A1 - Kutalik, Zoltán A1 - Luan, Jian'an A1 - Mägi, Reedik A1 - Randall, Joshua C A1 - Thomas W Winkler A1 - Andrew R Wood A1 - Workalemahu, Tsegaselassie A1 - Jessica Faul A1 - Jennifer A Smith A1 - Jing Hua Zhao A1 - Wei Zhao A1 - Chen, Jin A1 - Rudolf Ferhmann A1 - Hedman, Åsa K A1 - Karjalainen, Juha A1 - Schmidt, Ellen M A1 - Absher, Devin A1 - Amin, Najaf A1 - Anderson, Denise A1 - Beekman, Marian A1 - Bolton, Jennifer L A1 - Bragg-Gresham, Jennifer L A1 - Buyske, Steven A1 - Demirkan, Ayse A1 - Deng, Guohong A1 - Georg B Ehret A1 - Feenstra, Bjarke A1 - Feitosa, Mary F A1 - Fischer, Krista A1 - Goel, Anuj A1 - Gong, Jian A1 - Jackson, Anne U A1 - Kanoni, Stavroula A1 - Kleber, Marcus E A1 - Kristiansson, Kati A1 - Lim, Unhee A1 - Lotay, Vaneet A1 - Mangino, Massimo A1 - Irene Mateo Leach A1 - Medina-Gomez, Carolina A1 - Sarah E Medland A1 - Michael A Nalls A1 - Palmer, Cameron D A1 - Pasko, Dorota A1 - Pechlivanis, Sonali A1 - Peters, Marjolein J A1 - Prokopenko, Inga A1 - Shungin, Dmitry A1 - Stančáková, Alena A1 - Strawbridge, Rona J A1 - Yun Ju Sung A1 - Toshiko Tanaka A1 - Teumer, Alexander A1 - Trompet, Stella A1 - van der Laan, Sander W A1 - van Setten, Jessica A1 - Jana V. van Vliet-Ostaptchouk A1 - Wang, Zhaoming A1 - Yengo, Loic A1 - Zhang, Weihua A1 - Isaacs, Aaron A1 - Albrecht, Eva A1 - Ärnlöv, Johan A1 - Arscott, Gillian M A1 - Attwood, Antony P A1 - Bandinelli, Stefania A1 - Barrett, Amy A1 - Bas, Isabelita N A1 - Bellis, Claire A1 - Bennett, Amanda J A1 - Berne, Christian A1 - Blagieva, Roza A1 - Blüher, Matthias A1 - Böhringer, Stefan A1 - Bonnycastle, Lori L A1 - Böttcher, Yvonne A1 - Boyd, Heather A A1 - Bruinenberg, Marcel A1 - Caspersen, Ida H A1 - Yii-Der I Chen A1 - Robert Clark A1 - Daw, E Warwick A1 - de Craen, Anton J M A1 - Delgado, Graciela A1 - Dimitriou, Maria A1 - Doney, Alex S F A1 - Eklund, Niina A1 - Estrada, Karol A1 - Eury, Elodie A1 - Folkersen, Lasse A1 - Fraser, Ross M A1 - Melissa E Garcia A1 - Geller, Frank A1 - Giedraitis, Vilmantas A1 - Gigante, Bruna A1 - Alan S Go A1 - Golay, Alain A1 - Goodall, Alison H A1 - Gordon, Scott D A1 - Gorski, Mathias A1 - Hans-Jörgen Grabe A1 - Grallert, Harald A1 - Grammer, Tanja B A1 - Gräßler, Jürgen A1 - Grönberg, Henrik A1 - Groves, Christopher J A1 - Gusto, Gaëlle A1 - Jeffrey Haessler A1 - Hall, Per A1 - Haller, Toomas A1 - Hallmans, Göran A1 - Catharina A Hartman A1 - Hassinen, Maija A1 - Caroline Hayward A1 - Heard-Costa, Nancy L A1 - Helmer, Quinta A1 - Hengstenberg, Christian A1 - Oddgeir L Holmen A1 - Jouke-Jan Hottenga A1 - James, Alan L A1 - Janina Jeff A1 - Johansson, Åsa A1 - Jolley, Jennifer A1 - Juliusdottir, Thorhildur A1 - Kinnunen, Leena A1 - Koenig, Wolfgang A1 - Koskenvuo, Markku A1 - Kratzer, Wolfgang A1 - Laitinen, Jaana A1 - Lamina, Claudia A1 - Leander, Karin A1 - Lee, Nanette R A1 - Lichtner, Peter A1 - Lars Lind A1 - Lindström, Jaana A1 - Ken Sin Lo A1 - Lobbens, Stéphane A1 - Lorbeer, Roberto A1 - Lu, Yingchang A1 - Mach, François A1 - Patrik K E Magnusson A1 - Mahajan, Anubha A1 - McArdle, Wendy L A1 - McLachlan, Stela A1 - Menni, Cristina A1 - Merger, Sigrun A1 - Mihailov, Evelin A1 - Lili Milani A1 - Moayyeri, Alireza A1 - Monda, Keri L A1 - Morken, Mario A A1 - Mulas, Antonella A1 - Müller, Gabriele A1 - Müller-Nurasyid, Martina A1 - Musk, Arthur W A1 - Nagaraja, Ramaiah A1 - Markus M Nöthen A1 - Ilja M Nolte A1 - Pilz, Stefan A1 - Nigel W Rayner A1 - Renstrom, Frida A1 - Rettig, Rainer A1 - Ried, Janina S A1 - Ripke, Stephan A1 - Neil R Robertson A1 - Rose, Lynda M A1 - Sanna, Serena A1 - Scharnagl, Hubert A1 - Scholtens, Salome A1 - Schumacher, Fredrick R A1 - Scott, William R A1 - Seufferlein, Thomas A1 - Jianxin Shi A1 - Albert Vernon Smith A1 - Smolonska, Joanna A1 - Stanton, Alice V A1 - Steinthorsdottir, Valgerdur A1 - Kathleen E Stirrups A1 - Heather M Stringham A1 - Sundström, Johan A1 - Swertz, Morris A A1 - Swift, Amy J A1 - Syvänen, Ann-Christine A1 - Tan, Sian-Tsung A1 - Bamidele O Tayo A1 - Thorand, Barbara A1 - Thorleifsson, Gudmar A1 - Tyrer, Jonathan P A1 - Uh, Hae-Won A1 - Vandenput, Liesbeth A1 - Verhulst, Frank C A1 - Vermeulen, Sita H A1 - Verweij, Niek A1 - Vonk, Judith M A1 - Lindsay L Waite A1 - Warren, Helen R A1 - Dawn M Waterworth A1 - Michael N Weedon A1 - Wilkens, Lynne R A1 - Willenborg, Christina A1 - Wilsgaard, Tom A1 - Wojczynski, Mary K A1 - Wong, Andrew A1 - Alan F Wright A1 - Zhang, Qunyuan A1 - Brennan, Eoin P A1 - Murim Choi A1 - Dastani, Zari A1 - Alexander W Drong A1 - Eriksson, Per A1 - Franco-Cereceda, Anders A1 - Gådin, Jesper R A1 - Gharavi, Ali G A1 - Goddard, Michael E A1 - Handsaker, Robert E A1 - Huang, Jinyan A1 - Karpe, Fredrik A1 - Kathiresan, Sekar A1 - Keildson, Sarah A1 - Kiryluk, Krzysztof A1 - Kubo, Michiaki A1 - Lee, Jong-Young A1 - Liang, Liming A1 - Lifton, Richard P A1 - Ma, Baoshan A1 - McCarroll, Steven A A1 - McKnight, Amy J A1 - Min, Josine L A1 - Moffatt, Miriam F A1 - Grant W Montgomery A1 - Joanne M Murabito A1 - Nicholson, George A1 - Nyholt, Dale R A1 - Okada, Yukinori A1 - Perry, John R B A1 - Dorajoo, Rajkumar A1 - Reinmaa, Eva A1 - Salem, Rany M A1 - Sandholm, Niina A1 - Scott, Robert A A1 - Stolk, Lisette A1 - Takahashi, Atsushi A1 - Tanaka, Toshihiro A1 - Ferdinand M van 't Hooft A1 - Anna A E Vinkhuyzen A1 - Westra, Harm-Jan A1 - Wei Zhang A1 - Krina T Zondervan A1 - Andrew C Heath A1 - Arveiler, Dominique A1 - Bakker, Stephan J L A1 - Beilby, John A1 - Bergman, Richard N A1 - Blangero, John A1 - Bovet, Pascal A1 - Campbell, Harry A1 - Caulfield, Mark J A1 - Cesana, Giancarlo A1 - Chakravarti, Aravinda A1 - Daniel I Chasman A1 - Chines, Peter S A1 - Collins, Francis S A1 - Crawford, Dana C A1 - Cupples, L Adrienne A1 - Cusi, Daniele A1 - Danesh, John A1 - de Faire, Ulf A1 - Hester M den Ruijter A1 - Dominiczak, Anna F A1 - Erbel, Raimund A1 - Erdmann, Jeanette A1 - Johan G Eriksson A1 - Farrall, Martin A1 - Felix, Stephan B A1 - Ferrannini, Ele A1 - Ferrières, Jean A1 - Ford, Ian A1 - Forouhi, Nita G A1 - Forrester, Terrence A1 - Franco, Oscar H A1 - Gansevoort, Ron T A1 - Gejman, Pablo V A1 - Gieger, Christian A1 - Gottesman, Omri A1 - Gudnason, Vilmundur A1 - Gyllensten, Ulf A1 - Hall, Alistair S A1 - Tamara B Harris A1 - Andrew T Hattersley A1 - Hicks, Andrew A A1 - Hindorff, Lucia A A1 - Aroon Hingorani A1 - Hofman, Albert A1 - Homuth, Georg A1 - Hovingh, G Kees A1 - Humphries, Steve E A1 - Hunt, Steven C A1 - Hyppönen, Elina A1 - Illig, Thomas A1 - Jacobs, Kevin B A1 - Järvelin, Marjo-Riitta A1 - Jöckel, Karl-Heinz A1 - Johansen, Berit A1 - Jousilahti, Pekka A1 - Jukema, J Wouter A1 - Jula, Antti M A1 - Kaprio, Jaakko A1 - Kastelein, John J P A1 - Keinanen-Kiukaanniemi, Sirkka M A1 - Lambertus A Kiemeney A1 - Knekt, Paul A1 - Kooner, Jaspal S A1 - Charles Kooperberg A1 - Kovacs, Peter A1 - Kraja, Aldi T A1 - Kumari, Meena A1 - Kuusisto, Johanna A1 - Lakka, Timo A A1 - Langenberg, Claudia A1 - Loic Le Marchand A1 - Lehtimäki, Terho A1 - Lyssenko, Valeriya A1 - Männistö, Satu A1 - Marette, André A1 - Matise, Tara C A1 - McKenzie, Colin A A1 - McKnight, Barbara A1 - Moll, Frans L A1 - Morris, Andrew D A1 - Morris, Andrew P A1 - Murray, Jeffrey C A1 - Nelis, Mari A1 - Ohlsson, Claes A1 - Oldehinkel, Albertine J A1 - Ong, Ken K A1 - Pamela A F Madden A1 - Pasterkamp, Gerard A1 - Peden, John F A1 - Peters, Annette A1 - Postma, Dirkje S A1 - Pramstaller, Peter P A1 - Price, Jackie F A1 - Qi, Lu A1 - Olli T Raitakari A1 - Rankinen, Tuomo A1 - Rao, D C A1 - Rice, Treva K A1 - Ridker, Paul M A1 - Rioux, John D A1 - Ritchie, Marylyn D A1 - Rudan, Igor A1 - Veikko Salomaa A1 - Nilesh J Samani A1 - Saramies, Jouko A1 - Sarzynski, Mark A A1 - Schunkert, Heribert A1 - Schwarz, Peter E H A1 - Peter Sever A1 - Alan R Shuldiner A1 - Sinisalo, Juha A1 - Stolk, Ronald P A1 - Strauch, Konstantin A1 - Tönjes, Anke A1 - Trégouët, David-Alexandre A1 - Tremblay, Angelo A1 - Tremoli, Elena A1 - Virtamo, Jarmo A1 - Vohl, Marie-Claude A1 - Völker, Uwe A1 - Waeber, Gérard A1 - Gonneke Willemsen A1 - Witteman, Jacqueline C A1 - Zillikens, M Carola A1 - Adair, Linda S A1 - Amouyel, Philippe A1 - Asselbergs, Folkert W A1 - Assimes, Themistocles L A1 - Bochud, Murielle A1 - Boehm, Bernhard O A1 - Boerwinkle, Eric A1 - Bornstein, Stefan R A1 - Erwin P Bottinger A1 - Bouchard, Claude A1 - Cauchi, Stéphane A1 - Chambers, John C A1 - Chanock, Stephen J A1 - Cooper, Richard S A1 - de Bakker, Paul I W A1 - George Dedoussis A1 - Luigi Ferrucci A1 - Franks, Paul W A1 - Froguel, Philippe A1 - Leif C Groop A1 - Christopher A Haiman A1 - Hamsten, Anders A1 - Hui, Jennie A1 - Hunter, David J A1 - Hveem, Kristian A1 - Kaplan, Robert C A1 - Mika Kivimäki A1 - Kuh, Diana A1 - Laakso, Markku A1 - Yongmei Liu A1 - Nicholas G Martin A1 - März, Winfried A1 - Melbye, Mads A1 - Andres Metspalu A1 - Moebus, Susanne A1 - Munroe, Patricia B A1 - Njølstad, Inger A1 - Ben A Oostra A1 - Palmer, Colin N A A1 - Nancy L Pedersen A1 - Markus Perola A1 - Pérusse, Louis A1 - Peters, Ulrike A1 - Power, Chris A1 - Quertermous, Thomas A1 - Rauramaa, Rainer A1 - Fernando Rivadeneira A1 - Saaristo, Timo E A1 - Saleheen, Danish A1 - Sattar, Naveed A1 - Eric E Schadt A1 - Schlessinger, David A1 - Eline P Slagboom A1 - Snieder, Harold A1 - Timothy Spector A1 - Thorsteinsdottir, Unnur A1 - Stumvoll, Michael A1 - Tuomilehto, Jaakko A1 - André G Uitterlinden A1 - Uusitupa, Matti A1 - van der Harst, Pim A1 - Walker, Mark A1 - Wallaschofski, Henri A1 - Wareham, Nicholas J A1 - Watkins, Hugh A1 - David R Weir A1 - Wichmann, H-Erich A1 - James F Wilson A1 - Zanen, Pieter A1 - Ingrid B Borecki A1 - Deloukas, Panos A1 - Caroline S Fox A1 - Iris M Heid A1 - Jeff O'Connell A1 - David P Strachan A1 - Stefansson, Kari A1 - Cornelia M van Duijn A1 - Gonçalo R Abecasis A1 - Lude L Franke A1 - Timothy M Frayling A1 - McCarthy, Mark I A1 - Peter M Visscher A1 - Scherag, Andre A1 - Willer, Cristen J A1 - Boehnke, Michael A1 - Mohlke, Karen L A1 - Lindgren, Cecilia M A1 - Beckmann, Jacques S A1 - Barroso, Inês A1 - Kari E North A1 - Ingelsson, Erik A1 - Joel N Hirschhron A1 - Ruth J F Loos A1 - Elizabeth K Speliotes KW - Age Factors KW - BMI KW - Continental Population Groups KW - Energy Metabolism KW - Europe KW - Female KW - Genome-Wide Association Study KW - Glutamic Acid KW - Humans KW - Insulin KW - Male KW - Obesity KW - Polymorphism, Single Nucleotide KW - Quantitative Trait Loci KW - Synapses AB -

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

VL - 518 IS - 7538 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25673413?dopt=Abstract ER - TY - JOUR T1 - Health literacy and the digital divide among older Americans. JF - J Gen Intern Med Y1 - 2015 A1 - Helen G Levy A1 - Alexander T Janke A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Digital Divide KW - Female KW - Health Literacy KW - Humans KW - Internet KW - Male KW - Prospective Studies KW - Retrospective Studies KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: Among the requirements for meaningful use of electronic medical records (EMRs) is that patients must be able to interact online with information from their records. However, many older Americans may be unprepared to do this, particularly those with low levels of health literacy.

OBJECTIVE: The purpose of the study was to quantify the relationship between health literacy and use of the Internet for obtaining health information among Americans aged 65 and older.

DESIGN: We performed retrospective analysis of 2009 and 2010 data from the Health and Retirement Study, a longitudinal survey of a nationally representative sample of older Americans.

PARTICIPANTS: Subjects were community-dwelling adults aged 65 years and older (824 individuals in the general population and 1,584 Internet users).

MAIN MEASURES: Our analysis included measures of regular use of the Internet for any purpose and use of the Internet to obtain health or medical information; health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) and self-reported confidence filling out medical forms.

KEY RESULTS: Only 9.7% of elderly individuals with low health literacy used the Internet to obtain health information, compared with 31.9% of those with adequate health literacy. This gradient persisted after controlling for sociodemographic characteristics, health status, and general cognitive ability. The gradient arose both because individuals with low health literacy were less likely to use the Internet at all (OR = 0.36 [95% CI 0.24 to 0.54]) and because, among those who did use the Internet, individuals with low health literacy were less likely to use it to get health or medical information (OR = 0.60 [95% CI 0.47 to 0.77]).

CONCLUSION: Low health literacy is associated with significantly less use of the Internet for health information among Americans aged 65 and older. Web-based health interventions targeting older adults must address barriers to substantive use by individuals with low health literacy, or risk exacerbating the digital divide.

VL - 30 UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84914171477andpartnerID=40andmd5=41b0823f4329aba89308dad7c476949a IS - 3 N1 - Export Date: 20 January 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25387437?dopt=Abstract U4 - health literacy/health literacy/electronic health records/internet use/sociodemographic characteristics/sociodemographic characteristics ER - TY - JOUR T1 - Increase in Disability Prevalence Before Hip Fracture. JF - J Am Geriatr Soc Y1 - 2015 A1 - Irena Cenzer A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Dementia KW - Disability Evaluation KW - Disabled Persons KW - Educational Status KW - Female KW - Health Surveys KW - Hip Fractures KW - Humans KW - Income KW - Male KW - Mobility Limitation KW - Prevalence KW - United States AB -

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

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

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

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

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

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

PB - 63 VL - 63 IS - 10 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26480970?dopt=Abstract U2 - PMC4699653 U4 - medicare/ADMINISTRATIVE DATA/Disabilities/Hip Fractures/ADL/IADL ER - TY - JOUR T1 - Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair. JF - Nat Genet Y1 - 2015 A1 - Day, Felix R A1 - Ruth, Katherine S A1 - Thompson, Deborah J A1 - Kathryn L Lunetta A1 - Pervjakova, Natalia A1 - Daniel I Chasman A1 - Stolk, Lisette A1 - Finucane, Hilary K A1 - Sulem, Patrick A1 - Bulik-Sullivan, Brendan A1 - Tõnu Esko A1 - Andrew D Johnson A1 - Elks, Cathy E A1 - Franceschini, Nora A1 - He, Chunyan A1 - Altmaier, Elisabeth A1 - Brody, Jennifer A A1 - Lude L Franke A1 - Huffman, Jennifer E A1 - Keller, Margaux F A1 - McArdle, Patrick F A1 - Nutile, Teresa A1 - Porcu, Eleonora A1 - Robino, Antonietta A1 - Rose, Lynda M A1 - Schick, Ursula M A1 - Jennifer A Smith A1 - Teumer, Alexander A1 - Traglia, Michela A1 - Vuckovic, Dragana A1 - Yao, Jie A1 - Wei Zhao A1 - Albrecht, Eva A1 - Amin, Najaf A1 - Corre, Tanguy A1 - Jouke-Jan Hottenga A1 - Mangino, Massimo A1 - Albert Vernon Smith A1 - Toshiko Tanaka A1 - Gonçalo R Abecasis A1 - Andrulis, Irene L A1 - Anton-Culver, Hoda A1 - Antoniou, Antonis C A1 - Arndt, Volker A1 - Alice M. Arnold A1 - Barbieri, Caterina A1 - Beckmann, Matthias W A1 - Beeghly-Fadiel, Alicia A1 - Benitez, Javier A1 - Bernstein, Leslie A1 - Bielinski, Suzette J A1 - Blomqvist, Carl A1 - Boerwinkle, Eric A1 - Bogdanova, Natalia V A1 - Bojesen, Stig E A1 - Manjeet K. Bolla A1 - Borresen-Dale, Anne-Lise A1 - Boutin, Thibaud S A1 - Brauch, Hiltrud A1 - Brenner, Hermann A1 - Brüning, Thomas A1 - Burwinkel, Barbara A1 - Campbell, Archie A1 - Campbell, Harry A1 - Chanock, Stephen J A1 - Chapman, J Ross A1 - Yii-Der I Chen A1 - Chenevix-Trench, Georgia A1 - Couch, Fergus J A1 - Coviello, Andrea D A1 - Cox, Angela A1 - Czene, Kamila A1 - Darabi, Hatef A1 - De Vivo, Immaculata A1 - Ellen W Demerath A1 - Joe G Dennis A1 - Devilee, Peter A1 - Dörk, Thilo A1 - Dos-Santos-Silva, Isabel A1 - Dunning, Alison M A1 - John D Eicher A1 - Fasching, Peter A A1 - Jessica Faul A1 - Figueroa, Jonine A1 - Flesch-Janys, Dieter A1 - Gandin, Ilaria A1 - Melissa E Garcia A1 - García-Closas, Montserrat A1 - Giles, Graham G A1 - Giorgia G Girotto A1 - Goldberg, Mark S A1 - González-Neira, Anna A1 - Goodarzi, Mark O A1 - Grove, Megan L A1 - Gudbjartsson, Daniel F A1 - Guénel, Pascal A1 - Guo, Xiuqing A1 - Christopher A Haiman A1 - Hall, Per A1 - Hamann, Ute A1 - Henderson, Brian E A1 - Lynne J Hocking A1 - Hofman, Albert A1 - Homuth, Georg A1 - Hooning, Maartje J A1 - John L Hopper A1 - Hu, Frank B A1 - Huang, Jinyan A1 - Humphreys, Keith A1 - Hunter, David J A1 - Jakubowska, Anna A1 - Jones, Samuel E A1 - Kabisch, Maria A1 - Karasik, David A1 - Knight, Julia A A1 - Kolcic, Ivana A1 - Charles Kooperberg A1 - Kosma, Veli-Matti A1 - Kriebel, Jennifer A1 - Kristensen, Vessela A1 - Lambrechts, Diether A1 - Langenberg, Claudia A1 - Li, Jingmei A1 - Li, Xin A1 - Lindström, Sara A1 - Yongmei Liu A1 - Luan, Jian'an A1 - Lubinski, Jan A1 - Mägi, Reedik A1 - Mannermaa, Arto A1 - Manz, Judith A1 - Margolin, Sara A1 - Marten, Jonathan A1 - Nicholas G Martin A1 - Masciullo, Corrado A1 - Meindl, Alfons A1 - Michailidou, Kyriaki A1 - Mihailov, Evelin A1 - Lili Milani A1 - Milne, Roger L A1 - Müller-Nurasyid, Martina A1 - Michael A Nalls A1 - Neale, Benjamin M A1 - Nevanlinna, Heli A1 - Neven, Patrick A1 - Anne B Newman A1 - Børge G Nordestgaard A1 - Olson, Janet E A1 - Padmanabhan, Sandosh A1 - Peterlongo, Paolo A1 - Peters, Ulrike A1 - Petersmann, Astrid A1 - Peto, Julian A1 - Pharoah, Paul D P A1 - Nicola Pirastu A1 - Pirie, Ailith A1 - Pistis, Giorgio A1 - Polasek, Ozren A1 - David J Porteous A1 - Psaty, Bruce M A1 - Pylkäs, Katri A1 - Radice, Paolo A1 - Raffel, Leslie J A1 - Fernando Rivadeneira A1 - Rudan, Igor A1 - Rudolph, Anja A1 - Ruggiero, Daniela A1 - Cinzia Felicita Sala A1 - Sanna, Serena A1 - Sawyer, Elinor J A1 - Schlessinger, David A1 - Schmidt, Marjanka K A1 - Schmidt, Frank A1 - Schmutzler, Rita K A1 - Schoemaker, Minouk J A1 - Scott, Robert A A1 - Seynaeve, Caroline M A1 - Simard, Jacques A1 - Sorice, Rossella A1 - Southey, Melissa C A1 - Stöckl, Doris A1 - Strauch, Konstantin A1 - Swerdlow, Anthony A1 - Kent D Taylor A1 - Thorsteinsdottir, Unnur A1 - Toland, Amanda E A1 - Tomlinson, Ian A1 - Truong, Thérèse A1 - Tryggvadottir, Laufey A1 - Stephen T Turner A1 - Vozzi, Diego A1 - Wang, Qin A1 - Wellons, Melissa A1 - Gonneke Willemsen A1 - James F Wilson A1 - Winqvist, Robert A1 - Wolffenbuttel, Bruce B H R A1 - Alan F Wright A1 - Yannoukakos, Drakoulis A1 - Zemunik, Tatijana A1 - Wei Zhang A1 - Zygmunt, Marek A1 - Bergmann, Sven A1 - Dorret I Boomsma A1 - Buring, Julie E A1 - Luigi Ferrucci A1 - Grant W Montgomery A1 - Gudnason, Vilmundur A1 - Timothy Spector A1 - Cornelia M van Duijn A1 - Alizadeh, Behrooz Z A1 - Ciullo, Marina A1 - Crisponi, Laura A1 - Easton, Douglas F A1 - Paolo P. Gasparini A1 - Gieger, Christian A1 - Tamara B Harris A1 - Caroline Hayward A1 - Sharon L R Kardia A1 - Kraft, Peter A1 - McKnight, Barbara A1 - Andres Metspalu A1 - Alanna C Morrison A1 - Reiner, Alex P A1 - Ridker, Paul M A1 - Rotter, Jerome I A1 - Toniolo, Daniela A1 - André G Uitterlinden A1 - Ulivi, Sheila A1 - Völzke, Henry A1 - Wareham, Nicholas J A1 - David R Weir A1 - Laura M Yerges-Armstrong A1 - Price, Alkes L A1 - Stefansson, Kari A1 - Visser, Jenny A A1 - Ong, Ken K A1 - Chang-Claude, Jenny A1 - Joanne M Murabito A1 - Perry, John R B A1 - Murray, Anna KW - Age Factors KW - Aging KW - BRCA1 Protein KW - Breast Neoplasms KW - DNA Repair KW - Female KW - Genome KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Hypothalamus KW - Menopause KW - Middle Aged KW - Models, Genetic KW - Older Adults KW - Phenotype KW - Reproduction KW - Signal Transduction AB -

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

VL - 47 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26414677?dopt=Abstract 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 - Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression. JF - Am J Geriatr Psychiatry Y1 - 2014 A1 - Kenneth E Covinsky A1 - Irena Cenzer A1 - Kristine Yaffe A1 - Sarah O'Brien A1 - Dan G. Blazer KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Anhedonia KW - depression KW - Disabled Persons KW - Female KW - Humans KW - Interview, Psychological KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Risk Factors AB -

OBJECTIVES: Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death.

METHODS: In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders.

RESULTS: Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95% CI: 1.13-1.46).

CONCLUSION: Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness.

PB - 22 VL - 22 IS - 6 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23602308?dopt=Abstract U2 - PMC3766414 U4 - depression/activities of daily living/anhedonia/dysphoria/health status/quality of life ER - TY - JOUR T1 - Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality. JF - PLoS One Y1 - 2014 A1 - Sei J. Lee A1 - W John Boscardin A1 - Katharine A Kirby A1 - Kenneth E Covinsky KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Humans KW - Life Expectancy KW - Longevity KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mortality KW - Proportional Hazards Models KW - Risk Factors AB -

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

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

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

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

PB - 9 VL - 9 IS - 9 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25265291?dopt=Abstract U2 - PMC4180452 U4 - clinical decision-making/interventions/life Expectancy/cancer screening/mortality risk/mortality risk/survival Analysis/ELSA_/cross-national comparison/preventive health care 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 - Mortality and cardiovascular disease among older live kidney donors. JF - Am J Transplant Y1 - 2014 A1 - P. P. Reese A1 - R. D. Bloom A1 - H. I. Feldman A1 - Rosenbaum, P A1 - Wang, W A1 - P. Saynisch A1 - Tarsi, N M A1 - Mukherjee, N A1 - Garg, A X A1 - A. Mussell A1 - J. Shults A1 - Even-Shoshan, O A1 - R. R. Townsend A1 - J. H. Silber KW - Age Factors KW - Aged KW - Cardiovascular Diseases KW - Female KW - Follow-Up Studies KW - Humans KW - Kidney Transplantation KW - Living Donors KW - Longitudinal Studies KW - Male KW - Medicare KW - Middle Aged KW - Nephrectomy KW - Quality of Life KW - Renal Insufficiency KW - Time Factors KW - Treatment Outcome KW - United States AB -

Over the past two decades, live kidney donation by older individuals (≥55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41% were male and 7% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.

PB - 14 VL - 14 IS - 8 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25039276?dopt=Abstract U2 - PMC4105987 U4 - public policy/health services and outcomes research/kidney transplantation/nephrology/living donor/organ procurement/cardiovascular disease ER - TY - JOUR T1 - Why do older people change their ratings of childhood health? JF - Demography Y1 - 2014 A1 - Vuolo, Mike A1 - Kenneth F Ferraro A1 - Patricia M Morton A1 - Ting-Ying Yang KW - Adaptation, Psychological KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Health Status KW - Humans KW - Male KW - Memory KW - Middle Aged KW - Retrospective Studies KW - Self Report KW - Sex Factors KW - Socioeconomic factors AB -

A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults-those with more socioeconomic resources and better memory-were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one's rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources.

PB - 51 VL - 51 IS - 6 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25359668?dopt=Abstract U2 - PMC4253875 U4 - Retrospective questions/Self-rated health/Life course epidemiology/Reliability/Childhood conditions ER - TY - JOUR T1 - Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. JF - J Manipulative Physiol Ther Y1 - 2013 A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Suzanne E Bentler A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Databases, Factual KW - Disability Evaluation KW - Female KW - Geriatric Assessment KW - Humans KW - Low Back Pain KW - Male KW - Manipulation, Chiropractic KW - Medicare KW - Mobility Limitation KW - Musculoskeletal Diseases KW - Patient Satisfaction KW - Quality of Life KW - Risk Assessment KW - Sex Factors KW - Treatment Outcome KW - United States AB -

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

VL - 36 UR - https://www.ncbi.nlm.nih.gov/pubmed/24636108 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24144425?dopt=Abstract ER - TY - JOUR T1 - Functional limitations in older adults who have cognitive impairment without dementia. JF - J Geriatr Psychiatry Neurol Y1 - 2013 A1 - Tanya R Gure A1 - Kenneth M. Langa A1 - Gwenith G Fisher A1 - John D Piette A1 - Brenda L Plassman KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Dementia KW - Female KW - Humans KW - Male KW - Neuropsychological tests KW - Severity of Illness Index KW - Surveys and Questionnaires AB -

OBJECTIVE: To characterize the prevalence of functional limitations among older adults with cognitive impairment without dementia (CIND).

METHODS: Secondary data analysis was performed using the Aging, Demographics, and Memory Study data set. A total of 856 individuals aged ≥ 71 years were assigned to 3 diagnostic cognitive categories. A questionnaire was completed by a proxy informant regarding functional limitations for 744 of the 856 respondents.

RESULTS: Of the 744 patients, 263 (13.9%) had dementia, 201 (21.3%) had CIND, and 280 (64.8%) had normal cognition. Informants reported ≥1 instrumental activities of daily living (ADLs) limitation in 45% of the patients with CIND compared to 13% of the patients with normal cognition and 85% of the patients with dementia (P < .001). The ADL impairments among individuals with CIND were primarily attributed to physical health problems (n = 41; 40%).

CONCLUSIONS: Many individuals with CIND have impairment in a range of complex and basic daily activities, largely due to physical health problems.

VL - 26 IS - 2 N1 - NLM Title Abbreviation: J Geriatr Psychiatry Neurol U1 - http://www.ncbi.nlm.nih.gov/pubmed/23559664?dopt=Abstract U2 - PMC3726208 U4 - ADAMS/Cognitive Impairment/ADL and IADL Impairments/Physical health/Dementia/Functional limitation ER - TY - JOUR T1 - Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Kandauda Wickrama A1 - Jay A. Mancini A1 - Kwag, Kyunghwa A1 - Kwon, Josephine KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Status KW - Health Transition KW - Humans KW - Longitudinal Studies KW - Male KW - Marriage KW - Memory Disorders KW - Middle Aged KW - Socioeconomic factors AB -

OBJECTIVES: This study examines (a) the heterogeneity in individual multidimensional health trajectories and (b) the socioeconomic stratification of individual multidimensional health trajectories during the late older years.

METHOD: This study used prospective data from 1,945 adults, 75 to 85 years old, collected over an 8-year period from the Health and Retirement Study. To examine inconsistent findings in the research literature, a latent trajectory class analysis was performed.

RESULTS: Multidimensional overall health trajectories showed three heterogeneous latent classes (maintaining, persistently high, and deteriorating), and profiles of ascribed and achieved socioeconomic characteristics of multidimensional health trajectory classes showed a significant social and racial/ethnic stratification in late older years.

DISCUSSION: Past adverse socioeconomic circumstances, including childhood and adulthood adversity, are potential sources of unobserved heterogeneity of multidimensional health trajectories even in late older years. The identification of members of latent trajectory health classes and the associated antecedents linked to health class membership are consistent with a life-course conceptual framework. Thus, multidimensional health capturing the full range of health problems needs to be investigated for proper examination of socioeconomic correlates of health. This facilitates the understanding of the associations between life-course experiences and health in late old age that ultimately have implications for prevention and intervention.

PB - 68 VL - 68 UR - http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23197341?dopt=Abstract U3 - 23197341 U4 - health trajectories/health trajectories/Socioeconomic Differences/life Course/life Events/prevention/Public Policy/social Welfare ER - TY - JOUR T1 - Impact of cigarette smoking on utilization of nursing home services. JF - Nicotine Tob Res Y1 - 2013 A1 - Kenneth E. Warner A1 - Ryan J McCammon A1 - Brant E Fries A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Cross-Sectional Studies KW - Female KW - Hispanic or Latino KW - Humans KW - Length of Stay KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Nursing homes KW - Risk KW - Self Report KW - Smoking KW - Socioeconomic factors KW - United States KW - White People AB -

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

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

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

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

VL - 15 UR - http://ntr.oxfordjournals.org/content/early/2013/06/18/ntr.ntt079.abstract IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23803394?dopt=Abstract ER - TY - JOUR T1 - The influence of unpaid work on the transition out of full-time paid work. JF - Gerontologist Y1 - 2013 A1 - Dawn C Carr A1 - Ben Lennox Kail KW - Age Factors KW - Aged KW - Employment KW - Female KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - Retirement KW - Salaries and Fringe Benefits KW - Volunteers KW - Work AB -

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

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

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

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

VL - 53 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22859436?dopt=Abstract U2 - PMC3605938 U4 - retirement Planning/Public policy/baby boomers/partial retirement/labor force participation/unpaid work ER - TY - JOUR T1 - Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults. JF - Am J Epidemiol Y1 - 2013 A1 - Markus Jokela A1 - G David Batty A1 - Solja T. Nyberg A1 - Virtanen, Marianna A1 - Nabi, Hermann A1 - Archana Singh-Manoux A1 - Mika Kivimäki KW - Age Factors KW - Anxiety Disorders KW - Cohort Studies KW - Extraversion, Psychological KW - Female KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Neuroticism KW - Personality KW - Prospective Studies KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors AB -

Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study's graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.

PB - 178 VL - 178 UR - http://www.ncbi.nlm.nih.gov/pubmed/23911610 IS - 5 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23911610?dopt=Abstract U2 - PMC3755650 U4 - Meta-analysis/Mortality/Personality/Personality/Psychology/Survival analysis/cross-national comparison/Death ER - TY - JOUR T1 - Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. JF - J Gen Intern Med Y1 - 2013 A1 - Zivin, Kara A1 - Paul A Pirraglia A1 - Ryan J McCammon A1 - Kenneth M. Langa A1 - Sandeep Vijan KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Cost of Illness KW - Cross-Sectional Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States AB -

CONTEXT: Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.

OBJECTIVE: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN: Serial cross-sectional analysis of six biennial assessments.

SETTING: Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998).

MAIN OUTCOME MEASURE: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.

RESULTS: Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.

CONCLUSIONS: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.

PB - 28 VL - 28 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23835787?dopt=Abstract U2 - PMC3832736 U4 - Depression/Risk-Factors/Retirement/Older Adults/Depressive Symptoms ER - TY - JOUR T1 - Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults. JF - J Epidemiol Community Health Y1 - 2013 A1 - Richard G Wight A1 - Carol S Aneshensel A1 - Barrett, Christopher A1 - Michelle J Ko A1 - Joshua Chodosh A1 - Arun S Karlamangla KW - Age Factors KW - depression KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multilevel Analysis KW - Residence Characteristics KW - Retirement KW - Risk Factors KW - Socioeconomic factors KW - Stress, Psychological KW - Surveys and Questionnaires KW - Time Factors KW - Unemployment KW - United States KW - Urban Population AB -

BACKGROUND: Little is known about how a neighbourhood's unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed.

METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood's unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models.

RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood's unemployment history.

CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

PB - 67 VL - 67 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22918896?dopt=Abstract U2 - PMC3681821 U4 - Depressive Symptoms/depression/neighborhood Characteristics/employment status/mental Health/labor Force Participation/Socioeconomic Factors/Great Recession ER - TY - JOUR T1 - Women's receipt of Social Security retirement benefits: expectations compared to elections. JF - J Women Aging Y1 - 2013 A1 - Gillen, Martie A1 - Claudia J Heath KW - Age Factors KW - Aged KW - Decision making KW - Female KW - Humans KW - Longitudinal Studies KW - Middle Aged KW - Pensions KW - Retirement KW - Social Security KW - Socioeconomic factors KW - Time Factors KW - United States AB -

This research contributes knowledge regarding the options of early, normal, or delayed receipt of Social Security retirement benefits and research-based findings regarding women's expected and actual timing of election of Social Security retirement benefits. First, descriptive analyses of alternative retirement options, based on Social Security retirement benefit rules, are provided. Second, the 2000, 2002, 2004, and 2006 waves of Health and Retirement Study (HRS) data are used to analyze women's anticipated and actual election of Social Security retirement benefits. Third, based on these considerations, recommendations are made regarding Social Security retirement benefit receipt alternatives.

PB - 25 VL - 25 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24116993?dopt=Abstract U4 - retirement planning/Delayed Retirement/Womens studies/Social security/Women/Retirement benefits ER - TY - JOUR T1 - Is working later in life good or bad for health? An investigation of multiple health outcomes. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2013 A1 - Kandauda Wickrama A1 - Catherine W. O'Neal A1 - Kyung H. Kwag A1 - Lee, Tae K. KW - Activities of Daily Living KW - Age Factors KW - Aged KW - depression KW - Educational Status KW - Employment KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Memory, Short-Term KW - Middle Aged KW - Neuropsychological tests KW - Psychiatric Status Rating Scales KW - Sex Factors AB -

OBJECTIVES: To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years.

METHODS: We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics.

RESULTS: We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time.

DISCUSSION: Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.

PB - 68 VL - 68 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23887930?dopt=Abstract U4 - Medical Sciences--Psychiatry And Neurology/Employment/Older people/Personal health/Mental depression/Gerontology/Disability/Disability/Memory ER - TY - JOUR T1 - Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study. JF - Med Care Y1 - 2012 A1 - Victoria A. Shaffer A1 - Edgar C. Merkle A1 - Angela Fagerlin A1 - Jennifer J Griggs A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Antineoplastic Agents KW - Antineoplastic Protocols KW - Bayes Theorem KW - Breast Neoplasms KW - Cognition Disorders KW - Colorectal Neoplasms KW - Female KW - Health Behavior KW - Humans KW - Interviews as Topic KW - Male KW - Memory KW - Prospective Studies AB -

OBJECTIVES: This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy.

SUBJECTS: Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims.

MEASURES: The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year.

RESULTS: We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model).

CONCLUSIONS: There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.

VL - 50 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22683591?dopt=Abstract U2 - PMC3444668 U4 - chemotherapy/Cognitive decline/CANCER/Medicare claims/Linear Models/Linear Models ER - TY - JOUR T1 - Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries. JF - Journal of Manipulative & Physiological Therapeutics Y1 - 2012 A1 - Paula A Weigel A1 - Jason Hockenberry A1 - Suzanne E Bentler A1 - Kaskie, Brian A1 - Frederic D Wolinsky KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chiropractic KW - Combined Modality Therapy KW - Episode of Care KW - Female KW - Geriatric Assessment KW - Health Care Surveys KW - Health Services KW - Humans KW - Incidence KW - Insurance Claim Reporting KW - Low Back Pain KW - Medicare Part B KW - Musculoskeletal Diseases KW - Primary Health Care KW - Retrospective Studies KW - Sex Factors KW - Treatment Outcome KW - United States AB -

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

VL - 35 IS - 3 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 - Depressive symptoms in spouses of older patients with severe sepsis. JF - Crit Care Med Y1 - 2012 A1 - Dimitry S Davydow A1 - Catherine L Hough A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Age Factors KW - Aged KW - depression KW - Female KW - Hospitalization KW - Humans KW - Male KW - Multivariate Analysis KW - Prospective Studies KW - Psychiatric Status Rating Scales KW - Sepsis KW - Sex Factors KW - Spouses KW - Time Factors KW - United States AB -

OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse's presepsis history, whether this risk differs by sex, and is associated with a sepsis patient's disability after hospitalization.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).

PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.

MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20% at a median of 1.1 yrs presepsis to 34% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives' depression (odds ratio 2.61, 95% confidence interval 0.93, 7.38).

CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

VL - 40 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22635049?dopt=Abstract U2 - PMC3670798 U4 - sepsis/DISABILITY/DISABILITY/HOSPITALIZATION/medicare claims/depression/Depressive Symptoms/respondent incentives/Spousal care/WOMEN ER - TY - JOUR T1 - Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions. JF - J Aging Soc Policy Y1 - 2012 A1 - K. A. Sargent-Cox A1 - Kaarin J. Anstey A1 - Kendig, H. A1 - Skladzien, E. KW - Activities of Daily Living KW - Age Factors KW - Australia KW - Cross-Cultural Comparison KW - Florida KW - Health Benefit Plans, Employee KW - Health Status KW - Humans KW - Job Satisfaction KW - Middle Aged KW - Pensions KW - Public Policy KW - Retirement KW - Sex Factors KW - Socioeconomic factors KW - Time Factors KW - United States AB -

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

PB - 24 VL - 24 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22720888?dopt=Abstract U2 - PMC in process U4 - cross-national comparison/Australian Household Income and Labour Dynamics/retirement planning/Health insurance ER - TY - JOUR T1 - The effect of retirement on cognitive functioning. JF - Health Econ Y1 - 2012 A1 - Norma B Coe A1 - von Gaudecker, Hans-Martin A1 - Maarten Lindeboom A1 - Jürgen Maurer KW - Age Factors KW - Aged KW - Aging KW - Cognition KW - Decision making KW - Humans KW - Longitudinal Studies KW - Male KW - Mental Recall KW - Middle Aged KW - Occupations KW - Retirement KW - Socioeconomic factors KW - Time Factors AB -

Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers.

PB - 21 VL - 21 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21818822?dopt=Abstract U3 - 21818822 U4 - Cognitive Impairment/Decision Making/Well Being/labor Force Participation/early Retirement/DISABILITY/DISABILITY/retirement planning/early Retirement ER - TY - JOUR T1 - Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans. JF - J Behav Med Y1 - 2012 A1 - M. Maria Glymour A1 - Jessica J. Yen A1 - Anna Kosheleva A1 - J Robin Moon A1 - Benjamin D Capistrant A1 - Kristen K Patton KW - Age Factors KW - Aged KW - Black or African American KW - depression KW - Female KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Predictive Value of Tests KW - Prevalence KW - Risk Factors KW - Stroke KW - United States KW - White People AB -

Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.

PB - 35 VL - 35 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21656258?dopt=Abstract U2 - PMC3305882 U4 - depression/stroke/African American/Hispanics/Population Attributable Fraction/Population Attributable Fraction ER - TY - JOUR T1 - Gardening as a potential activity to reduce falls in older adults. JF - J Aging Phys Act Y1 - 2012 A1 - Tuo-Yu Chen A1 - Megan C Janke KW - Accidental Falls KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Chi-Square Distribution KW - Confidence Intervals KW - Exercise Test KW - Female KW - Gait KW - Gardening KW - Humans KW - Leisure activities KW - Male KW - Motor Activity KW - Odds Ratio KW - Postural Balance KW - Risk Assessment KW - Self Report KW - Task Performance and Analysis AB -

This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.

PB - 20 VL - 20 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22190117?dopt=Abstract U3 - 22190117 U4 - gardening/gardeners/Balance/Balance/gait-speed/gait-speed/Motor Activity - physiology/Accidental Falls/fall prevention/chronic conditions 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 - Health investment decisions in response to diabetes information in older Americans. JF - J Health Econ Y1 - 2012 A1 - Alexander N Slade KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alcohol Drinking KW - Body Weight KW - Decision making KW - Diabetes Mellitus KW - Empirical Research KW - Exercise KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Models, Psychological KW - Smoking KW - United States AB -

Diabetes is a very common and serious chronic disease, and one of the fastest growing disease burdens in the United States. Further, health behaviors, such as exercise, smoking, drinking, as well as weight status, are instrumental to diabetes management and the reduction of its medical consequences. Nine waves of the Health and Retirement Study are used to model the role of a recent diabetes diagnosis and medication on present and subsequent weight status, exercise, drinking and smoking activity. Several non-linear dynamic population average probit models are estimated. Results suggest that compared to non-diagnosed individuals at risk for high blood sugar, diagnosed diabetics respond initially in terms of increasing exercise, losing weight, and curbing smoking and drinking behavior, but the effect diminishes after diagnosis. Evidence of recidivism is also found in these outcomes, especially weight status and physical activity, suggesting that some behavioral responses to diabetes may be short-lived.

PB - 31 VL - 31 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22591712?dopt=Abstract U3 - 22591712 U4 - Studies/Diabetes/Health behavior/Physical fitness/Disease management/Public health/WEIGHT ER - TY - JOUR T1 - Marriage, gender and obesity in later life. JF - Econ Hum Biol Y1 - 2012 A1 - Sven E. Wilson KW - Age Factors KW - Aged KW - Body Mass Index KW - Female KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Models, Statistical KW - Obesity KW - Sex Factors KW - United States KW - Weight Gain KW - Weight Loss AB -

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

VL - 10 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22795874?dopt=Abstract U2 - PMC in process U4 - marriage/Risk factors/body mass/shared risk factor ER - TY - JOUR T1 - Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes. JF - Med Care Y1 - 2012 A1 - Mary R Janevic A1 - Sara J McLaughlin A1 - Cathleen M. Connell KW - Age Factors KW - Data collection KW - Diabetes Mellitus KW - Disclosure KW - Dyspnea KW - Exercise KW - Female KW - Guideline Adherence KW - Guidelines as Topic KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Sedentary Behavior KW - Sex Factors KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61).

CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.

VL - 50 IS - 5 N1 - Medical care Med Care. 2011 Dec 20. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22193415?dopt=Abstract U3 - 22193415 U4 - Diabetes/Physical Activity/African American/Hispanic/Self assessed health ER - TY - JOUR T1 - Predictors of self-report of heart failure in a population-based survey of older adults. JF - Circ Cardiovasc Qual Outcomes Y1 - 2012 A1 - Tanya R Gure A1 - Ryan J McCammon A1 - Christine T Cigolle A1 - Todd M Koelling A1 - Caroline S Blaum A1 - Kenneth M. Langa KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Awareness KW - Chi-Square Distribution KW - Comorbidity KW - Female KW - Health Knowledge, Attitudes, Practice KW - Health Status KW - Health Surveys KW - Heart Failure KW - Humans KW - Insurance Claim Review KW - Logistic Models KW - Male KW - Medicare KW - Odds Ratio KW - Patients KW - Predictive Value of Tests KW - Self Report KW - Socioeconomic factors KW - United States AB -

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

PB - 5 VL - 5 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22592753?dopt=Abstract U2 - PMC3370939 U4 - medicare claims/heart disease/self-reported health ER - TY - JOUR T1 - A prospective examination of the relationship between physical activity and dementia risk in later life. JF - Am J Health Promot Y1 - 2012 A1 - Mary E Bowen KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Body Mass Index KW - Confidence Intervals KW - Dementia KW - disease progression KW - Exercise KW - Female KW - Health Promotion KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Logistic Models KW - Male KW - Motor Activity KW - Multivariate Analysis KW - Odds Ratio KW - Prospective Studies KW - Psychometrics KW - Risk Factors KW - United States AB -

PURPOSE: To examine the relationship between vigorous physical activity and dementia risk.

DESIGN: Prospective study design utilizing physical activity data from the Health and Retirement Study and cognitive outcome data from the Aging, Demographics, and Memory Study.

SETTING: Community-based.

SUBJECTS: Adults age 71 and over (N  =  808) with 3 to 7 years of physical activity information prior to dementia/no dementia diagnosis.

MEASURES: Physical activity was measured by participation in vigorous activities such as aerobics, sports, running, bicycling, and heavy housework three or more times per week (yes/no). Dementia diagnosis was based on an expert panel (e.g., neuropsychologists, neurologists, geropsychiatrists) who performed and reviewed a battery of neuropsychological tests.

ANALYSIS: Binary logistic regression models were used to account for demographic characteristics, genetic risk factors (one or two apolipoprotein E ε4 alleles), health behaviors (e.g., smoking, drinking alcohol), health indicators (body mass index), and health conditions (e.g., diabetes, heart disease) in a sequential model-building process.

RESULTS: The relationship between vigorous physical activity and dementia risk remained robust across models. In the final model, older adults who were physically active were 21% (p ≤ .05) less likely than their counterparts to be diagnosed with dementia.

CONCLUSION: Vigorous physical activity may reduce the risk for dementia independently of the factors examined here. This study's findings are important given that few preventative strategies for dementia have been explored beyond hormonal therapy and anti-inflammatory drugs.

PB - 26 VL - 26 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22747314?dopt=Abstract U2 - PMC in process U4 - physical fitness/dementia/physical activity ER - TY - JOUR T1 - Race-ethnicity and health trajectories: tests of three hypotheses across multiple groups and health outcomes. JF - J Health Soc Behav Y1 - 2012 A1 - Tyson H Brown A1 - Angela M O'Rand A1 - Daniel E Adkins KW - Age Factors KW - Aging KW - Black or African American KW - ethnicity KW - Female KW - Health Behavior KW - Health Status Disparities KW - Health Surveys KW - Humans KW - Male KW - Mexican Americans KW - Middle Aged KW - Racial Groups KW - Risk Factors KW - Socioeconomic factors KW - Sociology, Medical KW - White People AB -

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.

PB - 53 VL - 53 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22940814?dopt=Abstract U2 - PMC3668643 U4 - Minority and ethnic groups/Older people/Cardiovascular disease/Inequality/Cultural differences/Cultural differences/Ethnicity/Diabetes/Socioeconomic Differences ER - TY - JOUR T1 - Racial and ethnic differences in hypertension risk: new diagnoses after age 50. JF - Ethn Dis Y1 - 2012 A1 - A. R. Quinones A1 - Jersey Liang A1 - Wen Ye KW - Age Factors KW - Aged KW - Black or African American KW - Cohort Studies KW - Female KW - Health Status Disparities KW - Humans KW - Hypertension KW - Incidence KW - Male KW - Mexican Americans KW - Middle Aged KW - Risk Factors KW - Socioeconomic factors KW - White People AB -

OBJECTIVES: Our study examines the differences in estimated risk of developing hypertension in Whites, Blacks, and Mexican-Americans aged > or = 50 for a period of 11 years.

DESIGN, SETTING, AND PARTICIPANTS: Data came from 9,259 respondents who reported being hypertension-free at the baseline in the Health and Retirement Study (HRS) with up to five time intervals (1998-2006). Discrete-time survival models were used to analyze ethnic variations in the probability of developing hypertension.

MAIN OUTCOME MEASURE: Estimated odds of developing hypertension.

RESULTS: The risk of newly diagnosed hypertension increased between 1995 and 2006 for HRS participants aged > or = 50. After adjusting for demographic and health status, the probability of incident hypertension among Black Americans was .10 during the period of 1995/96-1998, which increased steadily to .17 in 2004-2006, with cumulative incidence over the 11-year period at 51%. In contrast, among White Americans the risk was .07 during 1995/96-1998 and .13 in 2004-2006, with cumulative incidence at 43%. For Mexican-Americans, the probability also increased from .08 during 1995/ 96-1998 to .14 during 2004-2006, with cumulative incidence at 42%.

CONCLUSIONS: Relative to White and Mexican-Americans, Black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were accounted for.

PB - 22 VL - 22 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22764639?dopt=Abstract U3 - 22764639 U4 - Hypertension/minorities/socioeconomic factors/african-americans/mexican Americans/Hispanic/morbidity ER - TY - JOUR T1 - Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. JF - BMC Geriatr Y1 - 2012 A1 - Dominic J Cirillo A1 - Robert B Wallace KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cross-Sectional Studies KW - Disabled Persons KW - Female KW - Humans KW - Male KW - Middle Aged KW - Prevalence KW - Restless Legs Syndrome KW - Risk Factors KW - United States AB -

BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders.

METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation.

RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46).

CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.

PB - 12 VL - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22834914?dopt=Abstract U2 - PMC3433378 U4 - Restless legs syndrome/activities of daily living/ADL/IADL/mobility/Functional Assessment/Quality of Life ER - TY - JOUR T1 - Self- and other-oriented potential lifetime traumatic events as predictors of loneliness in the second half of life. JF - Aging Ment Health Y1 - 2012 A1 - Yuval Palgi A1 - Amit Shrira A1 - Menachem Ben-Ezra A1 - Sharon Shiovitz-Ezra A1 - Liat Ayalon KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Child KW - Child Abuse KW - Cross-Sectional Studies KW - depression KW - Female KW - Forecasting KW - Humans KW - Life Change Events KW - Loneliness KW - Male KW - Middle Aged KW - Self Psychology KW - Wounds and Injuries AB -

OBJECTIVES: This study examined the relationship between self- and other-oriented potential lifetime traumatic events (PLTE) and loneliness at the second half of life.

METHOD: The sample was comprised of 7446 respondents who completed the Health and Retirement Study (HRS) 2006 psychosocial questionnaire. PLTE were classified into self-oriented PLTE, defined as traumatic events that primarily inflict the self (e.g., being abused by parents) and other-oriented PLTE, defined as events that affect the self by primarily targeting others (e.g., death of one's child). We evaluated the role of self- and other-oriented PLTE as predictors of loneliness, as evaluated by the short R-UCLA. Analyses were stratified by age at which trauma happened categorized into four life periods (0-17, 18-30, 31-49, 50+).

RESULTS: The results showed that PLTE is positively related to loneliness. Moreover, the number of other-oriented PLTE, and even more pronouncedly self-oriented PLTE, that happened up until adulthood were the strongest predictors of loneliness at the second half of life.

CONCLUSION: The study suggests that self- and other-oriented PLTE reported to have occurred early in life are associated with perceived loneliness in the second half of life.

PB - 16 VL - 16 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22296337?dopt=Abstract U3 - 22296337 U4 - psycho-social/potential lifetime traumatic events/loneliness ER - TY - JOUR T1 - Stroke incidence in older US Hispanics: is foreign birth protective? JF - Stroke Y1 - 2012 A1 - J Robin Moon A1 - Benjamin D Capistrant A1 - Ichiro Kawachi A1 - Mauricio Avendano A1 - Subramanian, S V A1 - Lisa M. Bates A1 - M. Maria Glymour KW - Age Factors KW - Aged KW - Cohort Studies KW - Emigration and Immigration KW - Female KW - Hispanic or Latino KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retrospective Studies KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States KW - White People AB -

BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.

METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.

RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.

CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.

PB - 43 VL - 43 IS - 5 N1 - Moon, J Robin Capistrant, Benjamin D Kawachi, Ichiro Avendano, Mauricio Subramanian, S V Bates, Lisa M Glymour, M Maria T32-HL098048-01/HL/NHLBI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Stroke. 2012 May;43(5):1224-9. Epub 2012 Feb 21. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22357712?dopt=Abstract U3 - 22357712 U4 - Hispanic/stroke/Socioeconomic Factors/survival Analysis ER - TY - JOUR T1 - Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study. JF - Soc Sci Med Y1 - 2012 A1 - J Robin Moon A1 - M. Maria Glymour A1 - Subramanian, S V A1 - Mauricio Avendano A1 - Ichiro Kawachi KW - Age Factors KW - Aged KW - Cardiovascular Diseases KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prospective Studies KW - Retirement KW - Risk Factors KW - Sex Factors KW - Socioeconomic factors KW - Survival Analysis KW - Time Factors KW - United States AB -

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

PB - 75 VL - 75 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22607954?dopt=Abstract U2 - PMC3367095 U4 - Transitions/Retirement/Risk factors/Cardiovascular disease/Survival analysis/Medical research/Myocardial Infarction/Stroke ER - TY - JOUR T1 - Using marginal structural models to estimate the direct effect of adverse childhood social conditions on onset of heart disease, diabetes, and stroke. JF - Epidemiology Y1 - 2012 A1 - Nandi, Arijit A1 - M. Maria Glymour A1 - Ichiro Kawachi A1 - Tyler J VanderWeele KW - Age Factors KW - Age of Onset KW - Child KW - Diabetes Mellitus KW - Educational Status KW - Female KW - Heart Diseases KW - Humans KW - Income KW - Linear Models KW - Male KW - Middle Aged KW - Models, Statistical KW - Risk Factors KW - Social Class KW - Social Conditions KW - Socioeconomic factors KW - Stroke KW - United States AB -

BACKGROUND: Early-life socioeconomic status (SES) is associated with adult chronic disease, but it is unclear whether this effect is mediated entirely via adult SES or whether there is a direct effect of adverse early-life SES on adult disease. Major challenges in evaluating these alternatives include imprecise measurement of early-life SES and bias in conventional regression methods to assess mediation. In particular, conventional regression approaches to direct effect estimation are biased when there is time-varying confounding of the association between adult SES and chronic disease by chronic disease risk factors.

METHODS: First-reported heart disease, diabetes, and stroke diagnoses were assessed in a national sample of 9760 Health and Retirement Study participants followed biennially from 1992 through 2006. Early-life and adult SES measures were derived using exploratory and confirmatory factor analysis. Early-life SES was measured by parental education, father's occupation, region of birth, and childhood rural residence. Adult SES was measured by respondent's education, occupation, labor force status, household income, and household wealth. Using marginal structural models, we estimated the direct effect of early-life SES on chronic disease onset that was not mediated by adult SES. Marginal structural models were estimated with stabilized inverse probability-weighted log-linear models to adjust for risk factors that may have confounded associations between adult SES and chronic disease.

RESULTS: During follow-up, 24%, 18%, and 9% of participants experienced first onset of heart disease, diabetes, and stroke, respectively. Comparing those in the most disadvantaged with the least disadvantaged quartile, early-life SES was associated with coronary heart disease (risk ratio = 1.30 [95% confidence interval = 1.12-1.51]) and diabetes (1.23 [1.02-1.48]) and marginally associated with stroke via pathways not mediated by adult SES.

CONCLUSIONS: Our results suggest that early-life socioeconomic experiences directly influence adult chronic disease outcomes.

PB - 23 VL - 23 IS - 2 N1 - Nandi, Arijit Glymour, M Maria Kawachi, Ichiro VanderWeele, Tyler J HD060696/HD/NICHD NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't United States Epidemiology. 2012 Mar;23(2):223-32. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22317806?dopt=Abstract U2 - PMC3414366 U4 - Age Factors/Age of Onset/Child/Diabetes Mellitus/Educational Status/Female/Heart Diseases/Income/Linear Models/Linear Models/Models, Statistical/Risk Factors/Social Class/Social Conditions/Socioeconomic Factors/Stroke ER - TY - JOUR T1 - Anticipatory ex ante moral hazard and the effect of Medicare on prevention. JF - Health Econ Y1 - 2011 A1 - de Preux, Laure B KW - Age Factors KW - Aged KW - Alcohol Drinking KW - Female KW - Health Behavior KW - Health Services KW - Humans KW - Insurance Coverage KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Morals KW - Motor Activity KW - Proportional Hazards Models KW - Regression Analysis KW - Smoking KW - United States AB -

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

PB - 20 VL - 20 IS - 9 N1 - de Preux, Laure B Comparative Study England Health economics Health Econ. 2011 Sep;20(9):1056-72. doi: 10.1002/hec.1778. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21830252?dopt=Abstract U3 - 21830252 U4 - Age Factors/Alcohol Drinking/epidemiology/Alcohol Drinking/epidemiology/Female/Health Behavior/Health Services/economics/ethics/ utilization/Health Services/economics/ethics/ utilization/Humans/Insurance Coverage/economics/ethics/ statistics/Insurance Coverage/economics/ethics/ statistics/numerical data/Medically Uninsured/ statistics/Medically Uninsured/ statistics/numerical data/Medicare/economics/ statistics/Medicare/economics/ statistics/numerical data/Middle Aged/moral hazard/Motor Activity/Motor Activity/Proportional Hazards Models/Regression Analysis/Smoking/epidemiology/Smoking/epidemiology/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Kenneth M. Langa A1 - David R Weir KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Dementia KW - Educational Status KW - Female KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Multivariate Analysis KW - Neuropsychological tests KW - Odds Ratio KW - Prevalence KW - Sex Factors KW - United States AB -

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

PB - 66 Suppl 1 VL - 66 Suppl 1 IS - Suppl 1 N1 - Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States 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 Jul;66 Suppl 1:i162-71. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21743047?dopt=Abstract U2 - PMC3165454 U4 - Age Factors/Aged, 80 and over/Cognition/Cognition Disorders/ diagnosis/epidemiology/psychology/Cognition Disorders/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Educational Status/Female/Logistic Models/Longitudinal Studies/Multivariate Analysis/Neuropsychological Tests/Odds Ratio/Prevalence/Sex Factors/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Changes in the prevalence of cognitive impairment among older Americans, 1993-2004: overall trends and differences by race/ethnicity. JF - Am J Epidemiol Y1 - 2011 A1 - Sheffield, Kristin M A1 - M. Kristen Peek KW - Age Factors KW - Aged KW - Black People KW - Chi-Square Distribution KW - Cognition Disorders KW - Confidence Intervals KW - ethnicity KW - Female KW - Health Behavior KW - Health Status KW - Hispanic or Latino KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Odds Ratio KW - Prevalence KW - Racial Groups KW - Socioeconomic factors KW - United States KW - White People AB -

The authors used data from 6 waves of the Health and Retirement Study to evaluate changes in the prevalence of cognitive impairment among adults 70 years of age or older from 1993 to 2004. Having sampling weights for each wave enabled the authors to create merged waves that represented cross-sections of the community-dwelling older population for that year. Logistic regression analyses with year as the predictor were used to estimate trends and determine the contribution of sociodemographic and health status variables to decreasing trends in the prevalence of cognitive impairment over time (score ≤8 on a modified Telephone Interview Cognitive Screen). Results showed an annual decline in the prevalence of cognitive impairment of 3.4% after adjustment for age, gender, and prior test exposure (odds ratio (OR) = 0.966, 95% confidence interval (CI): 0.941, 0.992). The addition of socioeconomic variables to the model attenuated the trend by 72.1%. The annual percentage of decline in impairment was larger for blacks (OR = 0.943, 95% CI: 0.914, 0.973) and Hispanics (OR = 0.954, 95% CI: 0.912, 0.997) than for whites (OR = 0.971, 95% CI: 0.936, 1.006), although the differences were not statistically significant. Linear probability models used in secondary analyses showed larger percentage-point declines for blacks and Hispanics. Improvements in educational level contributed to declines in cognitive impairment among older adults-particularly blacks and Hispanics-in the United States.

PB - 174 VL - 174 IS - 3 N1 - Sheffield, Kristin M Peek, M Kristen T32-AG00270/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States American journal of epidemiology Am J Epidemiol. 2011 Aug 1;174(3):274-83. Epub 2011 May 27. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21622948?dopt=Abstract U2 - PMC3202156 U4 - African Continental Ancestry Group/statistics/African Continental Ancestry Group/statistics/numerical data/Age Factors/Chi-Square Distribution/Chi-Square Distribution/Cognition Disorders/ epidemiology/Cognition Disorders/ epidemiology/Confidence Intervals/Continental Population Groups/ statistics/Continental Population Groups/ statistics/numerical data/Ethnic Groups/ statistics/Ethnic Groups/ statistics/numerical data/European Continental Ancestry Group/statistics/European Continental Ancestry Group/statistics/numerical data/Female/Health Behavior/Health Status/Hispanic Americans/statistics/Hispanic Americans/statistics/numerical data/Humans/Logistic Models/Longitudinal Studies/Odds Ratio/Prevalence/Socioeconomic Factors/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey. JF - J Aging Health Y1 - 2011 A1 - James C. Lin A1 - Guerrieri, Joy Gioia A1 - Alison A . Moore KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Alcohol Drinking KW - Female KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Retirement AB -

OBJECTIVE: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS: Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

PB - 23 VL - 23 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21311049?dopt=Abstract U2 - PMC3233258 U4 - Risk assessment/Older people/Alcohol use/Aging/Comparative analysis ER - TY - JOUR T1 - Geriatric conditions develop in middle-aged adults with diabetes. JF - J Gen Intern Med Y1 - 2011 A1 - Christine T Cigolle A1 - Pearl G. Lee A1 - Kenneth M. Langa A1 - Lee, Yuo-Yu A1 - Zhiyi Tian A1 - Caroline S Blaum KW - Accidental Falls KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Diabetes Mellitus KW - Dizziness KW - Female KW - Geriatric Assessment KW - Health Status KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - pain KW - Urinary incontinence AB -

BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.

OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes.

DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006).

PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908).

MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain.

KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased.

CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.

PB - 26 VL - 26 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20878496?dopt=Abstract U2 - PMC3043187 U4 - geriatric conditions/diabetes/cognitive Impairment/falls/Incontinence/Vision Disorders/Hearing Disorders 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 - Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. JF - Eur J Epidemiol Y1 - 2011 A1 - Mieke Reuser A1 - Frans J Willekens A1 - Luc G Bonneux KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cognition Disorders KW - Educational Status KW - Female KW - Health Surveys KW - Humans KW - Incidence KW - Life Expectancy KW - Life Tables KW - Male KW - Middle Aged KW - Prevalence KW - Proportional Hazards Models KW - Retirement KW - Sex Factors KW - Smoking KW - Time Factors KW - United States AB -

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

PB - 26 VL - 26 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract U2 - PMC3109265 U4 - Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups ER - TY - JOUR T1 - The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006. JF - Am J Public Health Y1 - 2011 A1 - Richard J. Manski A1 - John F Moeller A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Haiyan Chen A1 - John V Pepper KW - Age Factors KW - Aged KW - Dental Care KW - Employment KW - Female KW - Health Care Surveys KW - Humans KW - Insurance, Dental KW - Male KW - Medically Uninsured KW - Middle Aged KW - Retirement KW - Socioeconomic factors KW - United States AB -

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

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

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

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

PB - 101 VL - 101 IS - 10 N1 - Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21852656?dopt=Abstract U2 - PMC3174340 U4 - dental Care/dental insurance/employee benefits/health care policy/health Status/health Insurance ER - TY - JOUR T1 - Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Briana Mezuk A1 - Amy S B Bohnert A1 - Scott M Ratliff A1 - Zivin, Kara KW - Age Factors KW - Aged KW - Alcoholism KW - Cohort Studies KW - Depressive Disorder KW - Female KW - Health Behavior KW - Health Surveys KW - Humans KW - Job Satisfaction KW - Logistic Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Prospective Studies KW - Retirement KW - Sex Factors KW - Statistics as Topic KW - Stress, Psychological KW - United States AB -

OBJECTIVE: To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults.

METHOD: Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse.

RESULTS: High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age.

DISCUSSION: Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.

PB - 66B VL - 66 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21427175?dopt=Abstract U2 - PMC3166196 U4 - Occupational stress/Job satisfaction/Occupational health/Alcohol use/Older people ER - TY - JOUR T1 - Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations. JF - Psychol Aging Y1 - 2011 A1 - Jersey Liang A1 - Xiao Xu A1 - Ana R Quiñones A1 - Joan M. Bennett A1 - Wen Ye KW - Age Factors KW - Aged KW - Black or African American KW - depression KW - disease progression KW - Female KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Socioeconomic factors KW - Time Factors KW - United States KW - White People AB -

This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9%), (b) low depressive symptoms (36.3%), (c) moderate and stable depressive symptoms (29.2%), (d) high but decreasing depressive symptoms (6.6%), (e) moderate but increasing depressive symptoms (8.3%), and (f) persistently high depressive symptoms (3.6%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.

PB - 26 VL - 26 IS - 4 N1 - Liang, Jersey Xu, Xiao Quinones, Ana R Bennett, Joan M Ye, Wen 5P30AG024824/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States UL1RR024986/RR/NCRR NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. United States Psychology and aging Psychol Aging. 2011 Dec;26(4):761-77. Epub 2011 Aug 29. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21875216?dopt=Abstract U2 - PMC3495237 U4 - Depression/ethnic differences/marital Status/Depressive Symptoms/CES Depression Scale/CES Depression Scale ER - TY - JOUR T1 - National estimates of the prevalence of Alzheimer's disease in the United States. JF - Alzheimers Dement Y1 - 2011 A1 - Brookmeyer, Ron A1 - Denis A Evans A1 - Liesi Hebert A1 - Kenneth M. Langa A1 - Steven G Heeringa A1 - Brenda L Plassman A1 - Walter Kukull KW - Age Factors KW - Alzheimer disease KW - Community Health Planning KW - Data collection KW - Humans KW - Incidence KW - Models, Statistical KW - Prevalence KW - Sampling Studies KW - United States AB -

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer's disease and dementia. ADAMS obtained direct estimates by relying on probability sampling nationwide. EBSHP relied on projection of localized prevalence estimates to the national population. The sampling techniques of ADAMS and EBSHP were rather similar, whereas their disease definitions were not. By contrast, EBSPH and CHAP have similar disease definitions internally, but use different calculation techniques, and yet arrive at similar prevalence estimates, which are considerably greater than those obtained by either Brookmeyer or ADAMS. Choice of disease definition may play the larger role in explaining differences in observed prevalence between these studies.

PB - 7 VL - 7 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255744?dopt=Abstract U2 - PMC3052294 U4 - Alzheimer disease/Dementia/Cognitive impairment/Prevalence/Population-based/Projection/Probability/sampling ER - TY - JOUR T1 - Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 2. JF - Alzheimers Dement Y1 - 2011 A1 - Seshadri, Sudha A1 - Alexa S. Beiser A1 - Au, Rhoda A1 - Philip A Wolf A1 - Robert S Wilson A1 - Ronald C Petersen A1 - David S Knopman A1 - Walter A Rocca A1 - Claudia H Kawas A1 - Maria M Corrada A1 - Brenda L Plassman A1 - Kenneth M. Langa A1 - Helena C Chui KW - Age Factors KW - Aging KW - Alzheimer disease KW - Cognition Disorders KW - Community Health Planning KW - Humans KW - Incidence KW - Longitudinal Studies KW - Neuropsychological tests KW - Prevalence KW - United States AB -

This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer's disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.

PB - 7 VL - 7 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255742?dopt=Abstract U2 - PMC3039838 U4 - Alzheimer disease/cognitive Impairment/PREVALENCE/Incidence/Dementia ER - TY - JOUR T1 - Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study. JF - J Am Geriatr Soc Y1 - 2011 A1 - Jennifer A Ailshire A1 - Hiram Beltrán-Sánchez A1 - Eileen M. Crimmins KW - Age Factors KW - Aged, 80 and over KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Social Class KW - Sociology KW - United States AB -

OBJECTIVES: To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status.

DESIGN: Nationally representative longitudinal study of older Americans.

SETTING: United States.

PARTICIPANTS: One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older.

MEASUREMENTS: Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function.

RESULTS: At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97 years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts.

CONCLUSION: On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.

PB - 59 VL - 59 IS - 12 N1 - Ailshire, Jennifer A Beltran-Sanchez, Hiram Crimmins, Eileen M United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2241-8. doi: 10.1111/j.1532-5415.2011.03723.x. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22188072?dopt=Abstract U2 - PMC3470876 ER - TY - JOUR T1 - Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study. JF - J Aging Health Y1 - 2011 A1 - Anda Botoseneanu A1 - Jersey Liang KW - Age Factors KW - Aged KW - Aging KW - Body Mass Index KW - ethnicity KW - Female KW - Health Status Disparities KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Obesity KW - Psychometrics KW - Risk Assessment KW - Self Report KW - Social Class KW - Socioeconomic factors KW - Time Factors KW - United States AB -

OBJECTIVE: To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories.

METHOD: Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates.

RESULTS: BMI increased linearly over time. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found.

DISCUSSION: Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.

PB - 23 VL - 23 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21068396?dopt=Abstract U2 - PMC3470852 U4 - Body mass index/Obesity/Middle age/Older people/Gender differences/Racial differences/Health risk assessment ER - TY - JOUR T1 - Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States. JF - Alzheimers Dement Y1 - 2011 A1 - Walter A Rocca A1 - Ronald C Petersen A1 - David S Knopman A1 - Liesi Hebert A1 - Denis A Evans A1 - Kathleen S Hall A1 - Gao, Sujuan A1 - Frederick W Unverzagt A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Lon R White KW - Age Factors KW - Alzheimer disease KW - Cognition Disorders KW - Cohort Studies KW - Community Health Planning KW - Dementia KW - Humans KW - Incidence KW - Prevalence KW - Residence Characteristics KW - Retrospective Studies KW - Time Factors KW - United States AB -

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified.

PB - 7 VL - 7 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255746?dopt=Abstract U2 - PMC3026476 U4 - Alzheimers disease/Dementia/Cognitive impairment/Prevalence/Incidence/Time trends ER - TY - JOUR T1 - Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach. JF - Soc Sci Med Y1 - 2011 A1 - David F Warner A1 - Tyson H Brown KW - Age Factors KW - Black or African American KW - Disability Evaluation KW - Disabled Persons KW - Female KW - Health Status Disparities KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Models, Statistical KW - Models, Theoretical KW - Sex Factors KW - Social Class KW - United States KW - White People AB -

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings & Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

PB - 72 VL - 72 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21470737?dopt=Abstract U4 - Ethnicity/Older people/Gender differences/Socioeconomic factors/Racial differences/Disability/Disability ER - TY - JOUR T1 - The urban neighborhood and cognitive functioning in late middle age. JF - J Health Soc Behav Y1 - 2011 A1 - Carol S Aneshensel A1 - Michelle J Ko A1 - Joshua Chodosh A1 - Richard G Wight KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aging KW - Chi-Square Distribution KW - Cognition KW - Cognition Disorders KW - ethnicity KW - Female KW - Health Status Disparities KW - Humans KW - Male KW - Middle Aged KW - Psychometrics KW - Residence Characteristics KW - Risk Factors KW - Socioeconomic factors KW - United States KW - Urban Population AB -

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

PB - 52 VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21673145?dopt=Abstract U2 - PMC3152319 U4 - Segregation/Cognitive ability/Cognition/reasoning ER - TY - JOUR T1 - Alcohol-consumption trajectories and associated characteristics among adults older than age 50. JF - J Stud Alcohol Drugs Y1 - 2010 A1 - Alyssa C Platt A1 - Frank A Sloan A1 - Philip Costanzo KW - Age Factors KW - Alcohol Drinking KW - Alcohol-Related Disorders KW - Educational Status KW - Female KW - Follow-Up Studies KW - Health Status KW - Health Surveys KW - Humans KW - Life Change Events KW - Linear Models KW - Male KW - Middle Aged KW - Sex Factors KW - Socioeconomic factors KW - Time Factors AB -

OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category.

RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

PB - 71 VL - 71 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20230713?dopt=Abstract U2 - PMC2841726 U4 - Older people/Alcohol use/Regression analysis/Demographics ER - TY - JOUR T1 - Characteristics of physical measurement consent in a population-based survey of older adults. JF - Med Care Y1 - 2010 A1 - Joseph W Sakshaug A1 - Mick P. Couper A1 - Mary Beth Ofstedal KW - Age Factors KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Physical Examination KW - Socioeconomic factors AB -

BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements.

OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one's demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics.

RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements.

RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender.

CONCLUSIONS: Physical measurement consent is not strongly associated with one's health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation.

PB - 48 VL - 48 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20050351?dopt=Abstract U3 - 20050351 U4 - Survey Methods/Measurement/Health Physical ER - TY - JOUR T1 - Coronary heart disease from a life-course approach: findings from the health and retirement study, 1998-2004. JF - J Aging Health Y1 - 2010 A1 - Mary E Bowen KW - Age Factors KW - Aged KW - Aging KW - Coronary Artery Disease KW - Educational Status KW - Female KW - Health Status Disparities KW - Health Surveys KW - Humans KW - Income KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Odds Ratio KW - Poverty KW - Prevalence KW - Retirement KW - Risk Assessment KW - Risk Factors KW - Self Report KW - Social Class KW - Socioeconomic factors KW - United States AB -

OBJECTIVE: Guided by a life-course approach to chronic disease, this study examined the ways in which childhood deprivation (low parental education and father's manual occupation) may be associated with coronary heart disease (CHD).

METHOD: Multilevel modeling techniques and a nationally representative sample of Americans above age 50 from the Health and Retirement Study (HRS; N = 18,465) were used to examine childhood and CHD relationships over the course of 6 years (1998-2004).

RESULTS: Having a father with

DISCUSSION: Policies and programs aimed at improving the conditions of poor children and their families may effectively reduce the prevalence of CHD in later life.

PB - 22 VL - 22 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20056814?dopt=Abstract U3 - 20056814 U4 - Life Cycle/health Status/socioeconomic Status/health risk ER - TY - JOUR T1 - Dental care expenditures and retirement. JF - J Public Health Dent Y1 - 2010 A1 - Richard J. Manski A1 - John F Moeller A1 - Haiyan Chen A1 - Patricia A St Clair A1 - Jody Schimmel A1 - Larry S. Magder A1 - John V Pepper KW - Age Factors KW - Aged KW - Dental Care KW - Educational Status KW - ethnicity KW - Female KW - Financing, Personal KW - Humans KW - Income KW - Insurance Coverage KW - Insurance, Dental KW - Male KW - Marital Status KW - Middle Aged KW - Mouth, Edentulous KW - Retirement KW - United States AB -

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

PB - 70 VL - 70 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20002876?dopt=Abstract U2 - PMC2891582 U4 - dental/utilization/dentistry/insurance/coverage/retirement ER - TY - JOUR T1 - Ethnicity and changing functional health in middle and late life: a person-centered approach. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2010 A1 - Jersey Liang A1 - Xiao Xu A1 - Joan M. Bennett A1 - Wen Ye A1 - Ana R Quiñones KW - Age Factors KW - Aged KW - Black or African American KW - Disabled Persons KW - disease progression KW - ethnicity KW - Female KW - Health Status KW - Health Status Disparities KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Likelihood Functions KW - Male KW - Marital Status KW - Middle Aged KW - Time Factors KW - United States KW - White People AB -

OBJECTIVES: Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans.

METHODS: Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis.

RESULTS: Five trajectories were identified: (a) excellent functional health (61%), (b) good functional health with small increasing disability (25%), (c) accelerated increase in disability (7%), (d) high but stable disability (4%), and (e) persistent severe impairment (3%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53%), moderate functional decrement (40%), and (c) large functional decrement (8%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics.

CONCLUSIONS: Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.

PB - 65 VL - 65 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20008483?dopt=Abstract U2 - PMC2883869 U4 - Minorities/DISABILITY/DISABILITY/functional Assessment/health outcomes ER - TY - JOUR T1 - Evolving self-rated health in middle and old age: how does it differ across Black, Hispanic, and White Americans? JF - J Aging Health Y1 - 2010 A1 - Jersey Liang A1 - A. R. Quinones A1 - Joan M. Bennett A1 - Wen Ye A1 - Xiao Xu A1 - Benjamin A Shaw A1 - Mary Beth Ofstedal KW - Age Factors KW - Aged KW - Aging KW - Black or African American KW - Diagnostic Self Evaluation KW - Female KW - Health Status Disparities KW - Hispanic or Latino KW - Humans KW - Linear Models KW - Male KW - Middle Aged KW - United States KW - White People AB -

OBJECTIVE: This research focuses on ethnic variations in the intraindividual changes in self-rated health.

METHOD: Data came from the Health and Retirement Study involving up to 6 repeated observations between 1995 and 2006 of a national sample of 18,486 Americans above 50 years of age. Hierarchical linear models were employed in depicting variations in self-rated health across White, Black, and Hispanic Americans.

RESULTS: Subjective health worsened over time albeit moderately. Relative to younger persons, older individuals rated their health poorer with a greater rate of deteriorating health. With reference to ethnic variations in the intercept and slope of perceived health, White Americans rated their health most positively, followed by Black Americans, with Hispanics rating their health least positively. This pattern held even when socioeconomic status, social networks, and prior health were adjusted.

DISCUSSION: Significant ethnic differences exist in the evolvement of self-rated health in middle and late life. Further inquiries may include analyzing ethnic heterogeneities from a person-centered perspective, health disparities across subgroups of Hispanics, effects of neighborhood attributes, and implications of left truncation.

PB - 22 VL - 22 UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833212/ IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19952367?dopt=Abstract U2 - PMC2833212 U4 - Self-rated health/trajectory/ethnic differences/Mortality/Disabilities ER - TY - JOUR T1 - An examination of older immigrants' use of dental services in the United States. JF - J Aging Soc Policy Y1 - 2010 A1 - Christina N Anderson A1 - Hyungsoo Kim KW - Age Factors KW - Aged KW - Dental Care for Aged KW - Educational Status KW - Emigrants and Immigrants KW - Female KW - Health Services Accessibility KW - Humans KW - Insurance, Dental KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Marital Status KW - Middle Aged KW - Multivariate Analysis KW - Sex Factors KW - Socioeconomic factors KW - United States AB -

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs.

PB - 22 VL - 22 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20390710?dopt=Abstract U3 - 20390710 U4 - Immigrants/Dental Care ER - TY - JOUR T1 - Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes. JF - Prev Chronic Dis Y1 - 2010 A1 - Chiu, Ching-Ju A1 - Linda A. Wray KW - Age Factors KW - Aged KW - Blood Glucose KW - Diabetes Mellitus, Type 2 KW - Female KW - Glycated Hemoglobin KW - Humans KW - Hypoglycemic Agents KW - Male KW - Middle Aged KW - Retrospective Studies KW - Socioeconomic factors AB -

INTRODUCTION: Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults.

METHODS: We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged >or=65 y) who self-reported having type 2 diabetes at baseline.

RESULTS: Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point.

CONCLUSION: Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control.

PB - 7 VL - 7 IS - 1 N1 - Using Smart Source Parsing Jan, :A08 Index Medicus U1 - http://www.ncbi.nlm.nih.gov/pubmed/20040223?dopt=Abstract U2 - PMC2811503 U4 - diabetes/demographics/treatment modality/lifestyle/hemoglobin A1c (HbA1c) levels ER - TY - JOUR T1 - Health trajectories among older movers. JF - J Aging Health Y1 - 2010 A1 - Janet M Wilmoth KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Regression Analysis KW - Social Class KW - Transients and Migrants AB -

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

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

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

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

PB - 22 VL - 22 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract U3 - 20710006 U4 - Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment ER - TY - JOUR T1 - Lifetime marital history and mortality after age 50. JF - J Aging Health Y1 - 2010 A1 - John C Henretta KW - Age Factors KW - Aging KW - Cohort Studies KW - Female KW - Health Status KW - Humans KW - Interpersonal Relations KW - Male KW - Marital Status KW - Middle Aged KW - Mortality KW - Multivariate Analysis KW - Proportional Hazards Models KW - Residence Characteristics KW - Risk Assessment KW - Risk-Taking KW - Smoking KW - Time Factors KW - United States AB -

OBJECTIVES: This article examines the relationship between lifetime marital history and mortality after age 50.

METHOD: Data are drawn from the Health and Retirement Study birth cohort of 1931 to 1941. The analysis utilizes three measures of marital history: number of marriages, proportion time married, and age at first marriage.

RESULTS: Three or more marriages and a lower proportion of adult life spent married are each associated with a higher hazard of dying after age 50 for both men and women even after controlling for current marital status and socioeconomic status. Smoking behavior accounts for part of the relationship of marital history and status with mortality.

DISCUSSION: Research on marital status and health should consider marital history as well as current status. Two topics are particularly important: examining the relationship in different cohorts and disentangling the potentially causal role of health behaviors such as smoking.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20660636?dopt=Abstract U3 - 20660636 U4 - Mortality Rates/Marriage/Marital Status/Smoking/Socioeconomic Status/Health Behavior/Health Problems/Dying/Health Policy ER - TY - JOUR T1 - Migration and psychological well-being among older adults: a growth curve analysis based on panel data from the Health and Retirement Study, 1996-2006. JF - J Aging Health Y1 - 2010 A1 - Don E Bradley A1 - Van Willigen, Marieke KW - Adaptation, Psychological KW - Age Factors KW - Aging KW - depression KW - Female KW - Happiness KW - Health Status KW - Humans KW - Life Change Events KW - Male KW - Mental Health KW - Middle Aged KW - Models, Psychological KW - Models, Theoretical KW - Multivariate Analysis KW - Psychometrics KW - Retirement KW - Stress, Psychological KW - Transients and Migrants AB -

PURPOSE: A vibrant body of research examines migration among older adults. Existing research, however, grants scarce attention to the implications of later-life migration for the migrants themselves. Our research focuses on the impacts of migration on depressive symptomatology among older U.S. adults.

METHODS: Our analysis employs six waves of panel data from the Health and Retirement Study, 1996-2006. Growth curve modeling techniques are employed.

RESULTS: Net of other stressful life events, migration effects appear to vary significantly across persons. Findings highlight the particularly depressive impact of moves motivated by negative life events or circumstances. Results further suggest that later life moves may be especially stressful for women and as individuals age.

DISCUSSION: The stress of moving late in life may depend on social integration at destination. Further research should pursue this issue. Study limitations and additional directions for further research are delineated.

PB - 22 VL - 22 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20495157?dopt=Abstract U3 - 20495157 U4 - Elderly/Migration/Well Being/Health/Retirement/mobility/Stress/Social Integration ER - TY - JOUR T1 - Modifiable risk factors for incidence of pain in older adults. JF - Pain Y1 - 2010 A1 - Yu Shi A1 - Hooten, W Michael A1 - Rosebud O. Roberts A1 - David O. Warner KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cross-Sectional Studies KW - Demography KW - depression KW - Female KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Overweight KW - pain KW - Prevalence KW - Retrospective Studies KW - Risk Assessment KW - Risk Factors KW - Smoking KW - United States AB -

Pain symptoms in aging populations have significant public health impact. The aim of this study was to determine risk factors for the incidence of pain in older adults, focusing on those factors that can be modified. Secondary analyses were performed of survey data from the nationally representative Health and Retirement Study of US adults older than 50 years. Generalized estimating equations logistic regressions were used to evaluate the effect of selected variables on the incidence of pain using biennial (1992 through 2006) data, determining the relationship between the incidence of pain and the potential risk factors. Of the 18,439 survey respondents in 2006, 34.1% (95% CI: 33.2%, 35.0%) reported that they were often troubled by pain; 24.3% reported having moderate to severe pain; and 22.3% reported that their daily life was affected by pain. Between 1992 and 2006, 7967 individuals reported new onset of pain in 169,762 person-years of follow-up, an incidence of 4.69 (4.59, 4.80) per 100 person-years. Depression and being overweight were independent predictors associated with an increased likelihood of incident pain. Current smoking increased the likelihood of incident pain only in those subjects who also reported depression. In conclusion, pain is a common symptom in older adults. Depression, smoking, and overweight are potentially modifiable risk factors and could be considered in the prevention and management of pain in older adults.

PB - 151 VL - 151 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20696524?dopt=Abstract U3 - 20696524 U4 - Age Factors/Demography/Depression/Depressive Symptoms/Incidence/Obesity/Prevalence/Risk Assessment/Risk Factors/Smoking/Public Policy ER - TY - JOUR T1 - Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study. JF - Ann Epidemiol Y1 - 2010 A1 - M. Maria Glymour A1 - Mujahid, Mahasin A1 - Wu, Qiong A1 - White, Kellee A1 - Tchetgen Tchetgen, Eric J KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Confidence Intervals KW - depression KW - Disabled Persons KW - Female KW - Health Status Disparities KW - Humans KW - Incidence KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Odds Ratio KW - Poverty KW - Residence Characteristics KW - Risk KW - Self-Assessment KW - Socioeconomic factors KW - Time Factors AB -

PURPOSE: By using a longitudinal cohort, we assessed the association between neighborhood disadvantage and incidence of poor health and function in three domains.

METHODS: More than 4,000 enrollees aged 55 to 65 years in the national Health and Retirement Study were assessed biennially from 1998 through 2006 for incidence of fair/poor self-rated health, elevated depressive symptoms, and limitations in six basic activities of daily living (disability). Each analysis was restricted to subjects without that condition in 1994 or 1996. Neighborhoods (census tracts, time-updated for moves), were considered disadvantaged if they fell below the 25th percentile in an index comprising six socioeconomic status indicators. Repeated measures logistic regressions, inverse probability weighted to account for individual confounders, selective survival, and loss to follow-up were used to estimate odds ratios (ORs) for incidence of each outcome in the wave after exposure to disadvantaged neighborhood.

RESULTS: After covariate adjustment, neighborhood disadvantage predicted onset of fair/poor SRH (OR, 1.36; 95% confidence interval, 1.15-1.59) but not disability (OR, 0.97; 0.81-1.16) or elevated depressive symptoms (OR, 0.97; 0.81-1.16).

CONCLUSIONS: Results confirmed previous findings that neighborhood disadvantage predicts self-rated health in a longitudinal context but did not support an association between neighborhood disadvantage and onset of disability or elevated depressive symptoms.

VL - 20 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20933193?dopt=Abstract ER - TY - JOUR T1 - Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61. JF - J Aging Health Y1 - 2010 A1 - Dianna D Carroll A1 - Heidi M Blanck A1 - Mary K. Serdula A1 - David R Brown KW - Activities of Daily Living KW - Age Factors KW - Aging KW - Chi-Square Distribution KW - Cohort Studies KW - Confidence Intervals KW - depression KW - Female KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Motor Activity KW - Multivariate Analysis KW - Obesity KW - Odds Ratio KW - Psychometrics KW - Self Report KW - Sex Factors KW - United States AB -

OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline.

METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status.

RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998.

DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20164412?dopt=Abstract U3 - 20164412 U4 - Physical Fitness/Health/Problems/Sex Differences/Males/depression/physical activity/obesity/aging/mental and emotional health problems ER - TY - JOUR T1 - Older adults' expectations to move: do they predict actual community-based or nursing facility moves within 2 years? JF - J Aging Health Y1 - 2010 A1 - Julie F. Sergeant A1 - David J Ekerdt A1 - Chapin, Rosemary K KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Community Health Services KW - Decision making KW - Female KW - Humans KW - Logistic Models KW - Male KW - Odds Ratio KW - Residence Characteristics KW - Skilled Nursing Facilities KW - Social Support KW - Statistics as Topic KW - Time Factors KW - Transients and Migrants AB -

OBJECTIVE: This study examined the relationship between older adults' expectations to move and actual residential relocation in the community or to a nursing facility within 2 years.

METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services.

RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves.

DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults' preferences to remain living in their homes.

VL - 22 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20495154?dopt=Abstract U3 - 20495154 U4 - expectations/Residential relocation/nursing Homes 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 - The Process of Retirement Planning Scale (PRePS): development and validation. JF - Psychol Assess Y1 - 2010 A1 - Jack H Noone A1 - Christine Stephens A1 - Fiona M. Alpass KW - Age Factors KW - Aged KW - Educational Status KW - Factor Analysis, Statistical KW - Female KW - Financing, Personal KW - Goals KW - Health Status KW - Humans KW - Internal-External Control KW - Male KW - Middle Aged KW - Pilot Projects KW - Planning Techniques KW - Psychological Tests KW - Psychology KW - Reproducibility of Results KW - Retirement KW - Surveys and Questionnaires AB -

Although a substantial proportion of the western population is approaching retirement age, little is known about how they are preparing for the future. Much attention has been paid to the consumption of educational material and retirement wealth in the present literature, but the process of retirement planning has been ignored. S. L. Friedman and E. K. Scholnick's (1997) theoretical model provided the basis for a comprehensive measure of retirement planning. According to their process theory, individuals develop an understanding of the problem, set goals, make a decision to start preparing, and finally undertake the behaviors needed to fulfill their goals. Fifty-two items were developed to assess each stage of the planning process for financial, health, lifestyle, and psychosocial retirement planning. These were tested on a population sample of 1,449 New Zealanders aged 49-60. Confirmatory factor analysis, bivariate correlations, and hierarchical regression provided support for the valid use of the measure. Necessary antecedents, such as the tendency to look to the future, and locus of control were significantly related to the Process of Retirement Planning Scale (PRePS). The PRePS also outperformed retirement planning measures used in the Health and Retirement Study (F. T. Juster & R. Suzman, 1995) after controlling for socioeconomic and psychological variables. This measure will enable social policy makers to determine which stages of retirement planning require support and intervention. The PRePS will also help to determine which domains of retirement planning predict well-being in later life and the factors which differentiate those who are planning from those who are not.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20822264?dopt=Abstract U3 - 20822264 U4 - retirement Planning/methodology/Public Policy ER - TY - JOUR T1 - The prospective relationship between binge drinking and physician visits among older adults. JF - J Aging Health Y1 - 2010 A1 - Kristi Rahrig Jenkins A1 - Robert A. Zucker KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Alcoholic Intoxication KW - Female KW - Health Resources KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status Indicators KW - Humans KW - Linear Models KW - Male KW - Michigan KW - Multivariate Analysis KW - Patient Satisfaction KW - Physicians KW - Prospective Studies KW - Psychometrics KW - Risk Assessment KW - Risk Factors KW - Self Report AB -

OBJECTIVES: The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics.

METHOD: Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits.

RESULTS: In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled.

DISCUSSION: The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20693519?dopt=Abstract U3 - 20693519 U4 - Drunkenness/Alcohol Abuse/Elderly/Health/Physicians/Sociodemographic/Socioeconomic Differences/Factors/Intervention/Retirement ER - TY - JOUR T1 - Situational versus chronic loneliness as risk factors for all-cause mortality. JF - Int Psychogeriatr Y1 - 2010 A1 - Sharon Shiovitz-Ezra A1 - Liat Ayalon KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Cause of Death KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Israel KW - Life Change Events KW - Loneliness KW - Male KW - Middle Aged KW - Risk Factors KW - social isolation KW - Surveys and Questionnaires KW - Time Factors AB -

BACKGROUND: Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality.

METHODS: To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004.

RESULTS: Those identified as "situationally lonely" (HR = 1.56; 95% CI: 1.52-1.62) as well as those identified as "chronically lonely" (HR = 1.83; 95% CI: 1.71-1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as "situationally lonely," individuals classified as "chronically lonely" had a slightly greater mortality risk.

CONCLUSIONS: The current study emphasizes the important role loneliness plays in older adults' health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20003631?dopt=Abstract U3 - 20003631 U4 - Loneliness/Older Adults/Isolation/Death/Demography/Dying/chronic loneliness/mortality/situational loneliness ER - TY - JOUR T1 - Trading years for perfect health: results from the health and retirement study. JF - J Aging Health Y1 - 2010 A1 - Liat Ayalon A1 - King-Kallimanis, Bellinda L KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Community Participation KW - Confidence Intervals KW - Culture KW - Epidemiologic Methods KW - ethnicity KW - Female KW - Health Surveys KW - Humans KW - Longevity KW - Male KW - Multivariate Analysis KW - Psychometrics KW - Retirement KW - Self Report KW - Surveys and Questionnaires KW - Time Factors AB -

OBJECTIVE: To evaluate the preferences of an ethnically diverse national sample of older Americans regarding length of life versus health quality.

METHOD: A time trade-off task administered as part of the 2002 wave of the Health and Retirement Study.

RESULTS: Respondents equated 6.86 (SD = 3.46) years of perfect health with 10 years of life in imperfect health. Women and those who ranked their health less favorably were more likely to give up years of life for perfect health. Relative to Whites, Blacks were more willing to live longer in imperfect health. Those of lower levels of education were more likely to prefer 10 years of life in imperfect health.

DISCUSSION: There is wide variability in responses to the time trade-off task that is partially associated with self-rated health, gender, ethnicity, and education.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20660638?dopt=Abstract U3 - 20660638 U4 - SELF-RATED HEALTH/demographics/GENDER/imperfect health ER - TY - JOUR T1 - Urban neighborhood context and mortality in late life. JF - J Aging Health Y1 - 2010 A1 - Richard G Wight A1 - Janet R. Cummings A1 - Arun S Karlamangla A1 - Carol S Aneshensel KW - Age Factors KW - Aged KW - Aging KW - Cognition KW - Confidence Intervals KW - depression KW - Female KW - Health Status KW - Humans KW - Los Angeles KW - Male KW - Middle Aged KW - Mortality KW - Odds Ratio KW - Poverty KW - Psychometrics KW - Residence Characteristics KW - Self Report KW - Socioeconomic factors KW - Statistics as Topic KW - Urban Population AB -

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults.

METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census.

RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic.

DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

PB - 22 VL - 22 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20056813?dopt=Abstract U2 - PMC3155256 U4 - Neighborhoods/Mortality Rates/Hispanic Americans/Dying/Elderly/Health/mortality/affluence/social work theory ER - TY - JOUR T1 - Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study. JF - Stroke Y1 - 2009 A1 - M. Maria Glymour A1 - Mauricio Avendano KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Algorithms KW - Epidemiologic Methods KW - ethnicity KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Retirement KW - Risk Factors KW - Sex Factors KW - Stroke KW - Treatment Outcome KW - United States AB -

BACKGROUND AND PURPOSE: Most stroke incidence studies use geographically localized (community) samples with few national data sources available. Such samples preclude research on contextual risk factors, but national samples frequently collect only self-reported stroke. We examine whether incidence estimates from clinically verified studies are consistent with estimates from a nationally representative US sample assessing self-reported stroke.

METHODS: Health and Retirement Study (HRS) participants (n=17 056) age 50+ years were followed for self- or proxy-reported first stroke (1293 events) from 1998 to 2006 (average, 6.8 years). We compared incidence rates by race, sex, and age strata with those previously documented in leading geographically localized studies with medically verified stroke. We also examined whether cardiovascular risk factor effect estimates in HRS are comparable to those reported in studies with clinically verified strokes.

RESULTS: The weighted first-stroke incidence rate was 10.0 events/1000 person-years. Total age-stratified incidence rates in whites were mostly comparable with those reported elsewhere and were not systematically higher or lower. However, among blacks in HRS, incidence rates generally appeared higher than those previously reported. HRS estimates were most comparable with those reported in the Cardiovascular Health Study. Incidence rates approximately doubled per decade of age and were higher in men and blacks. After demographic adjustment, all risk factors predicted stroke incidence in whites. Smoking, hypertension, diabetes, and heart disease predicted incident stroke in blacks.

CONCLUSIONS: Associations between known risk factors and stroke incidence were verified in HRS, suggesting that misreporting is nonsystematic. HRS may provide valuable data for stroke surveillance and examination of classical and contextual risk factors.

PB - 40 VL - 40 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19150869?dopt=Abstract U3 - 19150869 U4 - Stroke/SELF-RATED HEALTH/risk factors/Racial Differences ER - TY - JOUR T1 - Correlates of improvement in walking ability in older persons in the United States. JF - Am J Public Health Y1 - 2009 A1 - Joseph Feinglass A1 - Song, Jing A1 - Larry M Manheim A1 - Semanik, Pamela A1 - Rowland W Chang A1 - Dorothy D Dunlop KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Confidence Intervals KW - Female KW - Health Promotion KW - Humans KW - Male KW - Middle Aged KW - Motor Activity KW - Multivariate Analysis KW - Odds Ratio KW - Overweight KW - Smoking Prevention KW - Social Marketing KW - Socioeconomic factors KW - United States KW - Walking AB -

OBJECTIVES: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study.

METHODS: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors.

RESULTS: Among the 25% of the study population with baseline walking limitations, 29% experienced improved walking ability, 40% experienced no change in walking ability, and 31% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status.

CONCLUSIONS: Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans.

PB - 99 VL - 99 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19106418?dopt=Abstract U2 - PMC2661455 U4 - Health Physical/aging ER - TY - JOUR T1 - Does job loss cause ill health? JF - Health Econ Y1 - 2009 A1 - Salm, Martin KW - Activities of Daily Living KW - Age Factors KW - Cohort Studies KW - Cross-Sectional Studies KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Middle Aged KW - Sex Factors KW - Smoking KW - Socioeconomic factors AB -

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers' business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality.

PB - 18 VL - 18 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19634153?dopt=Abstract U3 - 19634153 U4 - Job Loss/Unemployment/health status ER - TY - JOUR T1 - Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work. JF - Soc Work Health Care Y1 - 2009 A1 - Cai, Qian A1 - J. Warren Salmon A1 - Mark E. Rodgers KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Female KW - Geriatric Assessment KW - Health Status KW - Homes for the Aged KW - Humans KW - Logistic Models KW - Male KW - Mental Health KW - Nursing homes KW - Proportional Hazards Models KW - Risk Factors KW - Sex Factors KW - Social work KW - Socioeconomic factors KW - United States AB -

Two statistical methods were compared to identify key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Social Work's interest in services to the elderly makes this research critical to the profession. Effectively transitioning the "baby boomer" population into appropriate long-term care will be a great societal challenge. It remains a challenge paramount to the practice of social work. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. Multivariable logistic regression and Cox proportional hazards model were performed and compared. Older age, lower self-perceived health, worse instrumental activities of daily living (IADL), psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic; owning a home; and having lower level of cognitive impairment reduced the admission risk. Home ownership showed a significant effect in logistic regression, but a marginal effect in the Cox model. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression, used frequently in analyses, can provide a good approximation to the Cox model in identifying factors of LSNH admission. However, the Cox model gives more information on how soon the LSNH admission may happen. Our analyses, based on two models, dually identified the factors associated with LSNH admission; therefore, results discussed confidently provide implications for both public and private long-term care policies, as well as improving the assessment capabilities of social work practitioners for development of screening programs among at-risk elderly. Given the predicted surge in this population, significant factors found from this study can be utilized in a strengths-based empowerment approach by social workers to aid in avoiding LSNH utilization.

PB - 48 VL - 48 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19197772?dopt=Abstract U3 - 19197772 U4 - Nursing Homes/Old Age/SELF-RATED HEALTH/ADL and IADL Impairments ER - TY - JOUR T1 - Health and well-being in older married female cancer survivors. JF - J Am Geriatr Soc Y1 - 2009 A1 - Aloen L. Townsend A1 - Karen J Ishler A1 - Karen F Bowman A1 - Rose, Julia Hannum A1 - Peak, Nicole Juszczak KW - Age Factors KW - Case-Control Studies KW - Depressive Disorder KW - Female KW - Health Status KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Marriage KW - Middle Aged KW - Neoplasms KW - Predictive Value of Tests KW - Risk Factors KW - Survivors KW - United States AB -

OBJECTIVES: To investigate differences between older married female cancer survivors and a matched comparison sample on physical health and on effects of health on depressive symptomatology.

DESIGN AND SETTING: National survey data from the 1992 Health and Retirement Study.

PARTICIPANTS: Married women who reported having been diagnosed with cancer (N=245) and married women who did not report a cancer diagnosis but who matched the survivors on age, race, and ethnicity (N=245).

MEASUREMENTS: Outcome measure was depressive symptomatology (modified CES-D). Predictors were multiple indicators of health and demographic characteristics.

RESULTS: Cancer survivors reported significantly worse health on all indicators but not higher depressive symptomatology after health and demographics were controlled. Predictors of higher depression were fatigue, pain, and lower education. These effects did not differ between groups.

CONCLUSION: Health impairment in cancer survivors highlights the need for ongoing follow-up care. Survivorship was associated indirectly with higher depressive symptomatology through its relationship with health impairment.

PB - 57 VL - 57 Suppl 2 IS - Suppl 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20122019?dopt=Abstract U2 - PMC3372320 U4 - CANCER/Women/Depressive Symptoms/Marriage 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 - Incidence and remission of urinary incontinence in a community-based population of women ≥ 50 years. JF - Int Urogynecol J Pelvic Floor Dysfunct Y1 - 2009 A1 - Yuko M Komesu A1 - Rebecca G Rogers A1 - Ronald M Schrader A1 - Cynthia M. Lewis KW - Age Factors KW - Black People KW - disease progression KW - Female KW - Hispanic or Latino KW - Humans KW - Incidence KW - Logistic Models KW - Longitudinal Studies KW - Middle Aged KW - Odds Ratio KW - Prevalence KW - Remission, Spontaneous KW - Severity of Illness Index KW - United States KW - Urinary incontinence KW - White People AB -

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

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

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

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

PB - 20 VL - 20 IS - 5 N1 - Times Cited: 1 Komesu, Yuko M. Rogers, Rebecca G. Schrader, Ronald M. Lewis, Cindi M. U1 - http://www.ncbi.nlm.nih.gov/pubmed/19229462?dopt=Abstract U2 - PMC3623953 U4 - Urinary Incontinence/health Status/logistic Models/incidence ER - TY - JOUR T1 - Marital trajectories and mortality among US adults. JF - Am J Epidemiol Y1 - 2009 A1 - Matthew E Dupre A1 - Audrey N Beck A1 - Sarah O. Meadows KW - Age Factors KW - Cohort Studies KW - Female KW - Health Behavior KW - Humans KW - Male KW - Marital Status KW - Middle Aged KW - Mortality KW - Retirement KW - Retrospective Studies KW - Risk Factors KW - Sex Factors KW - Time Factors KW - United States AB -

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

PB - 170 VL - 170 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19584130?dopt=Abstract U2 - PMC2732990 U4 - Marital Status/Mortality/Marital History/GENDER-DIFFERENCES ER - TY - JOUR T1 - Risk perception and preference for prevention of Alzheimer's disease. JF - Value Health Y1 - 2009 A1 - Chung, Sukyung A1 - Kala M. Mehta A1 - Shumway, Martha A1 - Alvidrez, Jennifer A1 - Eliseo J Perez-Stable KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cognition KW - Female KW - Health education KW - Health Knowledge, Attitudes, Practice KW - Health Surveys KW - Humans KW - Linear Models KW - Male KW - Multivariate Analysis KW - Psychometrics KW - Risk Assessment KW - Risk Factors KW - Social Perception KW - Statistics as Topic KW - United States AB -

OBJECTIVES: To understand how older adults perceive their risk of Alzheimer's Disease (AD) and how this may shape their medical care decisions, we examined whether presence of established risk factors of AD is associated with individuals' perceived risk of AD, and with preference for preventing AD.

PARTICIPANTS: Data came from the US Health and Retirement Study participants who were asked questions on AD risk perception (N = 778).

MEASUREMENTS: Perceived risk of AD was measured by respondents' estimate of their percent chance (0-100) developing AD in the next 10 years. Preference for AD prevention was measured with questions eliciting willingness to pay for a drug to prevent AD.

ANALYSIS: Multivariate linear regressions were used to estimate correlates of perceived risk and preference for prevention.

RESULTS: Better cognitive functioning and physical activity are associated with decreased perceived risk. Neither age nor cardiovascular disease is associated with perceived risk. African Americans have lower perceived risk than non-Latino whites; the difference is wider among people age 65 and above. Only 4% to 7% of the variation in perceived risk was explained by the model. Preference for prevention is stronger with increased perceived risk, but not with the presence of risk factors. Persons with better cognitive functioning, physical functioning, or wealth status have a stronger preference for prevention.

CONCLUSION: Some known risk factors appear to inform, but only modestly, individuals' perceived risk of AD. Furthermore, decisions about AD prevention may not be determined by objective needs alone, suggesting a potential discrepancy between need and demand for AD preventive care.

PB - 12 VL - 12 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19900252?dopt=Abstract U3 - 19900252 U4 - Alzheimers Disease/risk factors/Subjective Probabilities/Physical Activity/Cognitive Functioning ER - TY - JOUR T1 - Smoking and weight change after new health diagnoses in older adults. JF - Arch Intern Med Y1 - 2009 A1 - Patricia S Keenan KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Diabetes Mellitus, Type 2 KW - Health Behavior KW - Health Surveys KW - Heart Diseases KW - Humans KW - Longitudinal Studies KW - Lung Diseases KW - Middle Aged KW - Multivariate Analysis KW - Neoplasms KW - Overweight KW - Racial Groups KW - Smoking KW - Smoking cessation KW - Stroke KW - United States KW - Weight Loss AB -

BACKGROUND: Smoking and patterns of diet and activity are the 2 leading underlying causes of death in the United States, yet the factors that prompt individuals to adopt healthier habits are not well understood.

METHODS: This study was undertaken to determine whether individuals who have experienced recent adverse health events are more likely to quit smoking or to lose weight than those without recent events using Health and Retirement Study panel survey data for 20 221 overweight or obese individuals younger than 75 years and 7764 smokers from 1992 to 2000.

RESULTS: In multivariate analyses, adults with recent diagnoses of stroke, cancer, lung disease, heart disease, or diabetes mellitus were 3.2 times more likely to quit smoking than were individuals without new diagnoses (P < .001). Among overweight or obese individuals younger than 75 years, those with recent diagnoses of lung disease, heart disease, or diabetes mellitus lost -0.35 U of body mass index (calculated as weight in kilograms divided by height in meters squared) compared with those without these new diagnoses (P < .001). Smokers with multiple new diagnoses were 6 times more likely to quit smoking compared with those with no new diagnoses. The odds of quitting smoking were 5 times greater in individuals with a new diagnosis of heart disease, and body mass index declined by 0.6 U in overweight or obese individuals with a new diagnosis of diabetes mellitus (P < .001).

CONCLUSIONS: Across a range of health conditions, new diagnoses can serve as a window of opportunity that prompts older adults to change health habits, in particular, to quit smoking. Quality improvement efforts targeting secondary as well as primary prevention through the health care system are likely well founded.

PB - 169 VL - 169 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19204214?dopt=Abstract U2 - PMC3752594 U4 - Smoking/Weight/Chronic Disease ER - TY - JOUR T1 - Surrogate consent for dementia research: a national survey of older Americans. JF - Neurology Y1 - 2009 A1 - Scott Y H Kim A1 - H.M. Kim A1 - Kenneth M. Langa A1 - Jason H. Karlawish A1 - David S Knopman A1 - Appelbaum, P S KW - Advance directives KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Biomedical Research KW - Caregivers KW - Clinical Trials as Topic KW - Data collection KW - ethnicity KW - Female KW - Humans KW - Informed Consent KW - Legal Guardians KW - Male KW - Mental Competency KW - Middle Aged KW - Patient Participation KW - Proxy KW - Research Subjects KW - Surveys and Questionnaires KW - Therapeutic Human Experimentation KW - Third-Party Consent AB -

BACKGROUND: Research in novel therapies for Alzheimer disease (AD) relies on persons with AD as research subjects. Because AD impairs decisional capacity, informed consent often must come from surrogates, usually close family members. But policies for surrogate consent for research remain unsettled after decades of debate.

METHODS: We designed a survey module for a random subsample (n = 1,515) of the 2006 wave of the Health and Retirement Study, a biennial survey of a nationally representative sample of Americans aged 51 and older. The participants answered questions regarding one of four randomly assigned surrogate-based research (SBR) scenarios: lumbar puncture study, drug randomized control study, vaccine study, and gene transfer study. Each participant answered three questions: whether our society should allow family surrogate consent, whether one would want to participate in the research, and whether one would allow one's surrogate some or complete leeway to override stated personal preferences.

RESULTS: Most respondents stated that our society should allow family surrogate consent for SBR (67.5% to 82.5%, depending on the scenario) and would themselves want to participate in SBR (57.4% to 79.7%). Most would also grant some or complete leeway to their surrogates (54.8% to 66.8%), but this was true mainly of those willing to participate. There was a trend toward lower willingness to participate in SBR among those from ethnic or racial minority groups.

CONCLUSIONS: Family surrogate consent-based dementia research is broadly supported by older Americans. Willingness to allow leeway to future surrogates needs to be studied further for its ethical significance for surrogate-based research policy.

PB - 72 VL - 72 IS - 2 N1 - PMID 19139366 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19139366?dopt=Abstract U2 - PMC2663398 U4 - Dementia/Surrogate-based research/Surrogate-based research ER - TY - JOUR T1 - Work expectations, realizations, and depression in older workers. JF - J Ment Health Policy Econ Y1 - 2009 A1 - Tracy Falba A1 - Jody L Sindelar A1 - William T Gallo KW - Age Factors KW - depression KW - Employment KW - Female KW - Health Behavior KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Psychometrics KW - Retirement KW - Sex Factors KW - Stress, Psychological AB -

AIMS OF THE STUDY: In this study, we explore whether ex ante work expectations, conditional on work force status at age 62, affect self-reported depressive symptoms at age 62.

METHODS: Our sample includes 4,387 participants of the Health and Retirement Study, a national longitudinal survey of individuals born between 1931 and 1941, and their spouses. The sample is composed of workers who were less than 62 years of age at the study baseline (1992), and who had reached age 62 by the current study endpoint (2004). This sample enables comparison of realized work status with prior expectations. We estimate the impact of expected work status on self-reported depressive symptoms using negative binomial and logistic regression methods. Sex-stratified regressions are estimated according to full-time work status at age 62. The primary outcome is a summary measure of self-reported depressive symptoms based on a short form of the Center for Epidemiologic Studies-Depression (CES-D) scale. The explanatory variable of interest is the subjective probability of working full-time at the age of 62, reported by participants at the 1992 HRS baseline. We control for baseline socioeconomic and demographic variables as well as life events and changes in macroeconomic conditions that occur within the study timeframe.

RESULTS: Among participants who were not working full time at age 62, we find that men who provided a higher ex ante likelihood of full-time employment at 62 had significantly worse self-reported depressive symptoms than men who provided a lower ex ante likelihood. A similar effect was not found for women. Among participants who were working full time at age 62, we do not find a statistical relationship between ex ante expectations and age-62 self-reported depressive symptoms, for either men or women.

DISCUSSION: The results suggest that an earlier-than-anticipated work exit is detrimental to mental health for men nearing normal retirement age. Previous research has demonstrated that stress is a causal factor in depression, and a premature labor force departure, which is inconsistent with an individual's cognitive judgment of a suitably timed exit from work, is a psychologically stressful transition that could realistically induce depression. This may be especially true of men, who in this cohort, have stronger labor force attachment than women and tend to define their roles by their occupation. The advantages of the study include nationally representative data, a baseline depression control that circumscribes the effect of endogeneity, and a reasonably long follow-up. Despite our efforts to infer causality, unmeasured factors may account for part of the observed relationship. IMPLICATIONS FOR HEALTH POLICY AND RESEARCH: Depression is a disease that, if untreated, may have serious consequences for behavioral, medical, and social well-being. Our results suggest that further research should aim to estimate the magnitude of clinically severe and mild depression in populations of those who retire earlier than expected, especially for men. Such information could help health care planners and policy makers to direct resources to the mental health needs of men who retire prematurely.

PB - 12 VL - 12 UR - URL:http://www.icmpe.org/test1/journal/journal.htm Publisher'sURL IS - 4 N1 - Journal Article U1 - http://www.ncbi.nlm.nih.gov/pubmed/20195005?dopt=Abstract U2 - PMC3434685 U4 - Health Production/Economics of the Elderly/Handicapped/Non-labor Market Discrimination/Older Workers/depression ER - TY - JOUR T1 - Gender differences in functional status in middle and older age: are there any age variations? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Jersey Liang A1 - Joan M. Bennett A1 - Benjamin A Shaw A1 - Ana R Quiñones A1 - Wen Ye A1 - Xiao Xu A1 - Mary Beth Ofstedal KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Disabled Persons KW - Female KW - Health Status KW - Humans KW - Linear Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Sex Factors KW - United States AB -

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women's socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

PB - 63B VL - 63 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18818448?dopt=Abstract U2 - PMC3454348 U4 - GENDER-DIFFERENCES/Health Physical ER - TY - JOUR T1 - Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults. JF - J Aging Health Y1 - 2008 A1 - Valerie L Forman-Hoffman A1 - Kelly K Richardson A1 - Jon W. Yankey A1 - Stephen L Hillis A1 - Robert B Wallace A1 - Frederic D Wolinsky KW - Activities of Daily Living KW - Age Factors KW - Arthritis KW - Comorbidity KW - depression KW - Depressive Disorder KW - Diabetes Complications KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Surveys KW - Heart Diseases KW - Humans KW - Hypertension KW - Lung Diseases KW - Male KW - Mental Disorders KW - Middle Aged KW - Neoplasms KW - Obesity KW - Risk Factors KW - Sex Factors KW - Stroke KW - United States KW - Weight Gain AB -

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

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

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

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

PB - 20 VL - 20 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18390865?dopt=Abstract U3 - 18390865 U4 - Weight/Depressive Symptoms/COMORBIDITY/Health Physical ER - TY - JOUR T1 - Long-term effects of cancer survivorship on the employment of older workers. JF - Health Serv Res Y1 - 2008 A1 - Pamela F. Short A1 - Joseph J. Vasey A1 - John R. Moran KW - Age Factors KW - Aged KW - Data collection KW - Demography KW - Disease-Free Survival KW - Employment KW - Female KW - Health Status KW - Humans KW - Male KW - Maryland KW - Middle Aged KW - Neoplasms KW - Pennsylvania KW - Probability KW - Prospective Studies KW - Registries KW - Retrospective Studies KW - Sickness Impact Profile KW - Survivors KW - Time Factors AB -

OBJECTIVE: To estimate the long-term effects of cancer survivorship on the employment of older workers.

DATA SOURCES: Primary data for 504 subjects who were 55-65 in 2002 and were working when diagnosed with cancer in 1997-1999, and secondary data for a comparison group of 3,903 similarly aged workers in the Health and Retirement Study (HRS) in 2002.

STUDY DESIGN: Three employment outcomes (working, working full time, usual hours per week) were compared between the two groups. Both Probit/Tobit regressions and propensity score matching were used to adjust for potentially confounding differences between groups. Sociodemographic characteristics, baseline employment characteristics, and the presence of other health conditions were included as covariates.

DATA COLLECTION METHODS: Four telephone interviews were conducted annually with cancer survivors identified from tumor registries at four large hospitals in Pennsylvania and Maryland. Many of the questions were taken from the HRS to facilitate comparisons.

PRINCIPAL FINDINGS: Cancer survivors of both genders worked an average of 3-5 hours less per week than HRS controls. For females, we found significant effects of survivorship on the probability of working, the probability of working full-time, and hours. For males, survivorship affected the probability of full-time employment and hours without significantly reducing the probability of working. For both genders, these effects were primarily attributable to new cancers. There were no significant effects on the employment of cancer-free survivors.

CONCLUSIONS: Survivors with recurrences or second primary tumors may particularly benefit from employment support services and workplace accommodation. Reassuringly, any long-term effects on the employment of cancer-free survivors are fairly small.

PB - 43 VL - 43 IS - 1 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18211525?dopt=Abstract U2 - PMC2323147 U4 - CANCER/Labor Force Participation ER - TY - JOUR T1 - Spousal caregiving in late midlife versus older ages: implications of work and family obligations. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Julie C Lima A1 - Susan M Allen A1 - Goldscheider, Frances A1 - Intrator, Orna KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Employment KW - Family Relations KW - Female KW - Gender Identity KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Mobility Limitation KW - Spouses KW - Time Factors KW - United States AB -

OBJECTIVES: This study examined life-stage differences in the provision of care to spouses with functional impairment.

METHODS: We examined 1,218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses served as primary caregiver and the hours of care provided by spousal primary caregivers by life stage.

RESULTS: We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse.

DISCUSSION: Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age.

PB - 63B VL - 63 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18689772?dopt=Abstract U3 - 18689772 U4 - ADL and IADL Impairments/Marital Status/Caregiving ER - TY - JOUR T1 - Spousal smoking and incidence of first stroke: the Health and Retirement Study. JF - Am J Prev Med Y1 - 2008 A1 - M. Maria Glymour A1 - Triveni DeFries A1 - Ichiro Kawachi A1 - Mauricio Avendano KW - Age Factors KW - Confidence Intervals KW - Female KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Prospective Studies KW - Risk Factors KW - Smoking KW - Spouses KW - Stroke KW - Time Factors KW - Tobacco Smoke Pollution KW - United States AB -

BACKGROUND: Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke.

METHODS: Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged >or=50 years and married at baseline (n=16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1,130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse's smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birthstate; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease.

RESULTS: Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio=1.42, 95% CI=1.05, 1.93) and former smokers (hazard ratio=1.72, 95% CI=1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked.

CONCLUSIONS: Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.

PB - 35 VL - 35 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18692737?dopt=Abstract U2 - PMC2796850 U4 - Smoking/Stroke/Spouses ER - TY - JOUR T1 - Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education? JF - Stroke Y1 - 2008 A1 - Mauricio Avendano A1 - M. Maria Glymour KW - Age Distribution KW - Age Factors KW - Aged KW - Cohort Studies KW - Educational Status KW - Female KW - Humans KW - Incidence KW - Income KW - Life Style KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Proportional Hazards Models KW - Risk Factors KW - Socioeconomic factors KW - Stroke KW - United States AB -

BACKGROUND AND PURPOSE: This study examines the independent effect of wealth, income, and education on stroke and how these disparities evolve throughout middle and old age in a representative cohort of older Americans.

METHODS: Stroke-free participants in the Health and Retirement Study (n=19,565) were followed for an average of 8.5 years. Total wealth, income, and education assessed at baseline were used in Cox proportional hazards models to predict time to stroke. Separate models were estimated for 3 age-strata (50 to 64, 65 to 74, and >or=75), and incorporating risk factor measures (smoking, physical activity, body mass index, hypertension, diabetes, and heart disease).

RESULTS: 1542 subjects developed incident stroke. Higher education predicted reduced stroke risk at ages 50 to 64, but not after adjustment for wealth and income. Wealth and income were independent risk factors for stroke at ages 50 to 64. Adjusted hazard ratios comparing the lowest decile with the 75th-90th percentiles were 2.3 (95% CI 1.6, 3.4) for wealth and 1.8 (95% CI 1.3, 2.6) for income. Risk factor adjustment attenuated these effects by 30% to 50%, but coefficients for both wealth (HR=1.7, 95% CI 1.2, 2.5) and income (HR=1.6, 95% CI 1.2, 2.3) remained significant. Wealth, income, and education did not consistently predict stroke beyond age 65.

CONCLUSIONS: Wealth and income are independent predictors of stroke at ages 50 to 64 but do not predict stroke among the elderly. This age patterning might reflect buffering of the negative effect of low socioeconomic status by improved access to social and health care programs at old ages, but may also be an artifact of selective survival.

PB - 39 VL - 39 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18436891?dopt=Abstract U2 - PMC3079499 U4 - Stroke/Socioeconomic Factors/Education/income ER - TY - JOUR T1 - Age group differences in depressive symptoms among older adults with functional impairments. JF - Health Soc Work Y1 - 2007 A1 - Namkee G Choi A1 - Kim, Johnny S. KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Demography KW - depression KW - Disabled Persons KW - Female KW - Health Status KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Male KW - Middle Aged KW - United States AB -

This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed.

PB - 32 VL - 32 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17896674?dopt=Abstract U4 - Age Factors/Depression/ADL and IADL Impairments ER - TY - JOUR T1 - Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood. JF - Demography Y1 - 2007 A1 - Jenifer Hamil-Luker A1 - Angela M O'Rand KW - Adult KW - Age Factors KW - Child KW - Child Welfare KW - Health Status KW - Humans KW - Middle Aged KW - Myocardial Infarction KW - North Carolina KW - Poverty KW - Risk Assessment KW - Risk Factors KW - Sex Factors KW - Social Class KW - Socioeconomic factors KW - Time AB -

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

PB - 44 VL - 44 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17461340?dopt=Abstract U4 - childhood conditions/socioeconomic status/Heart Diseases 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 - Self-rated health trajectories and mortality among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Thomas R Miller A1 - Frederic D Wolinsky KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Cardiovascular Diseases KW - Cause of Death KW - Female KW - Follow-Up Studies KW - Health Status KW - Health Status Indicators KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Mortality KW - Multivariate Analysis KW - Risk Factors KW - Sex Factors KW - Smoking KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17284562?dopt=Abstract U4 - SELF-RATED HEALTH/mortality ER - TY - JOUR T1 - Weight and depressive symptoms in older adults: direction of influence? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Valerie L Forman-Hoffman A1 - Jon W. Yankey A1 - Stephen L Hillis A1 - Robert B Wallace KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Cohort Studies KW - Comorbidity KW - Depressive Disorder KW - Female KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Models, Statistical KW - Odds Ratio KW - Prospective Studies KW - Sex Factors KW - Statistics as Topic KW - United States KW - Weight Gain KW - Weight Loss AB -

OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95% CI = 1.00-1.54; women: OR = 1.12, 95% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17284566?dopt=Abstract U4 - Weight/Depressive Symptoms ER - TY - JOUR T1 - Changes in health for the uninsured after reaching age-eligibility for Medicare. JF - J Gen Intern Med Y1 - 2006 A1 - David W. Baker A1 - Joseph Feinglass A1 - Durazo-Arvizu, Ramon A1 - Whitney P. Witt A1 - Joseph J Sudano A1 - Jason A. Thompson KW - Age Factors KW - Aged KW - Cohort Studies KW - Eligibility Determination KW - Female KW - Health Status KW - Humans KW - Male KW - Medically Uninsured KW - Medicare KW - Middle Aged KW - Prospective Studies KW - United States AB -

BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.

OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.

DESIGN: Prospective cohort study.

PARTICIPANTS: Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.

MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)).

RESULTS: Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95% CI 0.96 to 1.56) or agility (ARR 1.33; 95% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.

CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.

PB - 21 VL - 21 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16879704?dopt=Abstract ER - TY - JOUR T1 - Postretirement earnings relative to preretirement earnings: gender and racial differences. JF - J Gerontol Soc Work Y1 - 2006 A1 - Martha N. Ozawa A1 - Hong, Baeg-Eui KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Data collection KW - Employment KW - Female KW - Humans KW - Income KW - Male KW - Men KW - Minority Groups KW - Pensions KW - Retirement KW - Salaries and Fringe Benefits KW - Sex Factors KW - Social Security KW - Time Factors KW - United States KW - White People KW - women AB -

As the social security program comes under increasing financial pressure in the coming decades, the federal government will encourage elderly people to continue to work. Data from the Social Security Administration indicate that earnings are already a sizable component of retirement income. But there is public concern about how women and minorities will fare economically in this changing policy environment. To what extent can women and minorities keep earning money after they reach retirement age? This article presents the results of a study that investigated the postretirement earnings, relative to the preretirement earnings, of women and minorities, and compared the results with those for men and whites. The major finding, based on regression analyses, was that women's postretirement earnings, relative to their preretirement earnings, were greater than those of men. Furthermore, the regression results indicate that nonwhites' postretirement earnings could not be predicted by their preretirement earnings or by any of the independent variables used in the study, including age, gender, education, marital status, number of children, occupation, and preretirement earnings.

PB - 32 VL - 47 IS - 3-4 N1 - Using Smart Source Parsing pp. May Sage Publications, Thousand Oaks CA U1 - http://www.ncbi.nlm.nih.gov/pubmed/17062523?dopt=Abstract U3 - 17062523 U4 - Employment/Retirement/WOMEN/Gender Differences/Labor Force Participation/Socioeconomic Status/Marital Status/Vulnerability/gerontology ER - TY - JOUR T1 - Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions. JF - Gerontologist Y1 - 2006 A1 - Adaeze B Akamigbo A1 - Frederic D Wolinsky KW - Age Factors KW - Aged KW - Female KW - Health Status KW - Homes for the Aged KW - Humans KW - Male KW - Nursing homes KW - Patient Admission KW - Risk Factors KW - Sex Factors KW - Social Support KW - Socioeconomic factors AB -

PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.

DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.

RESULTS: Expectations are not normally distributed: 14% of the participants refused to answer, 51% estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.

IMPLICATIONS: Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.

PB - 46 VL - 46 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16921000?dopt=Abstract ER - TY - JOUR T1 - Health insurance coverage during the years preceding medicare eligibility. JF - Arch Intern Med Y1 - 2005 A1 - David W. Baker A1 - Joseph J Sudano KW - Age Factors KW - Black or African American KW - Cohort Studies KW - Female KW - Health Status KW - Hispanic or Latino KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Male KW - Medically Uninsured KW - Middle Aged KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People AB -

BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear.

METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period.

RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3%, 10.8%, 9.7%, 8.8%, and 8.2%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3% by 2000; few participants (2.6%) were continuously uninsured. Only 60.1% of participants were continuously enrolled in private insurance across all 5 interviews.

CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.

PB - 165 VL - 165 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15824296?dopt=Abstract U4 - Age Factors/Cohort Studies/Female/Health Status/African-Americans/Health Insurance/Health Insurance Coverage/Sex Factors/Socioeconomic Factors/United States ER - TY - JOUR T1 - What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings. JF - Med Care Y1 - 2005 A1 - Peter A. Ubel A1 - Jankovic, Aleksandra A1 - Dylan M Smith A1 - Kenneth M. Langa A1 - Angela Fagerlin KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Attitude to Health KW - Calibration KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Interviews as Topic KW - Male KW - Prospective Studies KW - Psychometrics KW - Self Concept AB -

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age.

METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration.

RESULTS: A total of 1015 subjects responded to the rating task (98% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P's<0.075), whereas responses to the your-age scale did not (P=0.8).

CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

PB - 43 VL - 43 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16166876?dopt=Abstract U4 - Subjective phenomena/Methodology ER - TY - JOUR T1 - When is baseline adjustment useful in analyses of change? An example with education and cognitive change. JF - Am J Epidemiol Y1 - 2005 A1 - M. Maria Glymour A1 - Weuve, Jennifer A1 - Lisa F Berkman A1 - Ichiro Kawachi A1 - Robins, James M. KW - Age Factors KW - Aged KW - Bias KW - Cognition Disorders KW - Educational Status KW - Epidemiologic Methods KW - Female KW - Health Status KW - Humans KW - Longitudinal Studies KW - Male KW - Models, Statistical KW - Neuropsychological tests KW - Regression Analysis KW - United States AB -

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

PB - 162 VL - 162 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15987729?dopt=Abstract U4 - Methodology/EDUCATION/Health-cognitive ability ER - TY - JOUR T1 - Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. JF - Psychol Med Y1 - 2004 A1 - Ramin Mojtabai A1 - Mark Olfson KW - Age Factors KW - Aged KW - Depressive Disorder, Major KW - Female KW - Follow-Up Studies KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Prevalence KW - Residence Characteristics KW - Sex Factors KW - Socioeconomic factors KW - Time Factors KW - United States AB -

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults.

METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline.

CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.

PB - 34 VL - 34 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15099417?dopt=Abstract U4 - Depression ER - TY - JOUR T1 - Religion and functional health among the elderly: is there a relationship and is it constant? JF - J Aging Health Y1 - 2004 A1 - Benjamins, Maureen Reindl KW - Activities of Daily Living KW - Age Factors KW - Aging KW - Demography KW - Health Behavior KW - Health Status KW - Humans KW - Mental Health KW - Religion and Psychology KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: Religion significantly influences a variety of health outcomes, especially among the elderly. Few studies have examined how the relationship may differ by age within this age group. It is possible that increasing levels of religiosity within the elderly, or other age-related differences, may strengthen the influence of religion on functional limitations.

METHOD: This study used the Assets and Health Dynamics Among the Oldest Old Survey, a nationally representative, longitudinal data set, to estimate the effects of religious attendance and salience on functional ability.

RESULTS: More frequent attendance is associated with fewer functional limitations, whereas higher levels of salience are associated with more limitations. No significant age interactions were found.

DISCUSSION: Attendance and salience predict the number of functional limitations in the elderly but in different directions. These effects tend to be stable within the elderly population, indicating that further age divisions may not be necessary when examining this relationship in future studies.

PB - 16 VL - 16 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15155067?dopt=Abstract U4 - Religiosity/Aging/Health 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 - County-level income inequality and depression among older Americans. JF - Health Serv Res Y1 - 2003 A1 - Muramatsu, Naoko KW - Age Factors KW - Aged KW - Aged, 80 and over KW - depression KW - Female KW - Health Status Indicators KW - Humans KW - Income KW - Male KW - Socioeconomic factors KW - United States AB -

OBJECTIVES: To examine (1) whether county-level income inequality is associated with depression among Americans aged 70 and older, taking into consideration county-level mean household income and individual-level socioeconomic status (SES), demographic characteristics, and physical health, and (2) whether income inequality effects are stronger among people with lower SES and physical health.

DATA SOURCES: The individual-level data from the first wave of the Assets and Health Dynamics among the Oldest Old survey (1993-1994) were linked with the county-level income inequality and mean household income data from the 1990 Census.

STUDY DESIGN: Multilevel analysis was conducted to examine the association between income inequality (the Gini coefficient) and depression.

PRINCIPAL FINDINGS: Income inequality was significantly associated with depression among older Americans. Those living in counties with higher income inequality were more depressed, independent of their demographic characteristics, SES, and physical health. The association was stronger among those with more illnesses.

CONCLUSIONS: While previous empirical research on income inequality and physical health is equivocal, evidence for income inequality effects on mental health seems to be strong.

PB - 38 VL - 38 IS - 6 Pt 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14727801?dopt=Abstract U4 - Income Distribution/Depression ER - TY - JOUR T1 - Determinants of self-perceived changes in health status among pre- and early-retirement populations. JF - Int J Aging Hum Dev Y1 - 2003 A1 - Namkee G Choi KW - Activities of Daily Living KW - Age Factors KW - Female KW - Health Behavior KW - Health Status KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Multivariate Analysis KW - Retirement KW - Self Concept KW - United States AB -

Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects' selective optimization and resiliency.

PB - 56 VL - 56 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/14661813?dopt=Abstract U4 - Health Status/Subjective ER - TY - JOUR T1 - The labor market consequences of race differences in health. JF - Milbank Q Y1 - 2003 A1 - John Bound A1 - Timothy A Waidmann A1 - Michael Schoenbaum A1 - Bingenheimer,Jeffrey B. KW - Adult KW - Age Distribution KW - Age Factors KW - Attitude to Health KW - Black or African American KW - Cross-Cultural Comparison KW - Data Interpretation, Statistical KW - Employment KW - Female KW - Health Services Needs and Demand KW - Health Status Indicators KW - Humans KW - Indians, North American KW - Male KW - Middle Aged KW - Sex Distribution KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People PB - 81 VL - 81 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12941003?dopt=Abstract U4 - Racial Differences/Health Status/labor market behavior ER - TY - JOUR T1 - Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD). JF - Ann Fam Med Y1 - 2003 A1 - Truls Ostbye A1 - Gary N. Greenberg A1 - Donald H. Taylor Jr. A1 - Lee, Ann Marie M. KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Breast Neoplasms KW - Cost-Benefit Analysis KW - Female KW - Health Services for the Aged KW - Humans KW - Longitudinal Studies KW - Mammography KW - Middle Aged KW - Multivariate Analysis KW - Papanicolaou Test KW - Patient Acceptance of Health Care KW - Risk KW - United States KW - Uterine Cervical Neoplasms KW - Vaginal Smears AB -

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

PB - 1 VL - 1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15055410?dopt=Abstract U4 - Womens Health/Mammography/Pap Test ER - TY - JOUR T1 - Patterns and risk factors of change in somatic and mood symptoms among older adults. JF - Ann Epidemiol Y1 - 2001 A1 - Stephanie J. Fonda A1 - A. Regula Herzog KW - Age Factors KW - Aged KW - Depressive Disorder KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Least-Squares Analysis KW - Longitudinal Studies KW - Male KW - Mood Disorders KW - Regression Analysis KW - Risk Factors KW - Severity of Illness Index KW - Somatoform Disorders KW - United States AB -

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

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

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

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

PB - 11 VL - 11 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11454494?dopt=Abstract U4 - Age Factors/Depressive Disorder/Diagnosis/Epidemiology/Female/Follow up Studies/Geriatric Assessment/Human/Least Squares Analysis/Longitudinal Studies/Mood Disorders/Diagnosis/Epidemiology/Regression Analysis/Risk Factors/Severity of Illness Index/Somatoform Disorders/Diagnosis/Epidemiology/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Older adults and financial bequests. JF - Int J Aging Hum Dev Y1 - 2000 A1 - Goetting, Marsha A. A1 - Peter Martin A1 - Johnson, Christine KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Attitude KW - Female KW - Health Care Costs KW - Health Status KW - Humans KW - Male KW - Mental Health KW - Michigan KW - Models, Economic KW - Sampling Studies KW - Sex Factors KW - Socioeconomic factors KW - Spouses KW - Surveys and Questionnaires KW - Wills AB -

Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult's assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.

PB - 50 VL - 50 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10987344?dopt=Abstract U4 - Racial Differences Bequests/Inheritance ER - TY - JOUR T1 - Pension decisions in a changing economy: gender, structure, and choice. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2000 A1 - Melissa A. Hardy A1 - Kim Shuey KW - Age Factors KW - Choice Behavior KW - Decision making KW - Female KW - Humans KW - Male KW - Middle Aged KW - Models, Economic KW - Pensions KW - United States AB -

OBJECTIVES: As responsibility for financial security in retirement becomes more individualized, understanding the distribution and determinants of savings behavior grows in importance. Employed men and women often gain access to their pension assets when they change jobs. In this study gender differences in pre-retirement access to and disposition of accumulated pension assets are examined.

METHODS: The authors used data from the Health and Retirement Study to model pension participation, disposition of pension assets, and use of cash settlements derived from a pension plan in a previous job. Logit models provided estimates of gender differences in access to pensions and the preservation of pension funds for retirement.

RESULTS: Women were less likely to have participated in employer-sponsored pension plans; more likely to cash out accumulated pension assets when they changed jobs; and, when job changes occurred at relatively young ages, equally likely to spend the settlement. However, by their late 40s, women were more likely to save the settlement, a net gender difference that increased with age at which the settlement was received.

DISCUSSION: The structure of employment compensation continues to place women at a disadvantage. Gender differences in earnings and fringe benefits not only affect current financial status, but also cast a shadow over future financial security. Although the gender gap in pension coverage has been reduced, women with pensions have access to lower benefits and less in accumulated assets. As these continuing deficits are addressed, enhancing women's tendency to save pension assets for retirement can help them build financial security.

PB - 55B VL - 55 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10985298?dopt=Abstract U4 - Age Factors/Choice Behavior/Decision Making/Female/Human/Middle Age/Models, Economic/Pensions/United States 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 - Uninsured status and out-of-pocket costs at midlife. JF - Health Serv Res Y1 - 2000 A1 - Richard W. Johnson A1 - Crystal, Stephen KW - Age Factors KW - Female KW - Financing, Personal KW - Health Care Surveys KW - Health Services KW - Health Status KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Longitudinal Studies KW - Male KW - Medically Uninsured KW - Middle Aged KW - Models, Econometric KW - Multivariate Analysis KW - Surveys and Questionnaires KW - United States AB -

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

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

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

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

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

PB - 35 VL - 35 IS - 5 Pt 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11130804?dopt=Abstract U4 - Age Factors/Comparative Study/Female/Financing, Personal/Statistics and Numerical Data/Health Care Surveys/Health Services/Economics/Utilization/Health Status/Insurance Coverage/Insurance, Health/Longitudinal Studies/Medically Uninsured/Middle Age/Models, Econometric/Multivariate Analysis/Questionnaires/Support, Non U.S. Government/United States ER - TY - JOUR T1 - A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 1999 A1 - Mary Beth Ofstedal A1 - Zachary Zimmer A1 - Hui-Sheng Lin KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cross-Cultural Comparison KW - depression KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Male KW - Multivariate Analysis KW - Regression Analysis KW - Sex Factors KW - Socioeconomic factors KW - Surveys and Questionnaires KW - Taiwan KW - United States AB -

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

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

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

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

PB - 54B VL - 54 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10542831?dopt=Abstract U4 - Cognitive Functioning ER - TY - JOUR T1 - Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. JF - Am J Psychiatry Y1 - 1999 A1 - Carolyn L. Turvey A1 - Carney, C. A1 - Arndt, Stephan A1 - Robert B Wallace A1 - A. Regula Herzog KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Bereavement KW - Cohort Studies KW - depression KW - Depressive Disorder KW - Female KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Marital Status KW - Odds Ratio KW - Psychiatric Status Rating Scales KW - Risk Factors KW - Sex Factors KW - Widowhood AB -

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.

PB - 156 VL - 156 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10518172?dopt=Abstract U4 - Age Factors/Aged, 80 and Over/Bereavement/Cohort Studies/Depression/Depressive Disorders/Logistic Models/Longitudinal Studies/Marital Status/Odds Ratio/Psychiatric Status Rating Scales/Risk Factors/Sex Factors/Support, U.S. Government--PHS/Widowhood ER - TY - JOUR T1 - Women, marital status, and symptoms of depression in a midlife national sample. JF - J Women Aging Y1 - 1998 A1 - J R Earle A1 - M H Smith A1 - C.T. Harris A1 - Charles F Longino KW - Age Factors KW - Depressive Disorder KW - Female KW - Humans KW - Male KW - Marital Status KW - Marriage KW - Middle Aged KW - Surveys and Questionnaires AB -

Previous studies of the correlates of depression among women have not generally been based on adequate midlife samples or precision in the specification of marital status categories. The present analysis is designed to address these deficiencies and is based on data from the Health and Retirement Survey-Wave 1 (i.e., respondents 51 to 61 years old). Results indicate that married women are less likely to report symptoms of depression than their unmarried counterparts. The mental health benefits of marriage are greater for men than for women. Moreover, other variables, such as marital satisfaction, self-rated health, and employment status are more powerful predictors of emotional well-being in midlife than marital status per se. The quality of marriage affects depressive symptoms more strongly for women than men.

PB - 10 VL - 10 UR - https://www.ncbi.nlm.nih.gov/pubmed/9870051 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9870051?dopt=Abstract U4 - Health Status/Depression Symptoms/Economic Status/Basic Demographics ER - TY - JOUR T1 - Employee benefits, retirement patterns, and implications for increased work life. JF - EBRI Issue Brief Y1 - 1997 A1 - Fronstin, Paul KW - Age Factors KW - Aged KW - Employment KW - Female KW - Health Benefit Plans, Employee KW - Health Status Indicators KW - Humans KW - Male KW - Medicare KW - Middle Aged KW - Pensions KW - Private Sector KW - Retirement KW - Social Security KW - United States AB -

This Issue Brief examines why policymakers are concerned about the trend toward early retirement and how it relates to Social Security, Medicare, and employee health and retirement benefits. It reviews the rationale for the effects of economic incentives on early retirement decisions and includes a summary of empirical literature on the retirement process. It presents data on how employee benefits influence workers' expected retirement patterns. Finally, it examines the implications of public policies to reverse early-retirement trends and raise the eligibility age for Social Security and Medicare. An employee Benefit Research Institute/Gallup survey indicates that there is a direct link between a worker's decision to retire early and the availability of retiree health benefits. In 1993, 61 percent of workers reported that they would not retire before becoming eligible for Medicare if their employer did not provide retiree health benefits. Participation in a pension plan can be an important determinant of retirement. Twenty-one percent of pension plan participants planned to stop working before age 65, compared with 12 percent among nonparticipants. Workers whose primary pension plan was a defined benefit plan were more likely to expect to stop working before age 65 (23 percent) than workers whose primary plan was a defined contribution plan (18 percent). Expected income replacement rates effect retirement patterns, indicating that as the expected replacement increases, the probability of expecting to stop working before age 65 increases. Twenty-two percent of workers with an expected income replacement rate below 60 percent expected to stop working before age 65, compared with 29 percent for those in the 60-69 percent replacement range, and 30 percent for those in the 70-79 percent replacement range. Workers expecting to receive retiree health insurance are more likely to expect to stop working before age 65 than workers who do not expect to have retiree health insurance. Twenty-one percent of workers with retiree health insurance expected to stop working before age 65, compared with 12 percent of workers not expecting to receive retiree health insurance. The Social Security Old-Age and Survivors Insurance (OASI) program depends on obtaining sufficient revenue from active workers' payroll taxes to fund the benefits received by retired beneficiaries. Funding the program in the past was in large part effortless because of the relatively large number of workers per retiree. Today, funding the program is a greater challenge because the ratio of workers to retirees has fallen. Policymakers have been able to agree that reform of the program is necessary for its survival; however, the debate over options to reform the program is just beginning, and it is likely to be a long time before a consensus emerges.

PB - No. 184 UR - https://www.ncbi.nlm.nih.gov/pubmed/10166809 IS - 184 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10166809?dopt=Abstract U4 - Labor Force/Net Worth/Health Insurance Coverage/Retirement Behavior/Economic Status/Public Policy ER - TY - JOUR T1 - Health insurance coverage at midlife: characteristics, costs, and dynamics. JF - Health Care Financ Rev Y1 - 1997 A1 - Richard W. Johnson A1 - Crystal, Stephen KW - Age Factors KW - Costs and Cost Analysis KW - Demography KW - Female KW - Health Benefit Plans, Employee KW - Health Care Surveys KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Middle Aged KW - United States AB -

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

PB - 18 VL - 18 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194511/ IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/10170345?dopt=Abstract U4 - Age Factors/Costs and Cost Analysis/Demography/Female/Health Benefit Plans, Employee/Health Care Surveys/Human/Insurance Coverage/Insurance, Health/Classification/Statistics and Numerical Data/Logistic Models/Longitudinal Studies/Middle Age/Support, Non U.S. Government/Support, U.S. Government--PHS/United States ER - TY - JOUR T1 - Physical activity and smoking: gender comparisons among older African American adults. JF - J Health Care Poor Underserved Y1 - 1996 A1 - Lockery, Shirley A. A1 - Stanford, E. Percil KW - Age Factors KW - Black or African American KW - Education KW - Exercise KW - Female KW - Humans KW - Income KW - Male KW - Marital Status KW - Middle Aged KW - Risk Factors KW - Sampling Studies KW - Sex Factors KW - Smoking KW - Smoking cessation AB -

Little effort has been expended on the examination of systematic health risk behaviors among adult African Americans by gender. Using data from the national Health and Retirement Study (HRS), this article compares differences between male and female physical activity and smoking behaviors of African Americans aged 50 to 61. The analysis highlights a clear pattern of socioeconomic differences with current male smokers, who are more likely to be unmarried and in the lower income and educational levels. Among women, the relationship between smoking patterns, income, and education is less definitive and consistent. Our findings, confirmed by earlier studies, indicate that the largest percentage of the study population, both male and female, are not engaged in any form of regular physical exercise. Thus human service providers must be more attentive to gender and sociodemographic differences in smoking habits and patterns of physical activities to tailor policies and programs accordingly.

PB - 7 VL - 7 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/8768467?dopt=Abstract U4 - Smoking/Sex Differences/Health Behavior/Middle Aged Adults/Exercise/African-Americans ER -